Transcription
Basics 07.indd 18.8.2011 16:23:39
ESPENThe European Society for ClinicalNutrition and MetabolismBasics 07.indd 28.8.2011 16:23:39
BASICSIN CLINICALNUTRITIONFourth EditionEditor-in-ChiefLuboš SobotkaAssociate EditorsSimon P. AllisonAlastair ForbesOlle LjungqvistRémy F. MeierMarek PertkiewiczPeter B. SoetersGALÉNBasics 07.indd 38.8.2011 16:23:39
BASICS IN CLINICAL NUTRITIONFourth editionEditor-in-Chief Luboš SobotkaPublishing House GalénNa Bělidle 34, 150 00 Prague 5, Czech RepublicManaging Editor Lubomír Houdek, Dr.Editor-in-Chief Soňa Dernerová, Dr.Composition Kateřina Dvořáková – Galén, PraguePrint Glos, Špidlenova 436, 513 01 Semily, Czech Republicwww.espenbluebook.orgAll rights reserved. This book, or any thereof, may not be used or reproduced in any mannerwithout written permision. For information, address European Society of Parenteral and EnteralNutrition.This book was supported by grant of Czech Ministry of Education, Youth and SportsMSM0021620820. ESPEN, 2011 Galén, 2011ISBN 978-80-7262-821-6Basics 07.indd 48.8.2011 16:23:39
VEditor in ChiefLuboš Sobotka, MD, PhDProfessor of MedicineHead of Department of Metabolic Care andGerontologyMedical FacultyCharles UniversityHradec KrálovéCzech RepublicAssociate EditorsSimon P. Allison, MD, FRCPProfessor in Clinical NutritionDepartment of Diabetes, Endocrinologyand NutritionQueen’s Medical CenterNottinghamUnited KingdomAlastair Forbes, BSc, MD, FRCP, FHEAProfessor of Gastroenterology and ClinicalNutritionUniversity College LondonLondonUnited KingdomOlle Ljungqvist MD, PhDProfessor of SurgeryDept of SurgeryÖrebro University HospitalÖrebroSwedenBasics 07.indd Odd1:VRémy F. Meier, MDProfessor of MedicineHead of Department of Gastroenterology,Hepatology and NutritionUniversity HospitalKantonsspital LiestalLiestalSwitzerlandMarek Pertkiewicz, MD, PhDProfessor in SurgeryDepartment of General Surgery and ClinicalNutritionMedical University of WarsawWarsawPolandPeter B. Soeters, MD, PhDEmeritus Professor of SurgeryDepartment of SurgeryUniversity Hospital MaastrichtMaastrichtThe Netherlands8.8.2011 16:23:39
VIList of authorsSimon P. Allison, MD, FRCPProfessor in Clinical NutritionDepartment of Diabetes, Endocrinologyand NutritionQueen’s Medical CenterNottinghamUnited KingdomRaffaella Antonione MD,Internal MedicineClinica Medica, Ospedale di CattinaraAzienda Ospedaliero-UniversitariaTriesteItalyPeter AustinSenior PharmacistSouthampton University NHS HospitalsTrustSouthamptonUnited KingdomMette M Berger, MD, PhDProfessor of Intensive Care MedicineService of Intensive Care Medicine & BurnsLausanne University Hospital (CHUV)CH- 1011 LausanneSwitzerlandGyorgy Bodoky, MD, PhDProfessor of OncologySt. Laszlo Teaching HospitalDepartment of OncologyBudapestHungaryYves Boirie, MD, PhDProfessor of NutritionUniversity of Clermont-FerrandClinical Nutrition department of theUniversity Hospital of Clermont-FerrandHuman Nutrition Research CenterClermont-FerrandFranceBasics 07.indd Odd1:VIFederico Bozzetti MDSurgeon oncologistFaculty of MedicineUniversity of MilanMilanItalyMarco Braga MDProfesor of SurgeryDepartment of SurgerySan Raffaele Vita Salute UniversityMilanItalyFang Cai, MDPhysicianPostdoc R&DUnit of NutritionGeneva University HospitalGenevaSwitzerlandPhilip C. Calder, PhD, DPhilProfessor of Nutritional ImmunologyInstitute of Human Nutrition and HumanDevelopment and Health Academic UnitFaculty of MedicineUniversity of SouthamptonSouthampton General HospitalSouthamptonUnited KingdomMaria E. Camilo, MD, PhDProfessor of Medicine and NutritionHead of the Research Unit of Nutritionand MetabolismInstitute of Molecular MedicineMedical FacultyLisbon UniversityLisbonPortugal8.8.2011 16:23:39
