Obesity and critical care nutrition: current practice gaps and directions for future research

Critical Care, Journal Year: 2022, Volume and Issue: 26(1)

Published: Sept. 20, 2022

This review has been developed following a panel discussion with an international group of experts in the care patients obesity critical setting and focuses on current best practices malnutrition screening assessment, estimation energy needs for obesity, risks management sarcopenic value tailored nutrition recommendations, emerging role immunonutrition. Patients admitted to intensive unit (ICU) increasingly present overweight that require individualized considerations due underlying comorbidities, immunological factors such as inflammation, changes expenditure other aspects metabolism. While research continues accumulate, important knowledge gaps persist recognizing managing complex nutritional ICU obesity. Available assessment tools are limited lack validation heterogeneous impacting status this population. Estimations protein demands also may include estimations based upon ideal, actual, or adjusted body weight. Evidence is still sparse immunonutrition but presence inflammation impacts immune function suggest these nutrients hemodynamically stable patients. Educational efforts needed all clinicians who cases critically ill focus strategies optimal consideration issues weight stigma bias delivery care.Current should be undertaken considers whole person, including possibility preexisting altered metabolism, chronic stigma, which impact provision care. Additional applicability guidelines evidence therapy populations especially illness.

Language: Английский

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Skeletal Muscle in Hypoxia and Inflammation: Insights on the COVID-19 Pandemic

Frontiers in Nutrition, Journal Year: 2022, Volume and Issue: 9

Published: April 22, 2022

SARS-CoV-2 infection is often associated with severe inflammation, oxidative stress, hypoxia and impaired physical activity. These factors all together contribute to muscle wasting fatigue. In addition, there evidence of a direct viral infiltration into skeletal muscle. Aging characterized by sarcopenia or sarcopenic obesity conditions are risk for acute COVID-19 long-COVID-19 syndrome. From these observations we may predict strong association between decreased mass functions. While the relationship inactivity, chronic stress dysfunction well-known, effects on COVID-19-related hypoxemia inadequately investigated. The aim this review highlight metabolic, immunity-related redox biomarkers potentially affected reduced oxygen availability and/or fatigue in order shed light negative impact function. Possible countermeasures also reviewed.

Language: Английский

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Low muscle mass in COVID-19 critically-ill patients: Prognostic significance and surrogate markers for assessment

Clinical Nutrition, Journal Year: 2022, Volume and Issue: 41(12), P. 2910 - 2917

Published: March 1, 2022

Language: Английский

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From the Ketogenic Diet to the Mediterranean Diet: The Potential Dietary Therapy in Patients with Obesity after CoVID-19 Infection (Post CoVID Syndrome)

Current Obesity Reports, Journal Year: 2022, Volume and Issue: 11(3), P. 144 - 165

Published: May 6, 2022

This review primarily examines the evidence for areas of consensus and on-going uncertainty or controversy about diet physical exercise approaches in post-CoVID. We propose an ideal dietary activity approach that patient with obesity should follow after CoVID-19 infection order to reduce clinical conditions associated post-CoVID syndrome. The disease pandemic, caused by severe acute respiratory syndrome coronavirus-2, has spread all over globe, infecting hundreds millions individuals causing death. It is also known be several medical psychological complications, especially patients weight-related disorders who general pose a significant global public health problem, specific affected are on greater risk developing poorer outcomes experience higher rate mortality. Little still best nutritional adopted this To our knowledge, no recommendations exist manage report presentation therapeutic based ketogenic protocol followed transition Mediterranean post-infection CoVID, combined program address

Language: Английский

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Individualised Nutritional Care for Disease-Related Malnutrition: Improving Outcomes by Focusing on What Matters to Patients

Nutrients, Journal Year: 2022, Volume and Issue: 14(17), P. 3534 - 3534

Published: Aug. 27, 2022

Delivering care that meets patients' preferences, needs and values, is safe effective key to good-quality healthcare. Disease-related malnutrition (DRM) has profound effects on patients families, but often what matters not captured in the research, where focus measuring adverse clinical economic consequences of DRM. Differences terminology used describe values confounds problem. Individualised nutritional (INC) tailored a patient's specific needs, goals. Four pillars underpin INC: patients, shared decision making, evidence informed multi-modal monitoring outcomes. Although INC incorporated nutrition guidelines studies oral intervention for DRM adults, descriptions degree which it included varies. Studies patient groups show improves health The process (NCP) offers practical model help healthcare professionals individualise care. can be by all disciplines across settings. Interdisciplinary team approaches provide delivers without increased resources adapted include INC. This review relevance involved design, delivery evaluation regardless whether they need first-line or complex, highly specialised

