Transcription
Basicsin clinicalnutritionFifth EditionEditor in ChiefLuboš SobotkaAssociate EditorsSimon P. AllisonAlastair ForbesRémy F. MeierStéphane M. SchneiderPeter B. SoetersZeno StangaAndre Van GossumGalén
Basicsin clinicalnutritionFifth EditionEditor in ChiefLuboš SobotkaAssociate EditorsSimon P. AllisonAlastair ForbesRémy F. MeierStéphane M. SchneiderPeter B. SoetersZeno StangaAndre Van GossumGalénBasics in Clinical Nutrition 5.indd 35.8.2019 11:45:00
BASICS IN CLINICAL NUTRITIONFifth editionEditor in Chief Luboš SobotkaPublishing House GalénNa Popelce 3144/10a, 150 00 Prague 5, Czech RepublicManaging Editor Lubomír Houdek, Dr.Editor-in-Chief Soňa Dernerová, Dr.Composition Václav Zukal – Galén, PraguePrint FINIDR, s. r. o., Lipová 1965, 737 01 Český Těšín, Czech Republicwww.espenbluebook.orgAll rights reserved. This book, or any thereof, may not be used or reproduced in any manner without writtenpermision. For information, address European Society of Parenteral and Enteral Nutrition.Supported by the program PROGRES Q40/12. ESPEN, 1999, 2000, 2004, 2011, 2019 Galén, 1999, 2000, 2004, 2011, 2019ISBN 978-80-7492-427-9Basics in Clinical Nutrition 5.indd 45.8.2019 11:45:00
VEditor in ChiefLuboš Sobotka, MD, PhDProfessor of Medicine3rd Department of MedicineMetabolic Care and GerontologyMedical Faculty – Charles UniversityHradec KrálovéCzech RepublicAssociate EditorsSimon P. Allison, MD, FRCPProfessor in Clinical NutritionDepartment of Diabetes, Endocrinologyand NutritionQueen’s Medical CenterNottinghamUnited KingdomAlastair Forbes, BSc, MD, FRCP, FHEAClinical Professor of MedicineChief of Research and InnovationNorwich Medical SchoolUniversity of East AngliaNorwichUnited KingdomRémy F. Meier, MDProfessor of MedicineHead of Department of Gastroenterology,Hepatology and NutritionUniversity HospitalKantonsspital LiestalLiestalSwitzerlandStéphane M. Schneider, MD, PhD, FEBGHProfessor of NutritionNutritional Support UnitArchet University HospitalNiceFranceBasics in Clinical Nutrition 5.indd 5Peter B. Soeters, MD, PhDEmeritus Professor of SurgeryDepartment of SurgeryUniversity Hospital MaastrichtMaastrichtThe NetherlandsZeno Stanga, MD, PhDProfessor in Internal Medicine and ClinicalNutritionDivision of Endocrinology, Diabetes andClinical NutritionDivision of General Internal MedicineUniversity HospitalBernSwitzerlandAndre Van Gossum, MD, PhDProfesssorHead of the Clinic of Intestinal Diseasesand Nutritional SupportDepartment of GastroenterologyHopital ErasmeUniversite Libre de BruxellesBrusselsBelgium5.8.2019 11:45:00
VI List of authorsMichael Adolph, MD, PhDAssociate ProfessorHead of Nutrition Support TeamSenior Physician Anesthesiology and IntensiveCare MedicineUniversity Clinic TuebingenTuebingenGermanyCarla Aeberhard, PhDDepartment of Endocrinology, Diabetes andClinical NutritionBern UniversityHospital and University of BernBernSwitzerlandSimon P. Allison, MD, FRCPProfessor in Clinical NutritionDepartment of Diabetes, Endocrinology andNutritionQueen’s Medical CenterNottingham, UKRaffaella Antonione, MDInternal MedicineClinica Medica, Ospedale di CattinaraAzienda Ospedaliero-UniversitariaTriesteItalyPeter AustinSenior PharmacistSouthampton University NHS Hospitals TrustSouthamptonUnited KingdomMette M Berger, MD, PhDProfessor of Intensive care medicineService of Intensive Care Medicine & BurnsLausanne University Hospital (CHUV)CH- 1011 LausanneSwitzerlandBasics in Clinical Nutrition 5.indd 6Basics in Clinical NutritionStephan C Bischoff, MD, PhDProfessor of MedicineInstitute of Nutritional