Time filter

Source Type

Petah Tikva, Israel

Singer P.,Institute for Nutrition Research | Pichard C.,University of Geneva
Current Opinion in Clinical Nutrition and Metabolic Care | Year: 2013

Purpose of Review: Recent studies on the optimal modalities to feed patients during the ICU stay show divergent results. The level and the timing of energy provision is a critical issue, associated with the clinical outcome. These results questioned the clinical relevance of the recent guidelines issued by American, Canadian and European academic societies. Recent Findings: Four recent prospective randomized studies enrolled critically ill patients who received various nutritional regimens and tested the effect of nutritional support on outcome. The Tight Calorie balance Control Study (TICACOS) targeted on calorie administration according to measured energy expenditure and found increased ICU morbidity but improved hospital mortality. The large EpaNIC study compared 'early' with 'late' (parenteral nutrition) nutrition, mostly in patients after cardiac surgery, and found an increased morbidity associated with early parenteral nutrition. The supplemental parenteral nutrition (SPN) study randomized the patients after 3 days and targeted the calories administered by parenteral nutrition as a complement to unsuccessful enteral nutrition using indirect calorimetry. The SPN resulted in less nosocomial infections and shorter duration of mechanical ventilation. Finally, a recent Australian study enrolled patients unable to be early fed enterally to receive, or not, parenteral nutrition targeted at 1500kcal. No complications were noted in the parenteral nutrition group. Lessons from all these studies are summarized and should help in designing better studies and guidelines. Summary: The critical analysis of recent prospective studies comparing various levels of calorie administration, enteral versus parenteral nutrition and enteral versus SPN confirms the recommendations to avoid underfeeding and overfeeding. Parenteral nutrition, required if enteral feeding is failing, and if adjusted up to a measured optimal level, may improve outcome. More studies on the optimal level of energy and protein administration to optimize the clinical outcome are required to fine tune current guidelines. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Shapira N.,Institute for Nutrition Research
Israel Medical Association Journal | Year: 2012

The "Israeli Paradox" (1996) of low national health rankings despite adequate diet - attributed to high dietary n-6 polyunsaturated fatty acids (PUFA) - coincided with long-observed dichotomies between women's worse international status vs. men's advantage. This raised the possibility of a gender link to high n-6 risk potentially explaining both national phenomena. Israeli women's disadvantage was shown by worse international rankings, i.e., life expectancy (LE) - 11th vs. men's 3rd-best/22 countries (2000), and 14th vs. 6th/34 (2010); and all-cause and all-cancer mortality - both 15th vs. 2nd-best/22 (2000), and 15th vs. 6th/22 and 12th vs. 2nd-best/22 (2010). Cancer mortality rates for breast were 21.8% above vs. prostate 30.4% below Eur-A (27 country) averages (2005). Gender gaps/ ratios were smaller than European Union-15 averages, i.e., for LE at birth by 34.4-26.4% (2000-2010), respectively, and at 65 years 45.9-35.3%; all-cause mortality by 43.3-33.4%, and all-cancer 65.2-58.7%. The Israeli diet was mostly close to guidelines, but n-6 intake (10-12% kcal) was much higher than recommended and traditional "Mediterranean diet" levels. Research showing females' greater potential for conversion of PUFA to long-chain PUFA (LCPUFA) may suggest increased production of n-6 eicosanoids with known proinflammatory/ oxidative/carcinogenic potential. An "Israeli N-6 Gender Nutrition Paradox" hypothesis is suggested here for the first time, associating women's higher risk and lead in the national "paradox" with greater potential for n-6 conversion to pro-inflammatory/oxidative/carcinogenic eicosanoids compared to men. This may also exacerbate women's risk associated with genetic predisposition (i.e., BRCA) and/or sociopolitical stress. Global abandonment of traditional diets/foods together with increasing n-6 consumption and western disease rates emphasize the importance of considering gender nutrition in epidemiology and preventive strategies. Source