Language: Английский

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COVID-19: Lessons on malnutrition, nutritional care and public health from the ESPEN-WHO Europe call for papers

Clinical Nutrition, Journal Year: 2022, Volume and Issue: 41(12), P. 2858 - 2868

Published: Aug. 11, 2022

Language: Английский

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Impact of COVID-19 on preexisting comorbidities

Progress in molecular biology and translational science, Journal Year: 2025, Volume and Issue: unknown, P. 215 - 258

Published: Jan. 1, 2025

Language: Английский

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The Role of Nutrition in Mitigating the Effects of COVID-19 from Infection through PASC

Nutrients, Journal Year: 2023, Volume and Issue: 15(4), P. 866 - 866

Published: Feb. 8, 2023

The expansive and rapid spread of the SARS-CoV-2 virus has resulted in a global pandemic COVID-19 infection disease. Though initially perceived to be acute nature, many patients report persistent recurrent symptoms beyond infectious period. Emerging as new epidemic, “long-COVID”, or post-acute sequelae coronavirus disease (PASC), substantially altered lives millions people globally. Symptoms both PASC are individual, but share commonality established respiratory viruses, which include not limited chest pain, shortness breath, fatigue, along with adverse metabolic pulmonary health effects. Nutrition plays critical role immune function thus is implicated reducing risk severity for PASC. However, despite impact nutrition on these key physiological functions related PASC, precise onset remains elucidated. This narrative review will discuss emerging approaches that may play references clinical practice guidelines should remain primary resources practitioners.

Language: Английский

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Clinical nutrition in primary care: ESPEN position paper

Clinical Nutrition, Journal Year: 2024, Volume and Issue: 43(6), P. 1678 - 1683

Published: Feb. 21, 2024

Language: Английский

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Nutritional care is the first-line therapy for many conditions

Precision Nutrition, Journal Year: 2023, Volume and Issue: 2(4), P. e00059 - e00059

