Current opinion in clinical nutrition and metabolic care
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To characterize methods evaluating and to summarize studies linking various serum 25-hydroxyvitamin D [25(OH)D] concentrations with health status. ⋯ The distinction between deficiency and insufficiency is not useful or necessary. Serum 25(OH)D values below 120 nmol/l (48 ng/ml) are associated with preventable disease and are therefore indicative of deficiency. The upper limit of the normal range can be set at 225 nmol/l (90 ng/ml), although toxicity is rare below 500 nmol/l (200 ng/ml).
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To review the basic mechanisms of caloric intake reduction of bariatric surgery and its clinical and metabolic outcomes. To describe novel bariatric procedures, their effects on glucose homeostasis and insulin sensitivity and to explain the proposed mechanisms for type 2 diabetes mellitus (T2DM) resolution. ⋯ Bariatric surgery is the most effective therapy for obesity and obesity-related comorbidities today that provide high rates of resolution of T2DM with improvements in insulin resistance and β-cell function. Novel bariatric procedures offer a unique opportunity to understand the pathophysiology of T2DM and to identify potential pharmacologic targets for effective T2DM treatments and a potential cure.
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Curr Opin Clin Nutr Metab Care · May 2011
ReviewWhat is the power of evidence recommending routine probiotics for necrotizing enterocolitis prevention in preterm infants?
There is a lively discussion in literature whether routine use of probiotics should be recommended to reduce the incidence of severe necrotizing enterocolitis (NEC) and mortality in preterm infants. The aim of the present review is to analyze the level of evidence of published randomized controlled trials (RCTs) that different probiotic products reduce the incidence of severe NEC and mortality in preterm infants following Oxford Center for Evidence-based Medicine approach. ⋯ In circumstances of high local incidence of severe NEC, there is encouraging data (LoE 2b) for the use of probiotics. However, currently there is no level 1a evidence to recommend that all preterm infants should be fed probiotics routinely. Further, well designed RCTs on specific probiotics are required.
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Curr Opin Clin Nutr Metab Care · Mar 2011
ReviewBurns: where are we standing with propranolol, oxandrolone, recombinant human growth hormone, and the new incretin analogs?
The hypermetabolic response in critically ill patients is characterized by hyperdynamic circulatory, physiologic, catabolic and immune system responses. Failure to satisfy overwhelming energy and protein requirements after, and during critical illness, results in multiorgan dysfunction, increased susceptibility to infection, and death. Attenuation of the hypermetabolic response by various pharmacologic modalities is emerging as an essential component of the management of severe burn patients. This review focuses on the more recent advances in therapeutic strategies to attenuate the hypermetabolic response and its associated insulin resistance postburn. ⋯ Novel approaches to the management of critical illness by judicious glucose control and the use of pharmacologic modulators to the hypercatabolic response to critical illness have emerged. Investigation of alternative strategies, including the use of metformin, glucagon-like-peptide-1 and the PPAR-γ agonists are under current investigation.
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Curr Opin Clin Nutr Metab Care · Mar 2011
ReviewBioinformatics assistance of metabolic and nutrition management in the ICU.
To review the domains in which computerized information systems have proven beneficial in facilitating the metabolic and nutritional management ⋯ Computers are needed to analyze the increasing amount of data collected from critically ill patients from monitoring systems, laboratories and other sources. Studies have shown that computerized information systems do facilitate glucose control, helping reducing hypoglycemic events. They also improve nutritional monitoring (energy delivery and balance, protein and fat delivery), and quality of nutrition. They reduce nurse workload associated with the multiple balance calculations and ease visualization of events out of planned targets. Though integrated systems are expensive, they improve work efficiency.