VIINoël Cano, MD, PhDProfessor of NutritionHead, Human Nutrition Research Centerof Auvergne (CRNH Auvergne)Human Nutrition Unit, UMR 1019 INRAClermont UniversitéClinical Nutrition UnitClermont-Ferrand University HospitalClermont-FerrandFranceYvon A. Carpentier, MDProfessor of Pathological Biochemistryand NutritionDirector, L. Deloyers Laboratory forExperimental SurgeryUniversité Libre de BruxellesBrusselsBelgiumLuc Cynober, PharmD, PhDProfessor of NutritionHead of DepartmentsDept. of Experimental, Metabolicand Clinical Biology,Pharmacy Faculty - Paris DescartesUniversityand Clinical Chemistry Department,Cochin and Hôtel-Dieu Hospitals, APHPParisFranceErno Dardai, MD, PhDHead of Department of Anesthesiologyand Intensive TherapySt. Stephen’s HospitalBudapestHungaryNicolaas E. P. Deutz, MD, PhD.Professor of Geriatrics. Professorof Pediatrics and Nutrition.Center for Translational Research in Aging& Longevity.Donald W. Reynolds Institute on AgingUniversity of Arkansas for Medical SciencesLittle RockU.S.A.Basics 07.indd Odd1:VIIDavid F. Driscoll, PhDVice PresidentStable Solutions LLCEaston, MAU.S.A.Wilfred Druml, MDProfessor of MedicineMedical Department IIIDivision of NephrologyUniversity of Vienna and ViennaGeneral HospitalViennaAustriaStanley J. Dudrick, MD, FACSProfessor of SurgeryChairman, Department of SurgeryDirector, Program in SurgerySt. Mary’s HospitalWaterbury, CTYale University School of MedicineNew Haven, CTU.S.A.Yves Dupertuis, PhDBiologistResponsible investigator R&DUnit of NutritionGeneva University HospitalGenevaSwitzerlandMarinos Elia MD FRCPProfessor of Clinical Nutrition& MetabolismInstitute of Human NutritionUniversity of SouthamptonSouthampton General HospitalSouthamptonUnited KingdomJoel Faintuch, MD, PhDAssociate Professor of MedicineDepartment of GastroenterologySao Paulo University Medical SchoolChief of Nutrology Residency ProgramHospital das ClinicasSao PauloBrazil8.8.2011 16:23:40
VIIIKeneth C.H. Fearon MDProfessor of Surgical OncologyEdinburgh UniversityEdinburghUnited KingdomEric Fontaine, MD PhDProfessor of MedicineINSERM U1055 - LBFAJoseph Fourier UniversityGrenoble CedexFranceAlastair Forbes, BSc, MD, FRCP, FHEAProfessor of Gastroenterology and ClinicalNutritionUniversity College LondonLondonUnited KingdomKonstantinos Fragkos, MBClinical Research Fellow inGastroenterology and Clinical NutritionUniversity College LondonLondonUnited KingdomPeter Fürst, MD, PhDProfessor of Nutritional BiochemistryInstitute for Nutrition ScienceRheinische Friedrich-Wilhelms UniversityBonnGermanyWim G. van Gemert MD, PhDColorectal, Gastrointestinal and PediatricSurgeonAcademic Hospital MaastrichtMaastrichtThe NetherlandsLaurence Genton MDChief residentClinical NutritionGeneva University HospitalGenevaSwitzerlandBasics 07.indd Odd1:VIIIM. Cristina Gonzalez, MD, PhDAdjunt Professor of Post-GraduationProgram in Health and BehaviourCatholic University of PelotasPelotasBrazilOlivier Goulet, MD, PhDProfessor of PaediatricsDepartment of GastroenterologyHopital Necker Enfans-MaladesParisFranceRobert F. Grimble, BSc, PhD, RNutrProfessor of NutritionDivision of Developmental Originsof Health and DiseaseSchool of MedicineUniversity of SouthamptonSouthamptonUnited KingdomMartin Haluzik, MD, PhDProfessor of Medicine3 rd Department if Internal MedicineMedical Faculty 1Charles UniversityPragueCzech RepublicFolke Hammarqvist, MD, PhDProfessor in Emergency SurgeryDepartment of Surgical GastrocenterCLINTEC - Department of Clinical Science,Intervention and TechnologyKarolinska University Hospital HuddingeStockholmSwedenGil Hardy PhD FRSCProfessor of Pharmaceutical NutritionFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand8.8.2011 16:23:40