Published: Dec. 1, 2023

Nutritional care, medical nutrition, or nutrition therapy were developed based on the concept of nutritional support. Although term "nutritional support" mainly indicates supplementation insufficient nutrients, care implies additional goals that may include metabolic and immune function regulation treatment malnutrition in context underlying diseases. The ambitious goal is to ultimately improve status, clinical outcomes, quality life (QoL), prolong survival time, reduce costs. plays an important role disease-related malnutrition, its actual value has been underestimated for a long time. indeed considered auxiliary supportive therapy, with low priority routine practice. Nevertheless, recent years increasing number consensus opinions have proposed should be recommended as basic first-line multiple diseases given equal attention other treatments, such surgery drugs. Here, we will provide examples three main conditions implementation optimal care: replacement nutrient deficiencies abnormalities; disease aging-related malnutrition; prevention non-communicable (NCD), particular regard cardiometabolic Nutrition, health, disease: fundamental relationship Unhealthy food cause disease, whereas healthy balanced intake key health preservation. Besides their maintenance cell, tissue body mass composition, variety nutrients are essential growth development, cellular function, energy production, defense.[1] For instance, evolution system, diet well microbiome interconnected, selected foods dietary metabolites modulate cells inflammation both directly indirectly. Appropriate diets can therefore prognosis chronic autoimmune through inflammatory immunomodulatory effects. In general, specific preparations effective options several diseases, including but not limited malnutrition. Substantial progress research occurred years. New studies provided cause-effect demonstrations, identified quantitative etiologic effects, indicated heterogeneity, improved our understanding intakes major factors also conditions. These findings conversely contributed informed impact estimation potential policy planning.[2,3] substantial work still ahead, evidence-based shows preserve human QoL, together alternative drug treatments.[4,5] Nutrition deficiency dysmetabolic disorders Nutrient excess, dysfunction disorders, imbalance all lead disease. harm disease-associated benefits obvious. As example, maternal undernutrition contributes fetal restriction, which increases risk neonatal death. Undernutrition aggregate—fetal stunting, wasting, micronutrient vitamin A zinc along suboptimum breastfeeding—is 3.1 million child deaths annually, it accounted 45% 2011.[6] Deficiencies iodine iron, contribute children reaching developmental potential. There growing evidence sustained improvements early adult pre-pregnancy could birth outcomes offspring,[7] D omega-3 fatty acid during pregnancy protective against childhood wheezing.[8] example deficiencies, since was first described almost century ago, successfully used public intervention prevent rickets.[9] numerous caused by abnormalities metabolism cured special diet. phenylalanine toxic immature nerve impedes intellectual development. Food purpose (FSMP), milk powder, rice, wheaten food, remove phenylalanine, best therapeutic approach phenylketonuria, characterized lack enzymes metabolize avoid damage development.[10] Glutaric acidemia, presents catabolic amino metabolism, treated adequate FSMPs.[11] disease- Most acute combined intake, physical inactivity, derangements.[12] latter inflammation, oxidative stress, insulin resistance, altered macro- increased expenditure, leading catabolism loss muscle mass. Disease-related (DRM) physical, psychological, clinically relevant adverse dysfunction,[13] impaired disabilities autonomy, decreased bone mass, anemia, reduced cognitive function. complications further poor prognosis, wound healing, infection rates, tolerance related progression delayed recovery length stay hospitalization, and, eventually, mortality.[14,15] During coronavirus 2019 (COVID-19) pandemic, worsening unfortunately confirmed component burden acute, infectious conditions, presence obesity.[16,17] Hospitalized patients severe respiratory syndrome 2 (SARS-CoV-2) at risk,[18] management significantly patient outcomes.[19,20] Notably, despite existing discrepancies, selenium inhibit defenses COVID-19 disease.[21] DRM enhances economic healthcare. It reported United States, stroke, coronary heart failure, obstructive pulmonary (COPD), dementia, depression, breast colorectal cancer leads direct costs $15.5 billion. Indirect social costs, missed work, need personal caregivers, total up $156.7 billion per year.[22] European Union, cost cardiovascular €192 annually indirect costs.[23] Aging factor disabilities, expenditures expectancy worldwide. se skeletal (sarcopenia), spontaneous reduction enhanced challenges.[24] Healthy lifestyle protein calcium provision sufficiency, activity resistance exercise delay onset sarcopenia they limit established conditions.[25] Selected patterns adherence Mediterranean associated lower risks preserved function.[26,27] Several show shorten hospital stays, older miscellaneous conditions.[28–30] more than 1 inpatients, oral supplements (ONS) shortened hospitalization stays 21%, 21.6%, 30-day rehospitalization rate 6.7%.[31] Also importantly, benefit from care.[32] beneficial community residents home patients. one study, ONSs falls, extended adjusted QoL years.[33] From health-economic point view, calculated $1 invested save $52 future healthcare resources.[31] another report, estimated $580 sepsis, gastrointestinal tumors, infections, surgical complications, pancreatitis.[34,35] Among many paradigm DRM, most (30%–90%) experience because consequences.[36–38] Malnutrition approximately 40% die malnutrition.[39] Despite heterogeneity some discrepancies available studies, strong outcomes. Bargetzi et al calorie indicators, functional survival.[40] Timing seems important, study prolonged advanced compare later intervention.[41] Khosravi found alone second-line chemotherapy had equivalent roles progression-free overall non–small-cell lung who failed chemotherapy.