Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Mar 2013
ReviewCritical care nutrition support research: lessons learned from recent trials.
In the past year, there have been a few large-scale trials of nutrition support in the critical care setting that have produced negative results and have challenged certain assumptions. The purpose of this study is to review those current trials and illustrate key methodological points that should help with the interpretation of these trials, and inform the design of critical care nutrition trials of artificial nutrition in the future. ⋯ Future trials of nutrition support in the ICU, such as the TOP UP study, should include only 'high-risk' patients and should evaluate a broader range of outcomes than traditional ICU outcomes (28-day mortality, ventilator-free days, organ failure-free days, etc.). In the meantime, efforts to improve delivery of energy and protein to critically ill patients, such as with the enhanced protein-energy provision via the enteral route feeding protocol, are warranted.
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Curr Opin Clin Nutr Metab Care · Mar 2013
ReviewThe use of indirect calorimetry in the intensive care unit.
This review evaluates whether improvements have occurred in the value of predictive equations for use in designing nutritional therapeutic regimens in the ICU. The report also seeks to determine whether emerging strategies for nutrition therapy in the ICU change the need for an accurate measurement of energy requirements by indirect calorimetry. ⋯ The role of indirect calorimetry in the ICU should be expected to increase in the near future, as predictive equations may be too inaccurate to identify the appropriate goals of nutrition therapy.
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Oxidative stress plays a central role in the transition from simple steatosis to nonalcoholic steatohepatitis (NASH). An effective therapeutic strategy is to target reduction in oxidative stress in NASH patients. The aim of this review is to discuss the role of oxidative stress in NASH and biological activities of vitamin E and present available evidence on the therapeutic efficacy of vitamin E in NASH. ⋯ The prevalence of NAFLD is likely to increase over time due to the epidemics of obesity and diabetes. Presently, there is no definitive treatment for NAFLD. Based on available evidence, vitamin E (RRR-α-tocopherol) is only recommended in NASH adults without diabetes or cirrhosis and with aggressive histology. Validation is needed in children before its use can be recommended. Longer follow-up of randomized controlled trials are needed to assess long-term vitamin E safety.
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The pleotropic effects of vitamin D on chronic diseases have received significant attention; however, its role in acute illness is less understood. The purpose of this review is to summarize the current evidence regarding the role of vitamin D in acute stress and critical illness. ⋯ Single-point assessments of 25-hydroxyvitamin D following acute stress may provide an inaccurate assessment of vitamin D status. In such cases, measurement of binding proteins and free vitamin D metabolites may be essential to create a more realistic approximation of vitamin D status. Variations in patient responses to acute stress and critical illness may depend not only on the degree of systemic vitamin D insufficiency, but also on the individual tissue requirements.
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Curr Opin Clin Nutr Metab Care · Nov 2012
ReviewDo we need to take calcium with vitamin D supplements to prevent falls, fractures, and death?
The 2011 report by the US Institute of Medicine (IOM) on dietary reference intakes for calcium and vitamin D is based on meta-analyses of randomized controlled trials (RCTs), which concluded that vitamin D supplements need to be taken with calcium supplements to prevent falls, fractures, and all-cause mortality. This study reviews recent meta-analyses of RCTs of vitamin D supplementation to determine whether their conclusions are consistent with the meta-analyses underpinning the IOM report. ⋯ The inconsistency in the conclusions from meta-analyses is due to limitations in the design of previous RCTs of vitamin D supplementation. Large RCTs, giving higher doses of vitamin D (without calcium), should provide a clear answer within several years as to whether vitamin D supplements are beneficial by themselves.