Current Opinion in Clinical Nutrition & Metabolic Care,
Год журнала:
2024,
Номер
unknown
Опубликована: Дек. 24, 2024
Purpose
of
review
The
human
circadian
system
regulates
several
physiological
processes,
including
metabolism,
which
becomes
significantly
disrupted
during
critical
illness.
common
use
24-h
continuous
nutrition
support
feeding
in
the
intensive
care
unit
(ICU)
may
further
exacerbate
these
disruptions;
this
evaluates
recent
evidence
comparing
and
intermittent
schedules
critically
ill
adults.
Recent
findings
Research
different
adults
remains
limited.
meta-analyses
suggest
that
ICU
have
comparable
adverse
event
profiles,
gastrointestinal
intolerance.
A
retrospective
study
found
did
not
impact
glucose
variation
adults,
a
randomized
controlled
trial
reported
no
significant
differences
amino
acid,
lipid-based,
or
small
molecule
metabolite
profiles
between
two
regimens.
Potential
benefits
include
stimulation
muscle
protein
synthesis,
preservation
normal
hormone
secretion,
improved
attainment
nutritional
goals.
Summary
Current
suggests
safety
for
adult
patients.
However,
daytime
cyclic
are
expected
to
align
more
closely
with
physiology.
Given
lack
existing
supportive
data,
dynamic
approach
–
transitioning
from
early-acute
metabolic
phase
be
appropriate.
Clinical Nutrition,
Год журнала:
2025,
Номер
46, С. 169 - 180
Опубликована: Фев. 6, 2025
Critically
ill
children
requiring
treatment
in
a
pediatric
intensive
care
unit
(PICU)
suffer
from
anorexia
and/or
feeding
intolerance.
The
resulting
macronutrient
deficit
associates
with
poor
outcome.
Until
recently,
this
association
formed
the
basis
for
initiating
enteral
or
parenteral
early
to
improve
multicenter
"Early-versus-Late-Parenteral-Nutrition-in-the-Pediatric-Intensive-Care-Unit"
randomized
controlled
trial
(PEPaNIC-RCT)
addressed
whether
is
causal.
It
showed
that
supplementation
of
insufficient/contraindicated
nutrition
nutrition,
as
compared
accepting
throughout
first
week
PICU,
did
not
On
contrary,
it
caused
more
infections
and
prolonged
organ
support
PICU
stay,
adversely
affected
neurodevelopmental
outcomes
2
4
years
later.
Harm
was
present
all
subgroups
appeared
explained
by
dose,
specifically
amino-acid
lipid
glucose
doses.
These
findings
corroborated
results
large-scale
adult
RCTs.
Mechanisms
harm
enhanced
comprised
suppressed
cellular
repair
pathways
like
autophagy
ketogenesis,
illness-induced
alterations
thyroid
hormone
metabolism,
iatrogenic
hyperglycemia,
increased
urea
cycle
activity
through
anabolic
resistance,
induction
epigenetic
modifications
mediate
longer-term
developmental
impairments.
came
unexpected
many
intensivists.
Hence,
paradigm
has
only
slowly
begun
shift
toward
restrictive
administration
acute
phase
critical
illness.
Benefits
fasting
responses
have
become
clear,
provided
micronutrients
are
given
prevent
deficiencies
refeeding
syndrome.
insights
open
perspectives
studies
investigating
novel
nutritional
strategies
activate
fasting-induced
while
avoiding
starvation.
Current Opinion in Critical Care,
Год журнала:
2025,
Номер
unknown
Опубликована: Янв. 30, 2025
Purpose
of
review
To
summarize
the
clinical
evidence
on
nutritional
support
for
critically
ill
patients,
(patho)physiological
mechanisms
involved,
and
areas
future
research.
Recent
findings
Large
randomized
controlled
trials
have
shown
that
early
nutrition
induces
dose-dependent
harm
in
regardless
feeding
route,
high-dose
amino
acids
are
harmful.
Harm
has
been
attributed
to
feeding-induced
suppression
cellular
repair
pathways
including
autophagy
ketogenesis,
aggravation
hyperglycemia
insulin
needs,
increased
urea
cycle
activity.
Additionally,
acute
critical
illness
was
be
a
state
anabolic
resistance.
The
absence
benefit
enhanced
short-
long-term
outcomes
observed
all
studied
subgroups.
Summary
While
should
avoided
optimal
initiation
time
individual
patient,
as
well
ideal
composition
dosing
over
remain
unclear.