MedicineUniversity of HohenheimStuttgartGermanyGyorgy Bodoky, MD, PhDProfessor of OncologySt. Laszlo Teaching HospitalDepartment of OncologyBudapestHungaryProf Yves Boirie, MD, PhDUniversity of Clermont-FerrandClinical Nutrition department of the UniversityHospital of Clement-FerrandHuman Nutrition Research CenterClermont-FerrandFranceMarian A. E. van Bokhorst – de van derSchueren, RD, PhDSenior nutrition scientistDepartment of nutrition and dieteticsVU University Medical CenterAmsterdamThe NetherlandsDr Kurt BoeykensClinical Nutrition Nurse SpecialistNutrition Support TeamAZ Nicolaas HospitalSint-NiklaasBelgiumFederico Bozzetti, MDSurgeon oncologistFaculty of MedicineUniversity of MilanMilanItaly5.8.2019 11:45:00
VIIList of authors Valentina Bozzetti, MD, PhDNeonatal Intensive UnitSan Gerardo HospitalMonzaItalyMarco Braga, MDProfessor of SurgerySan Raffaele UniversityMilanItalyFang Cai, MDPhysicianUnit of NutritionGeneva University Hospital1211 Geneva 14SwitzerlandPhilip 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 NutritionResearch Unit of Nutrition and MetabolismInstitute of Molecular MedicineMedical FacultyLisbon UniversityLisbonPortugalNoël Cano, MD, PhDProfessor of NutritionHuman Nutrition Research Center of AuvergneHuman Nutrition Unit, UMR 1019 INRAClermont UniversityClinical Nutrition Unit, Clermont-FerrandUniversity HospitalClement-FerrandFranceBasics in Clinical Nutrition 5.indd 7Anja Carlsohn, Prof, DrDepartment of EcotrophologyFaculty of Life ScienceUniversity of Applied ScienceHamburgGermanyYvon A. Carpentier, MDProfessor of Pathological Biochemistry andNutritionL. Deloyers Laboratory for ExperimentalSurgeryUniversité Libre de BruxellesBrusselsBelgiumTommy Cederholm, MD, PhDProfessor of Clinical NutritionDepartment of Public Health and CaringSciencesUppsala UniversityUppsalaSwedenEmanuele Cereda, MD, PhDResearcher and PhysicianNutrition and Dietetics ServiceIRCCS Fondazione Policlinico San MatteoPaviaItalyIrit Chermesh, MDDeputy Director of GastroenterologyDepartmentMedical Director of Clinical NutritionRambam Health Care CampusHaifaIsraelMichael Chourdakis, MD, RD, MPH, PhDAssistant Professor of Medical NutritionDept.of MedicineAristotle University of ThessalonikiThessalonikiGreece5.8.2019 11:45:01
VIII Luc Cynober, PharmD, PhDProfessor of NutritionHead of DepartmentsDept. of Experimental, Metabolic and ClinicalBiologyPharmacy Faculty – Paris Descartes Universityand Clinical Chemistry DepartmentCochin and Hôtel-Dieu Hospitals, APHPParisFranceErno Dardai, MD, PhDDepartment of Anesthesiology and IntensiveTherapySt. Stephen’s HospitalBudapestHungarySarah Delliere, MD, MSService de BiochimieHopital CochinGroupe Hospitalier HUPC, APHPParisFranceNicolaas E. P. Deutz, MD, PhDProfessor of Geriatrics. Professor of Pediatricsand NutritionCenter for Translational Research in Aging& LongevityDepartment of Health and KinesiologyTexas A&M UniversityCollege Station, TXUSADavid F. Driscoll, PhDVice PresidentStable Solutions LLCEaston, MAUSABasics in Clinical Nutrition 5.indd 8Basics in Clinical NutritionWilfred 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, CTUSAMarinos Elia, MD, FRCPProfessor of Clinical Nutrition & MetabolismInstitute of Human NutritionUniversity of SouthamptonSouthampton General HospitalSouthamptonUnited KingdomNicholas D. Embleton, MD, MBBS, FRCPCH,BScConsultant Neonatal PediatricianHonorary Reader in Neonatal MedicineRoyal Victoria InfirmaryNewcastle HospitalNHS Foundation TrustNewcastle upon TyneUnited KingdomJoel Faintuch, MD, PhDSenior ProfessorDepartment of GastroenterologySao Paulo University Medical SchoolSao PauloBrazil5.8.2019 11:45:01
