P Nutr Soc
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Immunonutrition generally refers to the effect of the provision of specific nutrients on the immune system. These nutrients typically have immunoenhancing properties, and recent advances in nutrition support involve studies designed to exploit the desirable biological properties of these nutrients. The term immunonutrition strictly implies that we are focusing on the effect of certain nutrients on aspects of the immune system. ⋯ Major surgery evokes an acute-phase response, a transient immunosuppression and alterations in gastrointestinal function. Normal function is usually restored after a few days; however, in a subgroup of patients homeostasis may be lost and development of the systemic inflammatory response syndrome (SIRS) ensues. Results of recent clinical trials suggest that provision of immunomodulatory nutrients, including glutamine, arginine, n-3 polyunsaturated fatty acids and dietary nucleotides, may promote restoration of normal tissue function post-operatively and prevent the occurrence of SIRS.
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In 1996 the population of China reached 1.23 billion, 22% of the world population, and is expected to increase to 1.5 billion by 2020. As China has only 7% of the world's arable land such population increases are likely to have an important impact on food supply in China and the world. Projections of the potential impact are discussed. ⋯ The replacement of legumes, including soyabean, by meat and other animal products as rich sources of protein and other nutrients has been controversially argued on grounds of nutritional health, ecological impact, economic effects and world food supply. These arguments are reviewed and the pressures internal and external to China concerning the production and consumption of animal v. legume products are presented. It is concluded that nutritional policies to promote the consumption of soyabean are unlikely to be effective in the context of an increasingly free and global market.
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Nutritional therapy is an important component of the management of gastrointestinal inflammation, which disrupts the gut mucosal barrier leading to sepsis, SIRS and MODS. Future studies will be needed to define the role of specific nutrients in enhancing mucosal barrier function and supporting general immune function, and how this affects morbidity and mortality of critically-ill patients.
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Given the lack of understanding of the nutritional requirements in RA, plus the variability in its clinical course, it is difficult to produce specific dietary recommendations for RA. In general, sufferers should consume as varied a diet as possible, based on current Department of Health (1991) guidelines. ⋯ Self-imposed elimination diets should be avoided and suspected food intolerance tested under strict clinical supervision. Nutrient megadosing is inadvisable, although dietary supplementation with Ca, vitamin D, folic acid or multivitamins and minerals should be recommended where necessary.