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Nutritional demands in acute and chronic illness
Rosemary A Richardson1, H Isobel M Davidson
1Dietetics, Nutrition and Biological Sciences, Queen Margaret University College, Clerwood Terrace, Edinburgh EH12 8TS, UK. Nutrition.Dietetics@gvic.scot.nhs.uk
The Proceedings of the Nutrition Society
|March 17, 2004
Summary
Meeting nutritional needs in illness is challenging due to inaccurate energy requirement predictions and the impact of inflammation on eating behaviors. Addressing these issues is crucial for effective patient recovery and nutritional support.
Area of Science:
- Medical Sciences
- Nutritional Science
- Clinical Nutrition
Background:
- Disease, both acute and chronic, disrupts energy homeostasis, leading to altered dietary intake and increased energy expenditure.
- Negative energy balance in illness causes significant loss of both fat and lean body mass.
- Despite the apparent simplicity of providing adequate energy, meeting nutritional demands in sick patients is complex.
Purpose of the Study:
- To highlight the challenges in accurately determining and meeting the energy requirements of patients with metabolically-active diseases.
- To underscore the impact of the acute inflammatory response on ingestive behavior and nutritional target achievement.
- To explore strategies, such as using eicosapentaenoic acid in cancer cachexia, for improving nutritional support.
Main Methods:
- Review of existing literature on energy homeostasis disturbances in disease.
- Analysis of the limitations of predictive energy requirement formulas in clinical practice.
- Examination of the effects of the acute-phase response on nutritional intake and the efficacy of specific interventions.
Main Results:
- Accurate energy prescribing is uncommon in acute care settings, with only 25-32% of patients receiving intakes within 10% of their requirements.
- The acute inflammatory response significantly affects eating behaviors, often preventing the achievement of established nutritional targets.
- Interventions targeting the inflammatory response, like eicosapentaenoic acid in cancer cachexia, show promise for improving nutritional status.
Conclusions:
- Accurate assessment of individual energy expenditure and understanding the inflammatory response are critical for effective nutritional management in disease.
- Current predictive formulas and nutritional targets are often inadequate for patients experiencing acute-phase responses.
- Targeting inflammation presents a potential therapeutic strategy to enhance nutritional support and improve clinical outcomes in various diseases.