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Le Touquet – Paris-Plage, France

De Bandt J.-P.,Hopital Cochin Hopitaux Universitaires Paris Center HP | De Bandt J.-P.,University of Paris Descartes | Tamion F.,University of Rouen
Revue Francophone des Laboratoires | Year: 2014

In the intensive care unit, the patient, when not already malnourished on admission, has a high risk of malnutrition because of his possible inability to spontaneously cover his/her necessary nutritional requirements and owing to the injury-induced increase in his/her requirements. The initial nutritional assessment, besides giving a starting reference point, allows defining the urgency of the nutritional support and the risk of malnutrition-related complications. Once the modalities of nutritional assistance defined and implemented, it is of course necessary to monitor its effectiveness and tolerance. Biomarkers for nutritional assessment and followup are in the first place two serum proteins, albumin and transthyretin, rather a prognosis marker for the frst and a follow-up marker for the second, widely available in biology labs. The assessment of protein status may rely, for its easiest part, on the monitoring of nitrogen balance, preferably based on the measurement of total urinary nitrogen, but which will give only a static view of nitrogen metabolism; for laboratories with chromatographic equipment the determination of amino acids in blood (phenylalanine/tyrosine ratio) and urine (3-methyl-histidine) will provide information on the intensity of protein catabolism. Finally, the study of the complete plasma amino acid profile could be a promising tool for the individualized adaptation of nutritional support. © 2014 - Elsevier Masson SAS - Tous droits réservés. Source

Ginguay A.,Hopital Cochin Hopitaux Universitaires Paris Center HP | Neveux N.,Hopital Cochin Hopitaux Universitaires Paris Center HP | Neveux N.,University of Paris Descartes | Cynober L.,Hopital Cochin Hopitaux Universitaires Paris Center HP | Cynober L.,University of Paris Descartes
Revue Francophone des Laboratoires | Year: 2014

Nutrition, combining clinical and biological fields, aims to supply the suitable nutrients for growth and organism functions. For a long time, the contribution of biology to nutritional care was limited to the assessment of the nutritional status of patients, calculation of nutritional requirements and the effectiveness of nutritional support. Research progress in nutrition has led to broaden the scope of biology applications. Among these, a test, based on pharmacokinetic principles, allows an individual evaluation of optimal amino acid intake. This evaluation allows an adjustment of amino acid intake on a patient-to-patient basis and leads to an improvement of the nitrogen balance as observed in critically ill patients, which might improve the prognosis and survival. Outside of these nutritional aspects, biology can take part in diagnosis, prognosis and therapeutics activities using new biomarkers. This idea can be illustrated with a particular amino acid, namely citrulline. Citrullinemia allows the evaluation of the intestinal functionality because of its exclusive intestinal production. These two examples show the growing contribution of biology in the clinical nutrition field. © 2014 - Elsevier Masson SAS - Tous droits réservés. Source

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