Future
studies
elucidate
how
fasting-induced
can
activated
while
avoiding
prolonged
starvation,
high
need
could
prevented.
Potential
strategies
include
intermittent
fasting,
ketogenic
diets,
ketone
supplements,
alternative
glucose-lowering
agents,
whether
or
not
combination
with
exercise.
Clinical Nutrition,
Год журнала:
2025,
Номер
46, С. 45 - 51
Опубликована: Янв. 6, 2025
A
pragmatic
trial
and
its
secondary
analyses
have
demonstrated
that
nutritional
care
not
only
reduces
complications
but
also
significantly
improves
survival
in
medical
patients
at
risk
of
malnutrition.
In
contrast,
for
critically
ill
comparable
evidence
is
scarce.
Consequently,
many
propositions
refining
the
research
agenda
study
design
field
critical
nutrition
already
been
made.
The
aim
this
paper
to
elucidate
further
problems
care.
Critical
appraisal
literature
from
past
70
years.
We
identified
five
key
problems:
1.
immunologic
background
catabolism
2.
energy
goal
during
acute
phase
3.
quantification
endogenous
substrate
production
4.
incorporation
clinical
biological
data
into
design,
5.
cardiopulmonary
exercise
testing
recovery
phase.
solution
these
should
supplement
made
by
other
authors
essential
improving
after
Current Opinion in Clinical Nutrition & Metabolic Care,
Год журнала:
2025,
Номер
unknown
Опубликована: Янв. 27, 2025
To
share
current
concepts
and
provide
an
overview
of
the
contextual
issues
nutrition
practices
in
critically
ill
patients
resource-limited
settings
(RLSs)/low-
middle-income
countries
(LMICs).
Most
world's
population
reside
these
which
also
carries
greatest
burden
critical
illness.
There
is
a
paucity
evidence
on
practice
RLSs
international
guidelines
are
largely
based
derived
from
high-income
(HICs).
While
some
recommendations
adaptable
to
RLSs,
many
not
feasible
or
directly
transferable.
Despite
challenges
that
may
prevail,
pragmatic
solutions
can
address
difficulties
enhance
improve
patient
outcomes.
This
review
provides
contemporary
synopsis
covering
relevance
optimal
nutrition,
gives
insights
into
relevant
evaluates
recent
scientific
available
literature
pertinent
addresses
guidelines,
discusses
options
solutions,
deals
with
important
complications
arise,
offers
suggestions
future
considerations
settings.
Research Square (Research Square),
Год журнала:
2025,
Номер
unknown
Опубликована: Фев. 14, 2025
Abstract
Objective
Nutritional
support
is
crucial
for
critically
ill
patients.
Body
mass
index
(BMI)
represents
nutritional
reserves
to
some
extent,
but
it
unclear
whether
the
U-shaped
relationship
between
caloric
delivery
during
acute
phase
of
critical
illness
and
prognosis
applies
patients
across
all
BMI
categories.
Methods
This
secondary
analysis
a
multicenter
prospective
observational
study,
which
included
who
were
admitted
intensive
care
unit
(ICU)
at
least
3
days.
The
divided
into
two
subgroups
based
on
BMI:
normal
overweight
(BMI
>
25
kg/m²).
We
used
univariate
multivariate
Cox
regression
analyses
investigate
calorie
within
first
72
hours
ICU
admission
28-day
mortality,
explore
non-linear
exists
two.
Results
A
total
361
in
final
analysis,
including
272
subgroup
89
subgroup.
In
regression,
there
was
significant
(P
=
0.003)
association
0.002)
daily
delivered
calories
mortality.
Increasing
from
0
18
kcal/kg/day
associated
with
decreasing
mortality
(hazard
ratio
(HR)
0.892,
95%
CI
0.816–0.975),
while
increasing
(HR
1.116,
1.016–1.227));
subgroup,
higher
also
observed
increase
1.124,
1.043–1.211,
P
0.003),
this
disappeared
(P
0.466).
After
adjustment,
above
results
still
hold
up.
Conclusions
only
those
<
kg/m²,
no
such
curve
kg/m².
Further
research
needed
validate
conclusion.
Frontiers in Nutrition,
Год журнала:
2025,
Номер
12
Опубликована: Апрель 30, 2025
Introduction
Undernutrition
is
a
common
concern
among
critically
ill
children
and
adolescents
in
the
hospital
setting.
Inadequate
delivery
of
nutrition
therapy
(NT)
can
significantly
contribute
to
prevalence
undernutrition
pediatric
intensive
care
units
(PICUs).
