Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Nov 2006
ReviewUpdate on clinical micronutrient supplementation studies in the critically ill.
During the past 2 years a number of studies, meta-analyses and reviews have shown that micronutrient supplementation may be beneficial in critical illness. Selenium is emerging as a particularly important micronutrient. This paper reviews the evidence from trials in the critically ill, putting mechanisms, methods and shortcomings into perspective. ⋯ Plasma micronutrient concentrations are low during critical illness, as a result of losses, low intakes and dilution, and redistribution from plasma to tissues. An assessment of status is difficult. Micronutrient supplements appear beneficial in conditions such as major burns, trauma and sepsis and stroke, and are most likely to benefit patients with previous or actual depletion. The intravenous route seems more efficient than the enteral. Although chronic high intakes may be harmful, short-term interventions appear to be free of deleterious effects. Further research is required to determine the optimal micronutrient combinations and the doses required according to the timing of intervention and severity of disease.
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Curr Opin Clin Nutr Metab Care · Sep 2006
Review6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase and tumor cell glycolysis.
Neoplastic cells metabolize abundant glucose relative to normal cells in order to satisfy the increased energetic and anabolic needs of the transformed state. This review will summarize the requirement of 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatases for the regulation of glycolysis in cancer cells and their potential utility as targets for the development of antineoplastic agents. ⋯ These findings demonstrate a key role for the 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatases in neoplastic transformation and provide rationale for the development of agents that selectively inhibit the PFKFB3 enzyme as antineoplastic agents.
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Curr Opin Clin Nutr Metab Care · Sep 2006
ReviewGlutamine: role in gut protection in critical illness.
Recent literature has focused on the role of the gut and increased gut permeability as a driver of systemic inflammation in critical illness. Thus, the therapeutic potential for an agent to prevent gut barrier compromise and attenuate gut-derived inflammatory response is significant. ⋯ These mechanistic findings, combined with a limited amount of clinical data showing benefit on gut permeability in illness and injury, indicate more formal studies need to be carried out looking the role of glutamine in gut protection and as an antiinflammatory in critical illness.
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The current review focuses on recent studies, both clinical and from basic sciences, which approach possible pathomechanisms of critical illness myopathy in order to better derive potential clinical strategies for a preventive or curative clinical setting. Trends and concepts of clinical diagnosis and handling will be evaluated and their implications for muscle physiology and nutritional/metabolic intervention discussed. ⋯ The search for pathomechanisms is an important task for both clinical and basic sciences. Targets for treatment or prevention of critical illness myopathy include systemic inflammatory response, increased proteolysis and reduced antioxidative capacitance in critically ill patients.
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Brain nutrient sensing allows a fine regulation of different physiological functions, such as food intake and blood glucose, related to energy homeostasis. Glucose sensing is the most studied function and a parallel has been made between the cellular mechanisms involved in pancreatic beta cells and neurons. ⋯ Recent observations in brain nutrient sensing indicate subtle mechanisms, with different cellular and molecular mechanisms involved. This fact would explain the discrepancies reported in the expression of different proteins (glucose transporters, hexokinases, channels). Astrocytes may be involved in one type of response, thus adding a new level of complexity.