Nutrition
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The early provision of nutrients as part of specialized therapy for critically ill patients admitted for critical medical and surgical conditions is recommended by various international guidelines. Enteral nutrition is the first option and should be initiated 24-48 h after admission to an intensive care unit. Even after gastrointestinal anastomosis, early oral or enteral feeding is not only safe but also associated with enhanced recovery and fewer complications. ⋯ Although the precise caloric target remains controversial, the general consensus advocates the avoidance of prolonged hypocaloric or hypercaloric feeding. However, there is still debate about the timing of the initiation of parenteral nutrition when enteral nutrition either is impossible or does not meet the nutritional goals. Although controversy remains, two recent studies showed that when enteral feeding is not feasible the early initiation of parenteral nutrition was not associated with palpable benefit.
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This review aims to put an economic perspective on childhood and adolescent obesity by providing an overview on the latest literature on obesity-related costs and the cost effectiveness of interventions to prevent or manage the problem. ⋯ To design effective public policies against the obesity epidemic, a better understanding and a more precise assessment of the health care costs and the broader economic burden are necessary but, critically, depend on the collection of additional longitudinal data. The economic evaluation of childhood obesity interventions poses various methodologic challenges, which should be addressed in future research to fully use the potential of economic evaluation as an aid to decision making.