IXList of authors Joel J. Faintuch, MD, PhDProfessor of MedicineDepartment of MedicineHospital das ClinicasSao Paulo University Medical SchoolSao PauloBrazilEnrico Fiaccadori, MD, PhDRenal Failure UnitDivision of NephrologyParma University HospitalUniversity of ParmaParmaItalyEric Fontaine, MD, PhDProfessor of MedicineINSERM U1055 - LBFAJoseph Fourier UniversityGrenoble CedexFranceAlastair Forbes, BSc, MD, FRCP, FHEAClinical Professor of MedicineChief of Research and InnovationNorwich Medical SchoolUniversity of East AngliaNorwichUnited KingdomKonstantinos C. Fragkos, MB, BS, MSc, PhDClinical Research Fellow in Gastroenterologyand Clinical NutritionUniversity College LondonLondonUnited KingdomWim G. van Gemert, MD, PhDColorectal, Gastrointestinal and PediatricSurgeonAcademic Hospital Maastricht and MaastrichtUniversityMaastrichtThe NetherlandsBasics in Clinical Nutrition 5.indd 9Laurence Genton, MD, PhDProfessor in Clinical NutritionClinical NutritionGeneva University HospitalGenevaSwitzerlandM. Cristina Gonzalez, MD, PhDProfessor of Post-Graduation Program in Healthand BehaviourCatholic University of PelotasPelotas RSBrazilOlivier 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 Haluzík, MD, PhDProfessor of MedicineDepartment of Experimental DiabetologyInstitute for Clinical and Experimental MedicinePragueCzech RepublicFolke Hammarqvist, MD, PhDProfessor in Emergency SurgeryDepartment of Surgical Gastrocenter.CLINTEC – Department of Clinical Science,Intervention and TechnologyKarolinska University Hospital HuddingeStockholmSweden5.8.2019 11:45:01
X Basics in Clinical NutritionGil Hardy, PhD, FRSCProfessor of Pharmaceutical NutritionFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew ZealandPhilippe Jolliet, MDSenior LecturerMedical Intensive CareGeneva University HospitalGenevaSwitzerlandLaszlo Harsanyi, MD, PhDProfessor of Surgery1st Surgical DepartmentFaculty of MedicineSemmelweis UniversityBudapestHungaryCora F. Jonkers-Schuitema, RD, BcDietitianAcademic Medical CenterAmsterdamThe NetherlandsReem Hawarym RDKing Faisal Specialist Hospital & ResearchCenter11578 RiyadhSaudi ArabiaJ Pat Howard, RDHead of Nutrition and Dietetic ServicesUnited Bristol Healthcare TrustBristol Royal InfirmaryBristol BS2 8HWUnited KingdomFrancisco J. Karkow, MD, PhDFull ProfessorDepartment of NutritionFatima FacultyCaxias do SulBrazilLuiza Kent-Smith, PhD, RDProfessional Leader Nutrition & DieteticsSaskatoon Health RegionSaskatoonCanadaPao Ying Hsiao, MS, RD, LDNAssistant Professor and Registered DietitianDepartment of Nutritional SciencesPennsylvania State UniversityUSABerthold Koletzko, MD, PhDProfessor of PaediatricDivision Metabolic and Nutritional MedicineDr. von Hauner Children’s HospitalLudwig-Maximilians-University of MunichMunichGermanyMartin Hubner, MD, PDConsultant SurgeonDepartment of Visceral SurgeryLausanne University Hospital - CHUVLausanneSwitzerlandJens Kondrup, MD, Dr Med SciProfessor in Clinical NutritionClinical Nutrition Unit 5711Rigshospitalet University Hospital,CopenhagenDenmarkGordon L Jensen, MD, PhDProfessor of MedicineHead of Department of Nutritional SciencesPennsylvania State UniversityUSAAngela Koverech, MDDepartment of Clinical and Molecular MedicineSapienza UniversityRomeItalyBasics in Clinical Nutrition 5.indd 105.8.2019 11:45:01
