Current opinion in clinical nutrition and metabolic care
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The obesity paradox is a highly controversial concept that may be attributed to methodological limitations related to its identification. One of the primary concerns is the use of BMI to define obesity. This index does not differentiate lean versus adipose tissue compartments (i.e. body composition) confounding health consequences for morbidity and mortality, especially in clinical populations. This review will describe the past year's evidence on the obesity paradox phenomenon, primarily focusing on the role of abnormal body composition phenotypes in explaining the controversies observed in the literature. ⋯ In view of the body composition variability of patients with identical BMI, it is unreasonable to rely solely on this index to identify obesity. The consequences of a potential insubstantial obesity paradox are mixed messages related to patient-related prognostication.
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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.