IXLaszlo Harsanyi, MD, PhDProfessor of Surgery1st Surgical DepartmentFaculty of MedicineSemmelweis UniversityBudapestHungaryReem Hawary RDKing Faisal Specialist Hospital & ResearchCenterRiyadhSaudi ArabiaClaudia-Paula Heidegger, MDDeputy Head PhysicianDepartment of Anesthesiology,Pharmacology and Intensive Care.Division of intensive careGeneva University HospitalsGenevaSwitzerlandJ Pat Howard RDHead of Nutrition and Dietetic ServicesUnited Bristol Healthcare TrustBristol Royal InfirmaryBristolUnited KingdomCora F. Jonkers-Schuitema, BcDietitianAcademic Medical CenterAmsterdamThe NetherlandsLuiza Kent-Smith, PhD, RDProfessional Leader Nutrition & DieteticsSaskatoon Health RegionSaskatoonCanadaBerthold Koletzko, MD, PhDProfessor of PediatricsDivision Metabolic and NutritionalMedicineDr. von Hauner Children’s HospitalLudwig-Maximilians-University of MunichMunichGermanyJens Kondrup, MD, Dr Med SciProfessor in Clinical NutritionClinical Nutrition Unit 5711Rigshospitalet University Hospital,CopenhagenDenamrkPao Ying Hsiao, MS, RD, LDNDoctoral candidateDepartment of Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkU.S.A.Marek Kunecki, MD,Specialist in General SurgeryDepartment of Clinical NutritionDepartment of General and VascularSurgeryM. Pirogow Provincial Specialist HospitalLodzPolandGordon L Jensen, MD, PhD,Professor of MedicineHead of Department of Nutritional SciencesPennsylvania State UniversityUniversity ParkU.S.A.Irma Kushta, MDResident in Internal MedicineDepartment of Clinical MedicineSapienza, University of RomeRomeItalyPhilippe Jolliet, MDSenior LecturerMedical Intensive CareGeneva University HospitalGenevaSwitzerlandAlessandro Laviano, MDAssociate Professor of MedicineDepartment of Clinical MedicineSapienza, University of RomeRomeItalyBasics 07.indd Odd1:IX8.8.2011 16:23:40
XMiguel Leon-Sanz, MD, PhDAssociate Professor Endocrinologyand NutritionDepartment of MedicineMedical SchoolUniversity Hospital Doce de OctubreComplutense UniversityMadridSpainXavier Leverve, MD PhDProfessor of MedicineINSERM U1055 - LBFAJoseph Fourier UniversityGrenoble CedexFranceOlle Ljungqvist MD, PhDProfessor of SurgeryDept of SurgeryÖrebro University HospitalÖrebroSwedenDileep N Lobo, MS, DM, FRCS, FACSProfessor of Gastrointestinal SurgeryNottingham University HospitalsQueen’s Medical CentreNottinghamUnited KingdomMichael M. Meguid, MD, PhDProfessor EmeritusSurgery, Neuroscience and PhysiologyDepartment of SurgeryUpstate Medical UniversityUniversity HospitalSyracuse, NYU.S.A.Rémy F. Meier, MDProfessor of MedicineHead of Department of Gastroenterology,Hepatology and NutritionUniversity HospitalKantonsspital LiestalLiestalSwitzerlandMaarten F. von Meyenfeldt, MD, PhDProfessor of Surgical OncologyDepartment of SurgeryUniversity Hospital MaastrichtMaastrichtThe NetherlandsMaurizio Muscaritoli MDAsociate Profesor of MedicineDepartment of Clinical MedicineSapienza, University of RomeRomeItalyHerbert Lochs, MDProfessor of MedicineRectorMedical UniversityInnsbruckAustriaJan Maňák, MD, PhDHead of Medical ICUDepartment of Metabolic Careand GerontologyMedical FacultyCharles UniversityHradec KrálovéCzech RepublicBasics 07.indd Odd1:XStefan Mühlebach, PhDHospital Pharmacist FPHProfessor of Pharmacology and HospitalPharmacyMedical FacultyDivision of Clinical Pharmacology& ToxicologyUniversity Hospital of BaselSwitzerlandTon Naber, MD, PhDAssociate Professor of Clinical NutritionDepartment of Gastroenterologyand HepatologyMedical FacultyUniversity Medical Center NijmegenNijmegenThe Netherlands8.8.2011 16:23:40
XILuis Alberto Nin, MDProfessor in Nutrition and DirectorMagister in NutritionCatholic UniversityMontevideoUruguayMatthias Pirlich, MD, PhDProfessor of MedicineHead of Department of Internal MedicineEvangelische Elisabeth KlinikBerlinGermanyIbolya Nyulasi, MScMathias Plauth, MDProfessor of MedicineHead of Department of Internal MedicineCommunity Hospital DessauDessauGermanyDepartment of MedicineAlfred HospitalFaculty of MedicineNursing and Health SciencesClaytonAustraliaJohann Ockenga, MD, PhDProfessor in Internal MedicineDepartment of Gastroenterology,Endocrinology and Clinical NutritionKlinikum Bremen MitteBremenGermanyAnn Ödlund Olin PhD, RNManager of nursing developmentDepartment of Quality and Patient SafetyKarolinska University HospitalStockholmSwedenMarek Pertkiewicz, MD, PhDProfessor in SurgeryDepartment of General Surgery and ClinicalNutritionMedical