XIList of authors Zeljko Krznarič, MD, PhD, FEBGHProfessor of MedicineHead of Division of GastroenterologyDepartment of MedicineUniversity of ZagrebZagrebCroatiaIrma Kushta, MDDepartment of Clinical MedicineSapienza – University of RomeRomeItalyAlexey V. Lapitsky, MD, PhDResearch scientistLaboratory of Clinical NutritionSaint-Petersburg I.I. Dzhanelidze ResearchInstitute of Emergency MedicineSaint-PetersburgRussian FederationMiguel Leon-Sanz, MD, PhDProfessor Endocrinology and NutritionDepartment of MedicineMedical SchoolUniversity Hospital Doce de OctubreComplutense UniversityMadridSpainOlle Ljungqvist, MD, PhDProfessor of SurgeryFaculty of Medicine and Health,School of Health and Medical SciencesDepartment of SurgeryÖrebro University,ÖrebroSwedenValery M. Luft, MD, PhDProfessor, Head of Laboratory of ClinicalNutritionSaint-Petersburg I.I. Dzhanelidze ResearchInstitute of Emergency MedicineSaint-PetersburgRussian FederationBasics in Clinical Nutrition 5.indd 11Stanislav Klek, MD, PhDProfessor of SurgeryGeneral and Oncology Surgery UnitStanley Dudrick’s Memorial HospitalSkawinaPolandMarek Kunecki, MDSpecialist in General SurgeryDepartment of Clinical NutritionDepartment of General and Vascular SurgeryM. Pirogow Provincial Specialist HospitalLodzPolandAlessandro Laviano, MDAssociate Professor of MedicineDepartment of Translational and PrecisionMedicineSapienza University of RomeRomeItalyDileep N Lobo, MS, DM, FRCS, FACSProfessor of Gastrointestinal SurgeryNottingham University HospitalsQueen’s Medical CentreNottingham NG7 2UHUnited KingdomJan Maňák, MD, PhD3rd Department of MedicineMetabolic Care and GerontologyMedical Faculty – Charles UniversityHradec KrálovéCzech RepublicLuis Matos, MScDepartment of NutritionUSL GurdaPortoPortugal5.8.2019 11:45:01
XII Michael M. Meguid, MD, PhDProfessor EmeritusSurgery, Neuroscience and PhysiologyDepartment of SurgeryUpstate Medical UniversityUniversity HospitalSyracuse, NYUSARémy F. Meier, MDProfessor of MedicineHead of Department of Gastroenterology,Hepatology and NutritionUniversity HospitalKantonsspital LiestalLiestalSwitzerlandKatarina Melzer, PhDEquiliberty Consulting, LLCUniversity of LausanneLausanneSwitzerlandMaarten F. von Meyenfeldt, MD, PhDProfessor of Surgical OncologyDepartment of SurgeryUniversity Hospital MaastrichtMaastrichtThe NetherlandsAlvaro A. C. Morais, MD, MSFull ProfessorDepartment of SurgeryEMESCAM Medical SchollVitoriaBrazilAdéla Mrózková, MDDepartment of Hygiene andPreventive MedicineMedical FacultyCharles UniversityHradec KrálovéCzech RepublicBasics in Clinical Nutrition 5.indd 12Basics in Clinical NutritionStefan Mühlebach, PhDProfessor of Pharmacology and HospitalPharmacyHospital Pharmacist FPHMedical FacultyDivision of Clinical Pharmacology & ToxicologyUniversity Hospital of BaselBaselSwitzerlandMaurizio Muscaritoli, MD, FACNProfesor of MedicineDepartment of Clinical MedicineSapienza – University of RomeRomeItalyTon Naber, MD, PhDProfessor of Clinical NutritionDepartment of Gastroenterology andHepatologyMedical FacultyUniversity Medical Center NijmegenNijmegenThe NetherlandsLuis Alberto Nin, MDProfessor in Nutrition and Director Magister inNutritionCatholic UniversityMontevideoUruguayKristina Norman, PhDProfessor of Nutrition and GerontologyDepartment of Nutrition and GerontologyGerman Institute for Human Nutrition PotsdamRehbrückeUniversity of PotsdamPotsdamGermany5.8.2019 11:45:01
