Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Jan 2005
ReviewOptimizing functional exercise capacity in the elderly surgical population.
There are several studies on the effect of exercise post surgery (rehabilitation), but few studies have looked at augmenting functional capacity prior to surgical admission (prehabilitation). A programme of prehabilitation is proposed in order to enhance functional exercise capacity in elderly patients with the intent to minimize the postoperative morbidity and accelerate postsurgical recovery. ⋯ A concentrated 3-month progressive exercise prehabilitation programme consisting of aerobic training at 45-65% of maximal heart rate reserve (%HRR) along with periodic high-intensity interval training ( approximately 90% HRR) four times per week, 30-50 minutes per session, is recommended for improving cardiovascular functioning. A strength training programme of about 10 different exercises focused on large, multi-jointed muscle groups should also be implemented twice per week at a mean training intensity of 80% of one-repetition maximum. Finally, a minimum of 140 g ( approximately 560 kcal) of carbohydrate (CHO) should be taken 3 h before training to increase liver and muscle glycogen stores and a minimum of about 200 kcal of mixed protein-CHO should be ingested within 30 min following training to enhance muscle hypertrophy.
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Curr Opin Clin Nutr Metab Care · Sep 2004
ReviewThe impact of early nutrition on metabolic response and postoperative ileus.
Early nutrition has been evaluated and used as a possible strategy to decrease the negative impact of the metabolic response to injury and postoperative ileus. The metabolic response to injury, be it surgical or traumatic, is a physiological mechanism that, according to the magnitude and duration of the event, can impact on the patient's morbidity and survival. The adequate initial approach is a determinant factor that might influence its outcome. Simultaneously, gastrointestinal tract motility is transiently impaired, leading to the so-called postoperative ileus. The latter not only causes patient discomfort, but is also related to abdominal complications and worsening of the nutritional status, as well as increased length of hospital stay and costs. ⋯ Understanding perioperative pathophysiology and implementing care regimes through a multimodal approach in order to reduce the stress of the operation and the related postoperative ileus are major challenges. These factors will certainly impact on patient outcomes.
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Curr Opin Clin Nutr Metab Care · Jul 2004
ReviewCarbohydrate and weight control: where do we stand?
The Atkins diet has been criticized and vilified by much of the scientific community since it was proposed 30 years ago, because it challenged nutritional recommendations and dietary guidelines for a healthy diet. However, in spite of such recommendations the prevalence of obesity continues to rise. The present review evaluates recent scientific evidence and attempts to reach consensus on the confusion of weight-reducing diets. ⋯ Low-carbohydrate, Atkins-type diets have been demonstrated to have positive effects on weight loss and biomarkers of cardiovascular risk, which has prompted some researchers to question the validity of present-day dietary guidelines. Although evidence is accumulating in their favour, the safety and efficacy of low-carbohydrate, high-protein diets needs further long-term verification.
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The recent publication of the results of an aggressive approach to the treatment of hyperglycaemia in critically ill patients, and a rekindling of interest in the use of an infusion of glucose insulin and potassium as adjunctive therapy in a diverse group of patients with cardiovascular disease, warrants a review of the multiple effects of insulin and a review of laboratory and clinical studies. ⋯ This review will summarize some of the putative beneficial effects of insulin as a pharmacological agent, and review recent clinical data. Although the relative benefits of normoglycaemia in the critical care setting and the beneficial effects of insulin are difficult to differentiate, a substantial overlap exists. The extent to which these converging therapies (aggressive normoglycaemia and insulin pharmacotherapy) will be applicable to diverse clinical settings has yet to be determined.
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Curr Opin Clin Nutr Metab Care · Mar 2004
Review Comparative StudyCan it all be done by enteral nutrition?
During recent years techniques and metabolic considerations have been discussed intensively. One contributing reason is that results have not always been easy to interpret and introduce into clinical practice. Nutrition through the enteral and parenteral route has classically been compared, and this is the topic of this review. ⋯ Recent research has shown that enteral nutrition alone does not cover the total nutritional needs of intensive care unit patients. Enteral nutrition given early in a high dose is associated with a higher risk of complications. Metabolism in intensive care unit patients is different from the perioperative condition, which has been highlighted in recent studies with important clinical implications. The final solution has not been found yet, if it exists at all, and research in this field will continue. As the situation in biology and in real intensive care unit life is neither black nor white, it would be most beneficial for the intensive care unit patient if enteral nutrition and parenteral nutrition joined together in a good balance in order to avoid underload and overload.