n-3 Fatty acids are recognised as influencing both wound healing and immunity. We assessed the impact of a fish oil- and micronutrient-enriched formula (study formula) on the healing of pressure ulcers and on immune function in critically ill patients in an intensive care unit. A total of forty patients with pressure ulcers and receiving nutritional support were enrolled (intervention group, n 20, received study formula; and a control group, n 20, received an isoenergetic formula). Total and differential leucocyte count and percentage of adhesion molecule positive granulocyte and lymphocyte cells (CD11a, CD11b, CD18 and CD49b) were measured on days 0, 7 and 14. Percentage of positive lymphocytes for CD54, CD49b, CD49d and CD8 were also measured on days 0, 7 and 14. The state of pressure ulcers was assessed by using the pressure ulcer scale for healing tool score on days 7, 14 and 28 of treatment. No between-group differences in patient demographics, anthropometry or diagnostic class were observed. Patients who received the study formula showed significant increases in the percentage of positive CD18 and CD11a lymphocytes and of CD49b granulocytes as compared to controls (P < 0·05). While the severity of pressure ulcers was not significantly different between the two groups on admission, severity increased significantly over time for the control group (P < 0·05), but not for the study group. The present study suggests that a fish oil- and micronutrient-enriched formula may prevent worsening of pressure ulcers and that this effect may be mediated by an effect on adhesion molecule expression. Source

Silva V.,Institute for Nutrition Research | Barazzoni R.,University of Trieste | Singer P.,Institute for Nutrition Research | Singer P.,Rabin Medical Center | Singer P.,Tel Aviv University
Nutrition in Clinical Practice | Year: 2014

A biomarker is a measured characteristic that may be used as an indicator of some biological state or condition. In health and disease, biomarkers have been used not only for clinical diagnosis purposes but also as tools to assess effectiveness of a nutrition or drug intervention. When considering nutrition studies, evaluating the appropriate biomarker is a useful tool to assess compliance and incidence of a particular dietary component in the biochemistry of the organism. Fish oil is rich in ω-3 fatty acids that have well-known beneficial effects on human health mainly through its anti-inflammatory properties. It has been widely use to improve health and as a nutrition supplement in different pathological conditions such as cardiovascular, neurological, and critically ill related diseases. Eicosapentaenoic acid and docosahexaenoic acid levels present in different biological moieties (plasma, cellular membranes, adipose tissue, etc) are the best biomarkers of fish oil intake. Each biological source of fatty acids has its own advantages and disadvantages, thus which biomarker to choose and where to measure it requires a comprehension of the objectives of the investigation. In this article we will review key facts about fish oil intake biomarkers to evaluate how components of a specific diet could be monitored and identified in biological samples. Having an accurate assessment of nutrition patterns could provide effective targets for intervention aimed at modifying eating habits and lifestyle towards the improvement of health. © 2013 American Society for Parenteral and Enteral Nutrition. Source

Shapiro H.,Institute for Nutrition Research | Theilla M.,Institute for Nutrition Research | Attal-Singer J.,Rabin Medical Center | Singer P.,Institute for Nutrition Research
Nature Reviews Nephrology | Year: 2011

The complex metabolic, vascular and inflammatory perturbations that characterize diabetes mellitus often lead to progressive albuminuria, renal injury and dysfunction (diabetic nephropathy [DN]), and diabetes is the leading cause of end-stage renal disease in the US and Europe. Diet has an important role in cardiometabolic disorders and its potential influence on DN is of interest. Fatty acids are a major source of energy, but in excess, fatty acids (particularly saturated fatty acids) can induce lipotoxicity. Omega-3 polyunsaturated fatty acids (PUFAs) confer protection against cardiovascular disease-the major cause of death in patients with DN-by virtue of their antihyperlipidemic, antihypertensive, anti-inflammatory and other properties. Omega-6 PUFAs are also cardioprotective. However, a significant proportion of adults consume insufficient quantities of these essential nutrients. This Review describes the role of omega-3 and omega-6 PUFAs in nutrition and metabolism, with a focus on experimental, epidemiologic and clinical studies that have investigated their renoprotective effect in patients with diabetes. Results from a number of studies suggest, but do not firmly establish, that long-chain omega-3 PUFAs (found in fish oil) reduce albuminuria in the setting of DN. Intake of omega-6 fatty acids is associated with reduced albuminuria in experimental settings and in epidemiologic studies of DN. Although PUFAs do not seem to attenuate glomerular dysfunction, insufficient evidence exists to rule out such an effect. We feel that further research is needed into the potential of PUFA consumption and supplementation in DN. © 2011 Macmillan Publishers Limited. All rights reserved. Source

Discover hidden collaborations