University of WarsawWarsawPolandClaude Pichard, MD, PhDProfessor of MedicineHead of the Unit of NutritionGeneva University Hospital1211 Geneva 14SwitzerlandBasics 07.indd Odd1:XIJean-Charles Preiser, M.D., Ph.D.Clinical DirectorDepartment of Intensive CareErasme University HospitalBrusselsBelgiumIsabella Preziosa, MD, PhDClinical Nutrition Unit Umberto IPoliclinico di RomaRomeItalyJohn W. L. Puntis, BM (Hons), DM, FRCP,FRCPCHConsultant Paediatric GastroenterologistThe General Infirmary at LeedsLeeds, West YorkshireUnited KingdomPetronella L. M. Reijven MSc PhDNutritional ScientistDepartment of Clinical DieteticsMaastricht University Medical CentreMaastricht,The NetherlandsFilippo Rossi-Fanelli MDProfessor of MedicineHead of Department of Clinical MedicineSapienza, University of RomeRomeItaly8.8.2011 16:23:40
XIIErich Roth, PhD, MgPhilUniversity ProfessorHead of Surgical Research LaboratoryDepartment of SurgeryMedical University ViennaViennaAustriaHans P. Sauerwein, MDEmeritus Professor of Energy MetabolismAcademic Medical CenterAmsterdamThe NetherlandsStéphane M. Schneider, MD, PhD, FEBGHProfessor of NutritionNutritional Support UnitArchet University HospitalNiceFranceAnnemie M. W. J. Schols, PhDProfessor of Nutrition and Metabolismin Chronic DiseasesDepartment of Respiratory MedicineUniversity Hospital MaastrichtMaastrichtThe NetherlandsJoseph M.G.A. Schols MD, PhDProfessor of Chronic Care and NursingHome MedicineDepartment of General PracticeMaastricht UniversityMaastrichtThe NetherlansAlan Shenkin PhD, BSc, FRCP, FRC PathEmeritus ProfessorSchool of Clinical SciencesUniversity of LiverpoolLiverpoolUnited KingdomBasics 07.indd Odd1:XIIPierre Singer, MD,Clinical Professor in Anaesthesiaand Intensive CareDepartment of General Intensive Careand institute for Nutrition ResearchTel Aviv UniversityRabin Medical Center, Beilinson HospitalPetah TikvaIsraelAntonio Sitges-Serra, MD, FRCSProfessor of SurgeryHead of Department of SurgeryUniversity Hospital del MarBarcelona UniversityBarcelonaSpainLuboš Sobotka, MD, PhDProfessor of MedicineHead of Department of Metabolic Careand GerontologyMedical FacultyCharles UniversityHradec KrálovéCzech RepublicPeter B. Soeters, MD, PhDEmeritus Professor of SurgeryDepartment of SurgeryUniversity Hospital MaastrichtMaastrichtThe NetherlandsZeno Stanga, MDProfessor in Internal Medicine and ClinicalNutritionDivision of Endocrinology, Diabetesand Clinical NutritionDivision of General Internal MedicineUniversity HospitalBernSwitzerland8.8.2011 16:23:40
XIIIRebecca J Stratton PhD, RD, RNutrInstitute of Human NutritionUniversity of SouthamptonSouthampton General HospitalSouthamptonUnited KingdomŠtěpán Svačina, MD, PhDProfessor of MedicineHead of the 3rd Department of InternalMedicineMedical Faculty 1Charles UniversityPragueCzech RepublicBruno Szczygiel, MD, PhDProfessor of SurgeryDepartment of Human NutritionMedical University of WarsawWarsawPolandLuc Tappy, MDProfessor of PhysiologyChairman, Department of PhysiologySchool of Biology and MedicineLausanne UniversityConsulting PhysicianDivision of Endocrinology Diabetesand MetabolismLausanne University HospitalLausanneSwitzerlandVladimír Teplan, MD, PhDProfessor of MedicineChair of NephrologyInstitute for Postgradual EducationDepartment of NephrologyInstitute for Clinical and ExperimentalMedicinePragueCzech RepublicBasics 07.indd Odd1:XIIINachum Vaisman, MDProfessor of PediatricsHead of Clinical Nutrition UnitTel Aviv Sourasky Medical Centerand Tel Aviv Sourasky Medical SchoolTel AvivIsraelMarian A.E. van Bokhorst - de van derSchueren, RD, PhDSenior nutrition scientistDepartment of nutrition and dieteticsVU University Medical CenterAmsterdamThe NetherlandsAndre Van Gossum,MD,PhDProfesssor of MedicineHead of the Clinic of Intestinal Diseasesand Nutritional SupportDepartment of GastroenterologyHopital ErasmeUniversite Libre de BruxellesBrusselsBelgiumMaurits F. J. Vandewoude, MD, PhDProfessor of MedicineDepartment of GeriatricsFaculty of MedicineUniversity of AntwerpAntwerpBelgiumGeert Wanten, MD, PhD, MScGastroenterologist,Head Nutrition Support TeamIntestinal failure UnitDepartment of Gastroenterologyand HepatologyRadboud University Nijmegen MedicalCentre NijmegenNijmegenThe Netherlands8.8.2011 16:23:40
