Nutrition
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Liver disease occurs in 15% to 40% of adults on long-term parenteral nutrition, with steatosis being more common than cholestasis in the adult population. This problem has been well reported in the pediatric population, but we describe the case of a man who became profoundly jaundiced after being on parenteral nutrition for 3 y and responded rapidly to a change in lipid source from soybean and olive oil-based emulsion (ClinOleic) to a fish oil-based lipid emulsion (Omegaven).
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Controlled Clinical Trial
Increased plasma availability of L-arginine in the postprandial period decreases the postprandial lipemia in older adults.
Older adults have exaggerated postprandial lipemia, which increases their risk for cardiovascular disease. We sought to determine the effects of increased plasma L-arginine (L-ARG) availability on the oxidation of ingested fat (enriched with [1,1,1-(13)C]-triolein) and plasma triacylglycerol (TG) concentrations during the postprandial period in older subjects. ⋯ Increasing the plasma L-ARG availability during the postprandial period decreases the postprandial lipemia in older adults, in association with a decrease in the postprandial contribution of ingested lipids into TGs of the plasma small TG-rich lipoproteins.
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Malnutrition continues to be under-recognized and undertreated in the hospitalized setting. Although no "gold standard" for the diagnosis of malnutrition exists, the Subjective Global Assessment (SGA) is a commonly used malnutrition assessment tool. The study aim was to explore the reporting of inter-rater reliability (IRR) of the SGA when used as a nutritional assessment tool in the published literature. ⋯ The IRR is rarely reported in the published literature and has not yet been reported across experience levels.
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Diabetic macular edema and retinopathy are low-grade inflammatory conditions. Infusions of antitumor necrosis factor-α (anti-TNF-α) antibody and antivascular endothelial growth factor (anti-VEGF) antibody have been shown to be at least partly effective in the treatment of diabetic macular edema and proliferative diabetic retinopathy. Intravitreal therapy of diabetic macular edema by the anti-TNF-α antibody has been found to produce significant side effects and anti-VEGF therapy to be ineffective. ⋯ The retina is rich in polyunsaturated fatty acids, especially in ω-3, and several studies have shown that polyunsaturated fatty acids prevent diabetic retinopathy. Lipoxins, resolvins, and protectins derived from various polyunsaturated fatty acids possess anti-inflammatory actions and suppress the production of interleukin-6, and TNF-α and VEGF have antiangiogenic actions. In view of these evidences, I propose that lipoxins, resolvins, and protectins could be of significant benefit in the prevention and management of diabetic macular edema and retinopathy.