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- South African Journal of Clinical Nutrition
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- Volume 24, Issue sup-1, 2011
South African Journal of Clinical Nutrition - Supplement 1, January 2011
Volumes & issues
Supplement 1, January 2011
Author P.E. WischmeyerSource: South African Journal of Clinical Nutrition 24, pp 1 –7 (2011)More Less
Malnutrition has traditionally been thought to involve deficiencies in protein and energy (macronutrients); however, we know that specific key nutrients, when deficient. can also lead to significant morbidity and mortality. Large studies performed with replacement of single nutrients, such as zinc, in malnourished populations in Africa and other developing countries has led to reductions in respiratory infections and diarrhoeal diseases. In this regard, It is being increasingly that acutely ill hospitalized patients may not only be malnourished from a macronutrient standpoint, but that such patients may also be deficient in a number of key functional pharmaconutrients. This new knowledge creates a new era in nutritional support, where nutritional therapy is presenting the surgical and critical care community with a "unique opportunity" to improve patient outcomes with a safe, relatively inexpensive and effective intervention. Our vision for the future of nutritional pharmacology in surgery and critical care is one where there will be initiation of early (< 24-48 hours post-surgery or ICU admission) nutrient delivery, preferentially via the enteral route. This should be supplemented by parenteral nutrition in "at risk" patients, when adequate energy cannot be provided enterally. Pharmaconutrients to target therapy to specific disease states in such should be administered as separate components, in a manner similar to that of administering an antibiotic or drug.
Author A. PrinsSource: South African Journal of Clinical Nutrition 24, pp 8 –14 (2011)More Less
Bi-directional interactions between the gut and the brain play a role in health and disease. It is involved in glucose homeostasis, satiety and obesity, functional gastrointestinal disorders and possibly in inflammatory disorders such as inflammatory bowel disease. Data is starting to elucidate the conversation between the mini brain, enteric nervous system (ENS) and the central nervous system. Various factors play a role in the conversation including sensory output via afferents, neurotransmitters and the gut microbiota.
Author I. RetiefSource: South African Journal of Clinical Nutrition 24, pp 15 –18 (2011)More Less
Gastric motility disorders in the intensive care unit (ICU) are a reality leading to many complications including inadequate EN delivery. Care should be taken to understand what type of gastric motility disorder is present and therapy should be prescribed early to prevent worsening of clinical outcomes.
Author V. KotzeSource: South African Journal of Clinical Nutrition 24, pp 19 –22 (2011)More Less
Surgery patients are at risk for iatrogenic malnutrition and subsequent deleterious effects. The benefits of nutrition support on patient outcomes have been demonstrated and the possible benefit of perioperative nutrition support thus implied.
Enhanced recovery after surgery (ERAS) protocols, including perioperative nutrition support as a component thereof, is indicated in the management of patients. In contrast to this, it seems the current trend is to follow the traditional perioperative management even when existing data demonstrate no merit in continuing with these practices. Data suggests that all surgical patients should receive early postoperative nutrition support.
Immunonutrition, as part of ERAS has also been reported to derive beneficial effects in surgery patient outcomes but current clinical practice guidelines are inconsistent with regards to the administration of specific immunonutrients. Arginine is an immunonutrient that is of specific interest in surgical patients due to an assumed deficiency thereof. Insufficient arginine levels can lead to immunosuppression with an increased risk for complications. Available evidence indicates that all patients undergoing elective surgery with substantial risk of infectious complications should be prescribed arginine-supplemented diets along with omega-3 fatty acids, preferably pre- and postoperatively. No recommendations can be made on the practice of combined glutamine and arginine supplementation.
Nutrition and the child with cancer : where do we stand and where do we need to go? : review articleAuthor C.H. NieuwoudtSource: South African Journal of Clinical Nutrition 24, pp 23 –26 (2011)More Less
As a result of ongoing research and better supportive care, the treatment of childhood malignancies has dramatically improved survival in developed countries. The same cannot be said about the all important nutritional care of the child with cancer as much still needs to be done to reach the ultimate goal, namely to provide evidence based nutritional intervention that will contribute to further improvements in optimal outcomes. Furthermore, in developing countries, especially in Low Income Countries, malnutrition is only one aspect of socioeconomic disadvantages that are associated negatively with many components of cancer control, from access to care, through to treatment compliance, to long-term follow-up. In these settings economic evaluations of nutritional support in the form of cost-effectiveness and cost-utility analyses, would be logical undertakings.
Author S. VelaphiSource: South African Journal of Clinical Nutrition 24, pp 27 –31 (2011)More Less
Intrauterine growth is supported by continuous supply of nutrients from mother to the fetus throughout pregnancy therefore preterm birth causes disruption in delivery of nutrients to the fetus. In order to allow growth rate similar to that seen in utero, or avoid extra-uterine growth retardation there should be no interruption in delivery of nutrients from time of birth onwards. Extra-uterine growth retardation is associated with adverse outcomes including chronic lung disease, increased risk to infection and abnormal neurodevelopmental outcome. Provision of appropriate nutritional requirements soon after birth is critical for normal development and growth of preterm infants. Preterm infants are often not able to tolerate volumes of oral feeds that will provide adequate daily requirements for growth within the first week or two of life, therefore parenteral nutrition is often required. Understanding nutritional requirements for preterm infants who require parenteral nutrition is very important. This review discusses the nutritional requirements for preterm infants and parenteral nutrition.
The use of alternative lipid emulsions in paediatric and neonatal parenteral nutrition : review articleAuthor B.D. SaaymanSource: South African Journal of Clinical Nutrition 24, pp 32 –34 (2011)More Less
Lipid emulsions are an important part of paediatric parenteral nutrition as they provide energy, fat soluble vitamins and are a source of essential fatty acids. Soya bean based oil emulsions have however been identified as one of the major causative factors in the development of PN related cholestasis.
Author E. Van NiekerkSource: South African Journal of Clinical Nutrition 24, pp 35 –37 (2011)More Less
The premature infant may be exposed to an environment that is associated with the development of gastrointestinal complications. In preventing the latter, it is crucial that, if probiotics is chosen as a preventive measure, the selection of a safe product with documented probiotic properties together with close monitoring of patients is mandatory before offering this therapy for routine use in this high-risk deserving population. It is important to note that the effect of a probiotic bacterium is strain-specific. When considering the evidence from randomized control trials, researchers believe that probiotics should be offered as routine therapy for preterm infants, and that additional placebo-controlled trials are not necessary. The available guidelines may be a helpful tool in optimizing the use of probiotics in research settings.
Author M. Van ZylSource: South African Journal of Clinical Nutrition 24, pp 38 –41 (2011)More Less
Author J.A. KerSource: South African Journal of Clinical Nutrition 24 (2011)More Less
It has emerged over the past 10-20 years that the change in our lifestyle has led to the widespread deficiency of vitamin D. These lifestyle changes include the avoidance of sunlight (voluntary or greater reliance on artificial light), the reduction in the consumption of milk, and the worldwide epidemic of obesity.