XIVJan Wernerman, MD, PhDProfessor in AnaesthesiaDepartment of Anaesthesia and IntensiveCareCLINTEC - Department of Clinical Science,Intervention and TechnologyKarolinska University Hospital HuddingeStockholmSwedenKlaas R Westerterp, PhDProfessor of Human EnergeticsDepartment of Human BiologyMaastricht UniversityMaastrichtThe NetherlandsBasics 07.indd Odd1:XIVThomas Wild, MDMedical DirectorAcademy of Wound TechnologyParisFranceZdeněk Zadák, MD, PhDProfessor of MedicineDepartment of Metabolic Careand GerontologyMedical FacultyCharles UniversityHradec KrálovéCzech Republic8.8.2011 16:23:40
XVCONTENTS1. BASIC CONCEPTS IN NUTRITION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.1. Energy and protein balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.2. Body composition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71.2.1. Body composition and its measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71.2.1.1. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.2.1.2. Densitometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.2.1.3. Total body water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91.2.1.4. Anthropometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101.2.1.5. Other methods for measuring body composition . . . . . . . . . . . . 111.2.1.6. Precision of body composition estimates . . . . . . . . . . . . . . . . . . . 121.2.2. Bioelectrical Impedance Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131.2.2.1. Basic principle of the method. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141.2.2.2. Factors which influence BIA measurement . . . . . . . . . . . . . . . . . 171.2.2.3. BIA as marker of tissue health . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181.2.2.4. BIA methods used in clinical practice. . . . . . . . . . . . . . . . . . . . . . 181.3. Diagnosis of malnutrition — Screening and assessment . . . . . . . . . . . . . . . . . . . . 211.3.1. Definition of Malnutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211.3.2. Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221.3.3. Nutritional Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231.3.4. Techniques used in nutritional assessment . . . . . . . . . . . . . . . . . . . . . . . . . . 261.4. Influence of malnutrition on function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321.5. Overnutrition – functional and clinical consequences. . . . . . . . . . . . . . . . . . . . . . 361.5.1. Physiology of adipose tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371.5.2. Acute overfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391.5.3. Chronic overfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391.5.3.1. Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391.5.3.2. Obesity and metabolic complications . . . . . . . . . . . . . . . . . . . . . . 411.5.3.3. Metabolic syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431.5.4. Treatment of obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431.5.5. Perioperative nutritional treatment of obese patients . . . . . . . . . . . . . . . . . 451.6. Prevalence of malnutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461.6.1. Undernutrition (disease-related malnutrition) . . . . . . . . . . . . . . . . . . . . . . 471.6.2. Prevalence of undernutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481.6.3. Causes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501.6.4. Overnutrition (overweight/obesity). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501.7. Nutritional requirements for health at rest and upon exercise. . . . . . . . . . . . . . . 531.7.1. Adult subjects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 531.7.1.1. Macronutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 531.7.1.2. Micronutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Basics 07.indd Odd1:XV8.8.2011 16:23:41
