Nutrition in the acute phase of illness

Czech version

Authors: František Novák
Authors‘ workplace: IV. interní klinika 1. LF UK a VFN v Praze
Published in: Vnitř Lék 2019; 65(3): 219-226
Category:

Recentní výzkum výživy v akutní fázi onemocnění ukázal důležité nové poznatky o podávání vyšších dávek proteinů a možných nežádoucích účincích u pacientů v katabolizmu. Na druhou stranu se ukazuje, že realimentační hypofosfatemie a realimentační syndrom může být významným problémem u chronicky podvyživených akutně hospitalizovaných pacientů. Navíc se zdá, že enterální výživa nemusí být výhodnější než parenterální výživa u pacientů v šokovém stavu, u kterých dokonce nelze vyloučit horší výsledky enterální přístupu.

Overview

Recent research of nutrition in the acute phase has brought up important findings regarding high protein and energy administration in critical illness with suggested adverse outcomes in catabolic patients. On the other hand, refeeding hypophosphatemia and refeeding syndrome may also be common during acute illness especially in chronically malnourished patients. Moreover, enteral nutrition is no longer superior to parenteral nutrition in recent studies as signals of harm using the enteral route in shock have been suggested. A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale has been proposed. Nutrition screening, assessment and intervention guidelines in intensive care and in chronic polymorbid internal patients has recently been published. These new findings and guidelines will probably change the practice of metabolic and nutrition therapy in acute illness and subsequent recovery.

Keywords:

acute illness – guidelines – inflammation – malnutrition

Sources

Bounoure L, Gomes F, Stanga Z et al. Detection and treatment of medical inpatients with or at-risk of malnutrition: Suggested procedures based on validated guidelines. Nutrition 2016; 32(7–8): 790–798. Dostupné z DOI: <http://dx.doi.org/10.1016/j.nut.2016.01.019>.
Casaer MP, Mesotten D, Hermans G et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med 2011; 365(6): 506–517. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1102662>.
Heyland D, Muscedere J, Wischmeyer PE et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med 2013; 368(16): 1489–1497. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1212722>. Erratum in N Engl J Med 2013; 368(19): 1853. Dosage error in article text.
Doig GS, Simpson F, Heighes PT et al. Restricted versus continued standard caloric intake during the management of refeeding syndrome in critically ill adults: a randomised, parallel-group, multicentre, single-blind controlled trial. Lancet Respir Med 2015; 3(12): 943–952. Dostupné z DOI: <http://dx.doi.org/10.1016/S2213–2600(15)00418-X>.
Braunschweig CA, Sheean PM, Peterson SJ et al. Intensive nutrition in acute lung injury: a clinical trial (INTACT). JPEN J Parenter Enteral Nutr 2015; 39(1): 13–20. Dostupné z DOI: <http://dx.doi.org/10.1177/0148607114528541>.
Schuetz P. Food for thought: why does the medical community struggle with research about nutritional therapy in the acute care setting? BMC Med 2017; 15(1): 38. Dostupné z DOI: <http://dx.doi.org/10.1186/s12916–017–0812-x>.
Bally MR, Blaser Yildirim PZ, Bounoure L et al. Nutritional Support and Outcomes in Malnourished Medical Inpatients: A Systematic Review and Meta-analysis. JAMA Intern Med 2016; 176(1): 43–53. Dostupné z DOI: <http://dx.doi.org/10.1001/jamainternmed.2015.6587>.
Deutz NE, Matheson EM, Matarese LE et al. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clin Nutr 2016; 35(1): 18–26. Dostupné z DOI: <http://dx.doi.org/10.1016/j.clnu.2015.12.010>.
Singer P, Blaser AR, Berger MM et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2018; 38(1): 48–79. Dostupné z DOI: <http://dx.doi.org/10.1016/j.clnu.2018.08.037>.
Gomes F, Schuetz P, Bounoure L et al. ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clin Nutr 2018; 37(1): 336–353. Dostupné z DOI: <http://dx.doi.org/10.1016/j.clnu.2017.06.025>.
Cederholm T, Jensen GL, Correia MI et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clin Nutr 2018; 38(1): 1–9. Dostupné z DOI: <http://dx.doi.org/10.1016/j.clnu.2018.08.002>.
Cruz-Jentoft AJ, Bahat G, Bauer J et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48(1): 16–31. Dostupné z DOI: <http://dx.doi.org/10.1093/ageing/afy169>.
Fimognari FL, Pierantozzi A, De AW et al. The Severity of Acute Illness and Functional Trajectories in Hospitalized Older Medical Patients. J Gerontol A Biol Sci Med Sci 2017; 72(1): 102–108. Dostupné z DOI: <http://dx.doi.org/10.1093/gerona/glw096>.
Sorensen J, Kondrup J, Prokopowicz J et al. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr 2008; 27(3): 340–349. Dostupné z DOI: <http://dx.doi.org/10.1016/j.clnu.2008.03.012>.
Zusman O, Kagan I, Bendavid I et al. Predictive equations versus measured energy expenditure by indirect calorimetry: A retrospective validation. Clin Nutr 2018; pii: S0261–5614(18)30171–7. Dostupné z DOI: <http://dx.doi.org/10.1016/j.clnu.2018.04.020>.
Allingstrup MJ, Kondrup J, Wiis J et al. Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive Care Med 2017; 43(11): 1637–1647. Dostupné z DOI: <http://dx.doi.org/10.1007/s00134–017–4880–3>.
Vavrova L, Rychlikova J, Mrackova M et al. Increased inflammatory markers with altered antioxidant status persist after clinical recovery from severe sepsis: a correlation with low HDL cholesterol and albumin. Clin Exp Med 2016; 16(4): 557–569. Dostupné z DOI: <http://dx.doi.org/10.1007/s10238–015–0390–1>.
Reignier J, Boisrame-Helms J, Brisard L et al. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet 2018; 391(10116): 133–143. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(17)32146–3>.
Rosenthal MD, Carrott P, Moore FA. Autophagy: should it play a role in ICU management? Curr Opin Crit Care 2018; 24(2): 112–117. Dostupné z DOI: <http://dx.doi.org/10.1097/MCC.0000000000000486>.
Thiessen SE, Gunst J, Van den Berghe G. Role of glucagon in protein catabolism. Curr Opin Crit Care 2018; 24(4): 228–234. Dostupné z DOI: <http://dx.doi.org/10.1097/MCC.0000000000000509>.
Reintam BA, Starkopf J, Alhazzani W et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med 2017; 43(3): 380–398. Dostupné z DOI: <http://dx.doi.org/10.1007/s00134–016–4665–0>.
Olthof LE, Koekkoek WACK, van Settn C et al. Impact of caloric intake in critically ill patients with, and without, refeeding syndrome: A retrospective study. Clin Nutr 2018; 37(5): 1609–1617. Dostupné z DOI: <http://dx.doi.org/10.1016/j.clnu.2017.08.001>.
Mueller C, Compher C, Ellen DM. A.S.P.E.N. clinical guidelines: Nutrition screening, assessment, and intervention in adults. JPEN J Parenter Enteral Nutr 2011; 35(1): 16–24. Dostupné z DOI: <http://dx.doi.org/10.1177/0148607110389335>.

Labels

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Article was published in

Internal Medicine

2019 Issue 3