Objective
To
assess
impact
interruptions
on
volume
NT
delivered
with
basal
chronic
conditions,
as
well
calories
proteins
provided,
during
acute
phase
PICU.
Methods
A
cohort
patients
conditions
was
analyzed
evaluate
administration
enteral
or
parenteral
nutrition.
The
focus
not
effectively
underlying
causes
incomplete
NT.
Results
total
120
were
included,
majority
whom
undernourished
(47.5%)
by
body
mass
index-for-age
(BMI/A).
significant
proportion
prescribed
(EN)
(PN)
administered
first
third
days
evaluation.
most
prevalent
reasons
for
procedures
delays
complications
arising
treatment
Conclusion
Interruptions
are
frequent
children;
greater
day
both
EN
PN
after
initiation;
mild
gastrointestinal
main
administration.
Journal of Clinical Medicine,
Год журнала:
2025,
Номер
14(3), С. 991 - 991
Опубликована: Фев. 4, 2025
Background/Objectives:
Uncertainty
persists
about
the
best
methods
and
timing
for
providing
medical
nutrition
therapy
(MNT)
in
acute
phase
of
critical
illness.
We
conducted
an
overview
systematic
reviews
to
examine
appraise
findings
current
performed
updated
meta-analysis
incorporating
newly
published
randomized
controlled
trials
(RCTs)
investigate
whether
enteral
(EN)
is
superior
combination
EN
parenteral
(PN)
patients
admitted
intensive
care
unit
(ICU).
Methods:
systematically
searched
three
databases
retrieve
RCTs.
Two
independent
reviewers
screening,
data
extraction,
quality
assessment
processes.
The
random
effects
model
was
utilized
synthesize
regarding
primary
secondary
outcomes.
Results:
There
no
difference
between
two
interventions
efficacy
safety
endpoints,
apart
from
bloodstream
infections,
which
were
found
be
increased
group
that
received
EN+PN
(RR
=
1.27,
95%CI
1.03
1.56,
PI
0.91
1.77,
I2
0%).
Conclusions:
According
present
meta-analyses,
there
observed
benefit
on
mortality,
length
ICU
stay
or
hospitalization,
duration
mechanical
ventilation
critically
ill
receiving
a
PN
comparison
those
sole
ICU.
Furthermore,
rates
respiratory
infections
as
well
appearance
adverse
events,
such
vomiting
diarrhea.
On
other
hand,
increase
infection
who
compared
alone.
Due
limited
implications
results
clinical
practice,
further
research
needed.
The Journal of Steroid Biochemistry and Molecular Biology,
Год журнала:
2025,
Номер
unknown, С. 106720 - 106720
Опубликована: Март 1, 2025
Vitamin
D
deficiency
(VDD)
is
prevalent
globally
and
in
pediatric
intensive
care
units,
where
it
represents
a
modifiable
risk
factor
that
may
impact
patient
recovery
during
hospitalization.
Herein,
we
performed
retrospective
analysis
of
serum
samples
from
phase-II
randomized
placebo-controlled
trial
involving
single
large
bolus
10,000
IU/kg
vitamin
D3
ingested
by
critically
ill
children
with
VDD
(25-OH-D
<
50
nmol/L).
Targeted
untargeted
methods
were
used
to
comprehensively
measure
6
metabolites,
239
lipids,
68
polar
4
electrolytes
using
multi-step
data
workflow
for
compound
authentication.
Complementary
statistical
classified
circulating
metabolites/lipids
associated
repletion
following
high-dose
intake
(n=20)
versus
placebo
(n=11)
comprising
standard
maintenance
dose
(<
1000
IU/day).
There
was
striking
increase
median
concentrations
25-OH-D3
(4.7-fold),
3-epi-25-OH-D3
(24-fold)
their
C3-epimer
ratio
(6.7-fold)
treated
patients
on
day
3,
whereas
peaked
1
(128-fold)
unlike
placebo.
Treatment
response
differences
attributed
bioavailability
C3-epimerase
activity
without
evidence
hypercalcemia.
For
the
first
time,
report
detection
3-epi-D3
strongly
correlated
uptake
(r
=
0.898).
Metabolomic
studies
revealed
sufficiency
(serum
25-OH-D
>75
nmol/L)
coincided
lower
levels
3-methylhistidine,
cystine,
S-methylcysteine,
uric
acid,
two
lysophosphatidylcholines
7
days
after
treatment.
Rapid
correction
indicators
oxidative
stress,
inflammation,
muscle
protein
turn-over
contribute
clinical
benefits
high-risk
children.