Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Nov 2015
ReviewMicronutrient and amino acid losses in acute renal replacement therapy.
A wide range of renal replacement therapies is now available to support patients with acute kidney injury. These treatments utilize diffusion, convection or a combination of these mechanisms to remove metabolic waste products from the bloodstream. It is inevitable that physiologically important substances including micronutrients will also be removed. Here we review current knowledge of the extent of micronutrient loss, how it varies between treatment modalities and its clinical significance. ⋯ Patients with acute kidney injury are at high risk of disease-related malnutrition. The use of renal replacement therapy, although often essential for life support, results in loss of micronutrients into the filtrate or dialysate. Losses are probably greater with continuous convective treatments, but it is not yet known whether these losses are clinically significant or whether their replacement would improve patient outcomes.
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Curr Opin Clin Nutr Metab Care · Sep 2015
ReviewNoncoeliac gluten sensitivity: a diagnostic dilemma.
Noncoeliac gluten sensitivity (NCGS) has gained attention as an emerging clinical entity. Data regarding the epidemiology, pathogenesis, and management of NCGS are scattered in view of the diagnostic uncertainty surrounding the disorder. We aim to provide a current perspective of NCGS and its associated controversies. ⋯ Physicians are increasingly being posed with the dilemma of patients presenting with self-reported NCGS. However, this appears to be the tip of the iceberg and future studies are in need of delineating which gluten-based component is responsible for each individual patient's complaint.
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To provide an overview on the recent literature regarding metabolism during sepsis and outcome-related effects of nutrition therapy in septic patients. The question when and how these patients should be fed with respect to macronutrient intake is elaborated. ⋯ In the absence of strong clinical evidence, pathophysiological findings are discussed and nutritional strategies for septic patients derived. Future studies should explore the individual response to specific exogenous supply of macronutrients and micronutrients in the acute and persistent phase of severe systemic inflammation.
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Muscle wasting is common in severe critical illness. ICU-acquired weakness (ICU-AW) contributes to acute and long-term morbidity and mortality. The question remains whether nutrition therapy in ICU can prevent or attenuate these complications. This review aims at integrating the most recent clinical data in order to answer this important clinical and research question. Clinical evidence was obtained from randomized controlled trials (RCTs). Results from animal experiments and observational studies are referred to when - respectively - providing possible explanatory mechanisms or new hypotheses. ⋯ Current evidence does not support improved physical function with increased energy/protein provision in the first ICU week. Future RCTs aimed at reducing the burden of ICU-AW and improving long-term function should particularly focus on nutrition beyond the acute phase of critical illness and on non-nutritional interventions such as early mobilization.
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Curr Opin Clin Nutr Metab Care · Mar 2015
ReviewPreservation of autophagy should not direct nutritional therapy.
Recent reports in the literature have proposed that forced mandatory feeding should be avoided in the first week of critical illness to preserve autophagy, in order to maximize responses to oxidative stress, preserve organ function, and improve outcomes. ⋯ The argument to withhold feeding to preserve autophagy is poorly substantiated and should not interfere with the delivery of early enteral nutrition to the critically ill patient in that first week following admission to the ICU.