ISSN:1363-1950    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

A quarter or more of critically ill patients are likely to have carbohydrate intolerance or frank diabetes, either pre-existing or secondary to the stress of illness. Those patients who require parenteral nutrition should be treated using regimens similar to those used in nondiabetic patients, along with sufficient insulin (given by separate infusion) to maintain near-normal glycaemia. The role of novel substrates in diabetes remains to be established. In patients who require enteral nutrition, there is accumulating evidence that high-fat (as monounsaturated fatty acid) formulations achieve better overall metabolic control than conventional high-carbohydrate preparations. In view of the fact that macrovascular disease is the major cause of morbidity and mortality in type 2 diabetes in particular, and the fact that the risk of macrovascular complications is relatively unaffected by glycaemic control, the improved lipid and haemostatic profile achieved with preparations that are high in monounsaturated fatty acids is of particular importance in patients on long-term nutritional support.

ISSN:1363-1950    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Diabetes mellitus is a serious and fairly common metabolic disorder that affects carbohydrate, protein and fat metabolism. Indications for nutritional support are no different for patients with diabetes than in any other patient group. The setting may be recovery from surgery or trauma and transition to solid food is anticipated, or, as a result of permanent injury or stroke, enteral feeding may be the permanent manner of nutrition delivery. Attention must be given to the selection of a macronutrient intake that will optimize blood glucose and lipid control. It is vital that blood glucose concentration be carefully monitored and that over- and underfeeding be avoided.

ISSN:1363-1950    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Most patients with pancreatic cancer suffer from a variety of severe metabolic and nutritional disturbances. Despite this fact, the role of perioperative nutritional support for these patients remains controversial. This review highlights the results of randomized prospective clinical trials, and meta-analyses that have addressed this issue. The ‘current opinion’ put forth in this discussion is based on these reviews, and on personal observations in treating more than 500 patients.

ISSN:1363-1950    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Despite the extensive current literature on ethics, very few publications have specifically addressed the ethical issues surrounding the provision of nutrition to perioperative patients. Four publications are particularly relevant and highly recommended[1-4]. This review is an attempt to draw attention to those ethical issues that are relevant to the use of nutritional support in the perioperative patient and offer guidance on appropriate action by clinicians. Emphasis is on adult patients rather than children and not on the issues that surround the terminally ill patient. General principles are discussed first and then the application of these principles.

ISSN:1363-1950    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Current guidelines for the management of severe malnutrition are mainly based on new concepts regarding the causes of malnutrition and on advances in our knowledge of the physiological roles of micronutrients. In contrast to the early ‘protein dogma’, there is a growing body of evidence that severely malnourished children are unable to tolerate large amounts of dietary protein during the initial phase of treatment. Similarly, great caution must be exercised to avoid excessive supply of iron and sodium in the diet, while keeping energy intake at maintenance levels during early treatment. Because severely malnourished children require special micronutrients, a mineral-vitamin mix is added to the milk-based formula diets, which are specially designed for the initial treatment and the rehabilitation phase. To further improve nutritional rehabilitation and reduce cases of relapse, ‘ready-to-use therapeutic food’ and ‘ready-to-eat nutritious supplements’ with relatively low protein (10% protein calories) and high fat content (54-59% lipidic calories) have been developed. Although current dietary recommendations do not differentiate between oedematous and nonoedematous forms of malnutrition or between adults and children, there are indications that further clarification is still needed for applying dietary measures for specific target groups.

ISSN:1363-1950    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The mechanisms of senescence remain to be fully defined. This review focuses on recent advances in our understanding of body protein turnover, which is essential for the remodeling of tissues and production of specific proteins in time of need. Recent advances in technology make it possible to measure the synthesis rate of muscle myosin heavy chain, mitochondrial proteins and sarcoplasmic proteins, providing insight into the mechanisms of the sarcopenia of aging. A reduced synthesis rate of myosin heavy chain and mitochondrial protein may explain muscle weakness and fatiguability that occurs with aging. Aging also seems to affect selected liver proteins such as fibrinogen. The potential roles of exercise and hormone replacement in slowing the age-related decline in protein turnover is discussed.

ISSN:1363-1950    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

This paper reviews the recent literature concerning the importance of the gut in extraintestinal protein metabolism. A growing body of evidence suggests that the gut modulates amino acid flux and inter-organ relationships in various metabolic states. This may be particularly true during the absorptive period, when the gut: (1) controls amino acid absorption; (2) may modulate catabolism and uptake for synthesis of absorbed amino acid; and (3) consequently influences the availability of liver and extrasplanchnic amino acids, as well as their pattern and kinetics through portal flow delivery.

ISSN:1363-1950    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

This review is concerned with the status of our current research related to the exchange of amino acids across organs. Accumulation of knowledge regarding how amino acid pools are maintained within the body remains a work in progress. In recent years, the use of organ balance measurement techniques in combination with isotopic tracers has much increased our understanding of the role of the kidney and splanchnic organs in amino acid metabolism, and in kidney and liver gluconeogenesis from amino acids. An interorgan cooperation between the kidney and splanchnic organs for leucine-ketoisocaproate metabolism has also been demonstrated.

ISSN:1363-1950    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

As a precursor of nitric oxide, polyamines and other molecules with enormous biologic importance, L-arginine plays versatile key roles in nutrition and metabolism. Arginine is an essential amino acid in the fetus and neonate, and is conditionally an essential nutrient for adults, particularly in certain disease conditions. L-Arginine administration is beneficial in improving reproductive, cardiovascular, pulmonary, renal, gastrointestinal, liver and immune functions, and in facilitating wound healing. The effect of L-arginine in treating many common health problems is unique among amino acids, and offers great promise for improved health and well-being in the future.

ISSN:1363-1950    

出版商:OVID    

年代:2000

数据来源: OVID