Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Jul 2009
ReviewDichotomic actions of glutamine in host versus tumour: an emerging concept.
Malignancy is characterized by a systemic deficiency of glutamine (GLN). The debate over whether GLN supplementation should be standard of cancer patients is still topical. This review focuses on recent findings on the effect of GLN administration on the incidence and severity of adverse effects in host due to radiotherapy or chemotherapy or both and on its putative adjuvant role on cytotoxicity of radiotherapy and chemotherapy on tumour. ⋯ Recent studies have shown that GLN could have dichotomic actions in host versus in tumour, probably in link with glutathione metabolism, suggesting that GLN could be used in clinical practice to increase the therapeutic index of oncological treatments.
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Curr Opin Clin Nutr Metab Care · May 2009
ReviewSelenium supplementation in the critically ill: posology and pharmacokinetics.
To analyze current evidence for the posology and pharmacokinetics of selenium supplementation in the critically ill. ⋯ This review summarizes current knowledge on selenium supplementation in the critically ill. High-dose i.v. selenite as a bolus injection plus continuous infusion appears well tolerated and optimizes selenium plasma levels and antioxidant selenoenzymes activities. Additional investigations into the posology and pharmacokinetic profile of selenium are still required. Further studies should aim to demonstrate a definitive benefit of i.v. selenite, alone or in combination, on antioxidant capacity and mortality in the critically ill.
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Curr Opin Clin Nutr Metab Care · May 2009
ReviewChallenges of nutritional assessment in pediatric ICU.
The nutritional assessment of children in the pediatric ICU is unique in view of the metabolic changes of the underlying disease. This review addresses the use and limitations of anthropometry and laboratorial and body composition markers in the diagnosis of the nutritional status of such patients. ⋯ Nutritional assessment is one of the main aspects of the pediatric intensive care patient and is the most important tool to avoid hospital undernutrition. There is currently no gold standard for nutritional assessment in the pediatric ICU. The results of anthropometric and laboratory markers must be jointly analyzed, but individually interpreted according to disease and metabolic changes, in order to reach a correct diagnosis of the nutritional status and to plan and monitor the nutritional treatment.
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Curr Opin Clin Nutr Metab Care · Mar 2009
ReviewEnteral omega-3 in acute respiratory distress syndrome.
The acute respiratory distress syndrome (ARDS) is a severe illness that is often the cause of death in ICU patients. A safe and effective intervention for this condition is lacking. Fish oil-based enteral nutrition [rich in n-3 polyunsaturated fatty acids (PUFAs) and antioxidants] improved clinical outcomes in a previous trial on ARDS patients but was ineffective, or even harmful in other studies utilizing different fish oil formulae (rich in n-3 PUFAs and arginine) in severely ill ICU patients. Until most recently, consistent evidence that enteral n-3 PUFA is therapeutic in ARDS was lacking. ⋯ Enteral administration of fish oil, antioxidants and physiologic amounts of arginine improve oxygenation and clinical outcomes in ICU patients with impaired oxygenation. Whether n-3 PUFA per se produces such benefit is the subject of an ongoing clinical study.
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Curr Opin Clin Nutr Metab Care · Mar 2009
ReviewGastrointestinal complications in critically ill patients: what differs between adults and children?
The objective of this review has been to analyse and compare the causes, incidence, severity and treatment of gastrointestinal complications in critically ill children and adults. ⋯ Gastrointestinal complications limit the efficacy of enteral nutrition in the critically ill patient and can affect morbidity and mortality. Consensus must be reached on the definition of the criteria of excessive gastric residues, constipation and diarrhoea, and studies must be performed that evaluate the efficacy of prokinetic agents on altered gastrointestinal motility and the effects of diet and laxatives on constipation in the critically ill adult and child.