XIIIList of authors Ibolya Nyulasi, MScDepartment of MedicineAlfred HospitalFaculty of MedicineNursing and Health SciencesClaytonAustraliaJohann Ockenga, MD, PhDProfessor in Internal MedicineDepartment of Gastroenterology,Endocrinology and Clinical NutritionKlinikum Bremen MitteBremenGermanyLoris Pironi, MDAssociate professor of Food and DieteticSciencesDepartment of Medical and Surgical ScienceSchool of MedicineUniversity of BolognaBolognaItalyMathias Plauth, MDProfessor of MedicineHead of Department of Internal MedicineCommunity Hospital DessauDessauGermanyAnn Ödlund Olin, PhD, RNManager of nursing developmentDepartment of Quality and Patient SafetyKarolinska University HospitalStockholmSwedenJean-Charles Preiser, MD, PhDClinical DirectorDepartment of Intensive CareErasme University HospitalBrusselsBelgiumOlivier Pantet, MDService of Intensive Care Medicine & BurnsLausanne University Hospital (CHUV)CH- 1011 LausanneSwitzerlandJohn W. L. Puntis, BM (Hons), DM, FRCP,FRCPCHConsultant Paediatric GastroenterologistThe General Infirmary at LeedsLeeds, West YorkshireUnited KingdomClaude Pichard, MD, PhDProfessor of MedicineHead of the Unit of Unit of NutritionGeneva University Hospital1211 Geneva 14SwitzerlandMatthias Pirlich, MD, PhDProfessor of MedicineHead of DepartmentDepartment of Internal MedicineEvangelische Elisabeth KlinikLützowstr. 24-2610785 BerlinGermanyBasics in Clinical Nutrition 5.indd 13Petronella Lucia Martha Reijven, MSc, PhDNutritional ScientistDepartment of Clinical DieteticsMaastricht University Medical CentreMaastricht,The NetherlandsFilippo Rossi Fanelli MD, FACNProfesor of MedicineDepartment of Clinical MedicíněSapienza – University of RomeRomeItaly5.8.2019 11:45:01
XIV Nada Rotovnik Kozjek, MD, PhDAssociate Professor of Oncology and DieteticsInstitute of OncologyClinical Nutrition UnitMedical FacultyUniversity of LjubljanaSloveniaHans P. Sauerwein, MDEmeritus Professor of Energy MetabolismAcademic Medical CenterAmsterdamThe NetherlandsAnastasia M. Sergeeva, MDJunior research scientistLaboratory of Clinical NutritionSaint-Petersburg I. I. Dzhanelidze ResearchInstitute of Emergency MedicineSaint-PetersburgRussian FederationAlan Shenkin, PhD, BSc, FRCP, FRCPathEmeritus ProfessorSchool of Clinical SciencesUniversity of LiverpoolLiverpoolL69 3GAUnited KingdomStéphane M. Schneider, MD, PhD, FEBGHProfessor of NutritionNutritional Support UnitArchet University HospitalNiceFranceJos M. G. A. Schols, MD, PhDProfessor of chronic care and nursing homemedicineDepartment of General PracticeMaastricht UniversityMaastrichtThe NetherlandsBasics in Clinical Nutrition 5.indd 14Basics in Clinical NutritionPhilipp Shütz, MD, MPHProfessor of MedicineMedical University DepartmentKantonsspital AarauAarauSwitzerlandPierre Singer, MDClinical Professor in Anaesthesia and IntensiveCareDepartment of General Intensive Care andinstitute for Nutrition ResearchTel Aviv UniversityRabin Medical Center, Beilinson HospitalPetah TikvaIsraelAntonio Sitges-Serra, MD, FRCSProfessor of SurgeryHead of Department of SurgeryUniversity Hospital del MarBarcelona UniversityBarcelonaSpainJacek Sobocki, MD, PhDProfessor of SurgeryDepartment of Surgery and Clinical NutritionMedical University of WarsawWarsawPolandLuboš Sobotka, MD, PhDProfessor of Medicine3rd Department of MedicineMetabolic Care and GerontologyMedical Faculty – Charles UniversityHradec KrálovéCzech RepublicOndřej Sobotka, MD, PhD3rd Department of MedicineMetabolic Care and GerontologyMedical Faculty – Charles UniversityHradec KrálovéCzech Republic5.8.2019 11:45:01