[42] Lu reduces death 32% 2.9 months esophageal gastric cancer.[43] undergoing non-surgical treatment, chemoradiotherapy tolerance, side time.[44] pre-rehabilitation starting before time anti-cancer treatments (approximately weeks advance), chemoradiotherapy, improving prolonging concurrent anti-tumor treatments. Perioperative ONS formulas, included within after (ERAS) protocol,[45] proven element critical step achieve better results, reductions intensive unit (ICU), stay, mortality.[46] Based above considerations findings, guidelines recommendations undergo regular screening evaluation, managed accordingly stages treatment.[37,44,45,47] Prevention NCDs NCDs, hypertension, diabetes, cerebrovascular mostly, although exclusively over-nutrition unhealthy habits,[48] become threats world's population.[49] Indeed, scientific increase low-income middle-income countries 2000, previously seen high-income settings.[50] share causal behavioral factors,[51,52] high-energy/fat diet,[53,54] high ultra-processed foods,[55] salt intake,[56] fresh fruit vegetable diet, obesity,[57] inactivity,[58] tobacco smoking, alcohol excess.[58] (eg, salt, energy, fat cholesterol inactivity) derangements systemic stress injury, resistance,[59] mortality.[60] mentioned above, enhance similar synergistic state DRM. consultation education TV media, service advertisements, popular science articles, family follow-up, ways) help population adhere lifestyle, limiting consumption, use low-fat dairy products, consuming saturated cholesterol, reducing red processed meat, whole grains, fruits, vegetables, nuts, seeds, legumes, attaining weight, reverse moderate survival.[61–63] prevention, randomized controlled trials polyunsaturated oil (CVD) ≈30%, achieved statin treatment.[64] (adequate levels fruits vegetables fish, olive oil, wine),[65] potentially vegetarian shown incidence various cancers,[66] while survival.[67,68] DASH pattern, widely international diabetes association guidelines, disease[69] kidney disease.[70] China, hypertension type H (hypertension hyperhomocysteinemia) folate homocysteine levels.[71] Folate blood pressure stroke. Antihypertensive supplementations stroke corresponding financial China.[72,73] exercise, therapies interventions syndrome, resulting beta-cell mellitus, polycystic ovary (PCOS), hyperinsulinemia, reactive hypoglycemia.[74] pattern staple Chinese individuals.[75] Cancer represents prevention. World Research Foundation (WCRF) American Society (AICR) versions recommending cereals, legumes [over 2/3]; weight control, maintaining index (BMI) between 20 23 kg/m2; exercise; eating less meat refined sugar alcohol) aimed preventing lifestyle. Changes spectrum suggest urgent level primary secondary prevention.[76] highlighting data National Center China showed past 30 years, tumors exposure carcinogens pickled, smoked, moldy food), gastric, esophageal, liver cancer, decreased, cancers prevalence Western (high-energy/high-fat activity) obesity, colorectal, thyroid, prostate, 2- 3-fold.[77] Dietary drugs considered. always considered, preliminary pre-clinical suggested restriction potentiate efficacy of, alleviate drugs.[78] Further needed this hypothesis. premature ovarian insufficiency (POI) ranks among top reproductive impair functioning systems. Symptoms partially alleviated hormone therapy. effect proliferative, anti-inflammatory, antioxidant, mitochondria-protective potential, course menopause POI driving attention.[79] control adequate, well-designed cornerstone any when confirms safety, bioavailability, efficacy. Maintaining good glycemic crucial people pre-diabetes, general population. Strategies involve prescription glucose-lowering modulation Restriction high-glycemic carbohydrates glucose medication.[80] obvious, adequately emphasized guidelines.[81] evidence, national government agencies Societies Examples include: "2010 Guidelines Americans," "Nutrition Facts labels," "Healthy People 2020" US[82,83]; Canadian Hypertension Education Program (2016),[84] Task Force dyslipidemias Cardiology (ESC) Atherosclerosis (EAS),[23] "Diabetes program Japan 21," "WHO City Initiative Japan," "Current status issues concerning Health 21,"[85,86] Seoul Metabolic Syndrome Management South Korea,[87] Diet (DaHA) Singapore,[88,89] (2010),[90] living Asian Indians.[91] approaches, insurance US, comprehensive follow-up programs. formulas supported programs.[92] approaches appear encouraging results. large Dutch 2005 Americans alternate Approaches Stop (DASH) scores mortality, COPD, diabetes. Additional measures advocating coordinated promotion government, society, individuals, families. accelerate development establishment discipline, nutritionists systems, disseminate awareness, establish promote populations FSMP meals, carry out economics care. Outlook perspectives play measure. Awareness huge benefits, remains professionals. However, emerging contributor frailty. Additionally, allow dosage effects drugs, long-term gained attention. future, recognized promoted surgery, radiotherapy, chemotherapy, adapt monitoring process. Changing paradigms, emphasizing Implementation requires efforts staff, families, policymakers, insurance, support.[93] part mandatory curricula schools, staff implement right. precision diagnosis basis graded evaluation determining reversible guiding formulation management[94–96]; gene testing, determination genetic phenotypes, individualized care[97]; detection assessment addition composition analysis obesity-related NCDs.[98] Therefore, highly professional task involving wide range fields, diets, genomics, metabolomics. independent technology department order conduct diagnosis. An appropriate damages treatment-related curing accelerating rehabilitation; timely would inevitably continuous deterioration fifth vital sign, screening, patients, conducted risk. Funding This Key Technologies Development (grant no. 2022YFC2009600). Conflicts Interest authors declare no known competing interests relationships appeared influence paper.

Language: Английский

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