XVIBasics in Clinical Nutrition1.7.2.Nutritional needs of infants, children and adolescents . . . . . . . . . . . . . . . . 611.7.2.1. Nutrient requirements for growth and development . . . . . . . . . 621.7.2.2. Nutrient requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 642. NUTRITIONAL PHYSIOLOGY AND BIOCHEMISTRY . . . . . . . . . . . . . . . . . . . . . . 772.1. Appetite and its control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 772.1.1. Peripheral signals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 782.1.2. Hypothalamic pathways integrating peripheral signals . . . . . . . . . . . . . . . 802.2. Digestion and absorption of nutrients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 832.2.1. Principal sites of digestion and absorption . . . . . . . . . . . . . . . . . . . . . . . . . . 842.2.2. The small intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 852.2.2.1. Carbohydrates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 852.2.2.2. Lipids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 882.2.2.3. Proteins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 902.2.2.4. Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 922.2.2.5. Water electrolytes and trace elements . . . . . . . . . . . . . . . . . . . . . . 932.2.3. The absorptive functions of the colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 942.2.3.1. Water and electrolytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 942.2.3.2. Metabolic and digestive functions . . . . . . . . . . . . . . . . . . . . . . . . 942.3. Energy metabolism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 962.3.1. Calorimetry for the measurement of energy expenditure . . . . . . . . . . . . . 962.3.2. Components of energy expenditure, measurement and determinants . . . . .992.3.3. Disease-related alterations in energy expenditure . . . . . . . . . . . . . . . . . . . 1002.3.4. Energy expenditure in intensive care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1012.4. Carbohydrate metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1032.4.1. Carbohydrates in normal metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1032.4.2. Regulation of glucose metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1042.4.3. Effects of stress on glucose metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1052.4.4. Metabolic responses to critical illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1072.5. Lipid metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1082.5.1. Basic pathways in lipid metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1092.5.2. Lipid metabolism in fasting conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1122.5.3. Influence of surgical stress, sepsis and organ failure . . . . . . . . . . . . . . . . . 1132.6. Protein and amino acid metabolism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1152.6.1. Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1162.6.2. Protein turnover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1172.6.3. Metabolism of amino acids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1182.6.4. Whole body protein synthesis and/or breakdown . . . . . . . . . . . . . . . . . . . 1192.6.5. Methods to measure protein metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . 1232.7. Water and electrolytes in health and disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1282.7.1. Water and fluid compartments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1282.7.2. Flux of fluid through the gastrointestinal tract. . . . . . . . . . . . . . . . . . . . . . 1302.7.3. Role of the kidney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1312.7.4. External fluid balance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1322.7.5. Effects of starvation and injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1332.7.6. Electrolytes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1332.8. Physiological function and deficiency states of trace elements . . . . . . . . . . . . . 1402.9. Physiological function and deficiency states of vitamins. . . . . . . . . . . . . . . . . . . 145Basics 07.indd Odd1:XVI8.8.2011 16:23:41
ContentsXVII2.10. Antioxidants in health and disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1532.10.1. Oxidative stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1542.10.2. Oxidation in vivo and neutralisation of RNOS . . . . . . . . . . . . . . . . . . . . . 1552.10.3. Dietary recommendations for antioxidants . . . . . . . . . . . . . . . . . . . . . . . . 1562.11. Dietary fibre: metabolism and physiological effects . . . . . . . . . . . . . . . . . . . . . . . 1572.11.1. Physicochemical properties and metabolism of fibre . . . . . . . . . . . . . . . . 1582.11.2. Physiological effects of fibre in the gut and the clinical implications . . . . .1622.12. Simple and stress starvation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1702.12.1. Energy stores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1712.12.2. Simple starvation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1712.12.3. Stress starvation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1732.12.4. Malnutrition and the response to injury . . . . . . . . . . . . . . . . . . . . . . . . . . . 1752.13. Influence of genotype on inflammation and metabolism . . . . . . . . . . . . . . . . . . 1782.13.1. Single nucleotide polymorphisms and cytokines . . . . . . . . . . . . . . . . . . . . 1782.13.2. Gender gene effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1802.13.3. Genotype insulin sensitivity and body fat mass and distribution . . . . . . 1802.13.4. Genomic effects on longevity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1812.13.5. Influence of genotype on anti-inflammatory responses to nutrients. . . . . .1822.14. Injury and sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1852.14.1. Main cytokines and their effect during injury and sepsis . . . . . . . . . . . . . 1852.14.1.1. Reaction of the immune system . . . . . . . . . . . . . . . . . . . . . . . . . 1862.14.1.2. Endocrine changes during the inflammatory response . . . . . . 1872.14.1.3. The immune response exerts a high metabolicand nutritional cost upon the body . . . . . . . . . . . . . . . . . . . . . . . 1872.14.1.4. Adverse effects of cytokines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1892.14.1.5. Antioxidant defences are depleted by infection and trauma. . 1902.14.1.6. Influence of phenotype on the cytokine response. . . . . . . . . . . 1912.14.2. The neuroendocrine response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1922.14.2.1. Neural stimuli and the sympathetic nervous system. . . . . . . . . 1932.14.2.2. Endocrine effects on metabolism. . . . . . . . . . . . . . . . . . . . . . . . . 1942.14.2.3. Therapeutic implications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1952.14.3. Metabolic response to injury and sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . 1972.14.3.1. Stress response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1982.14.3.2. Substrate metabolism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1992.15. Metabolic response to hypoxia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2032.15.1. Transient response to anoxia or acute hypoxia. . . . . . . . . . . . . . . . . . . . . . 2042.15.2. Functional adaptation to hypoxia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2052.15.3. Molecular adaptation to hypoxia . . . . . . . . . . . . . .
The European Society for Clinical Nutrition and Metabolism ESPEN BBasics_07