XVList of authors Maarten R. Soeters, MD, PhDDepartment of Endocrinology and MetabolismUniversity of AmsterdamAcademic Medical CenterAmsterdamThe NetherlandsBruno Szczygiel, MD, PhDProfessor of SurgeryDepartment of Human NutritionMedical University of WarsawWarsawPolandP. B. Soeters, MD, PhDEmeritus Professor of SurgeryDepartment of SurgeryUniversity Hospital MaastrichtMaastrichtThe NetherlandsLuc Tappy, MDProfessor of PhysiologyChairman, Department of PhysiologySchool of Biology and MedicineLausanne UniversityLausanneSwitzerlandMattias Soop, MD, PhDConsultant surgeonIrving National Intestinal Failure UnitSalford Royal HospitalReader Manchester UniversityUnited KingdomZeno Stanga, MD, PhDProfessor in Internal Medicine and ClinicalNutritionDivision of Endocrinology, Diabetes andClinical NutritionDivision of General Internal MedicineUniversity HospitalBernSwitzerlandRebecca Stratton, PhD, RD, RNutrInstitute of Human NutritionUniversity of SouthamptonSouthampton General HospitalSouthamptonUnited KingdomŠtěpán Svačina, MD, PhDProfessor of MedicineHead of the 3rd Department of Internal MedicineMedical Faculty 1Charles UniversityPragueCzech RepublicBasics in Clinical Nutrition 5.indd 15Vladimír Teplan, MD, PhDProfesor of MedicineInstitute for Postgraduál EducationDepartment of NephrologyInstitute for Clinical and Experimental MedicínePragueCzech RepublicRonan Thibault, MD, PhDProfessor of NutritionNuMeCan InstituteCHU Rennes, Univ. Rennes, INSERM, INRADept. Nutrition and EndocrinologyReferral Centre for Rare Digestive DiseasesHome Parenteral Nutrition CentreRennesFranceChristel Tran, MDConsulting PhysicianDivision of Endocrinology Diabetes andMetabolismLausanne University HospitalLausanneSwitzerlandElena Y. Tyavokina, MDHead of Somatopsychiatry DepartmentSaint-Petersburg I.I. Dzhanelidze ResearchInstitute of Emergency MedicineSaint-PetersburgRussian Federation5.8.2019 11:45:01
XVI Nachum Vaisman, MDProfessor of PediatricsHead of Clinical Nutrition UnitTel Aviv Sourasky Medical Centerand Tel Aviv Sourasky Medical SchoolTel AvivIsraelMaurits F. J. Vandewoude, MD, PhDProfessor of MedicineDepartment of GeriatricsFaculty of MedicineUniversity of AntwerpAntwerpBelgiumAndre Van Gossum, MD, PhDProfesssorHead of the Clinic of Intestinal Diseases andNutritional SupportDepartment of GastroenterologyHopital ErasmeUniversite Libre de BruxellesBrusselsBelgiumGeert Wanten, MD, PhD, MScGastroenterologist, Head Nutrition SupportTeamIntestinal failure UnitDepartment of Gastroenterology andHepatologyRadboud University Nijmegen Medical CentreNijmegenNijmegenThe NetherlandsBasics in Clinical Nutrition 5.indd 16Basics in Clinical NutritionJan Wernerman, MD, PhDProfessor in AnaesthesiaDepartment of Anaesthesia and Intensive CareCLINTEC – Department of Clinical Science,Intervention and TechnologyKarolinska University Hospital HuddingeStockholmSwedenKlaas R Westerterp, PhDProfessor of Human EnergeticsDepartment of Human BiologyMaastricht UniversityMaastrichtThe NetherlandsThomas Wild, MDDepartments of Dermatology, Venereology,Allergology and ImmunologyDessau Medical CenterDessauGermanyZdeněk Zadák, MD, PhDProfessor of Medicine3rd Department of Medicine, Metabolic Care andGerontologyMedical Faculty – Charles UniversityHradec KrálovéCzech Republic5.8.2019 11:45:01
XVIIContents1. Basic conceptsin nutrition . . . . . . . . . . . . . . . . . . . . . . .1.5.1.2.1.6.1.2.1.7.1.2.2.1.2.2.1.1.2.2.2.Energy and protein balance . . . . . . . . . . 1Body composition . . . . . . . . . . . . . . . . . . 6Measurement of body composition . . . . 6Background . . . . . . . . . . . . . . . . . . . . . . . . 6Densitometry . . . . . . . . . . . . . . . . . . . . . . . 7Hydrometry . . . . . . . . . . . . . . . . . . . . . . . . 7Anthropometry . . . . . . . . . . . . . . . . . . . . . 8Electrical conductance . . . . . . . . . . . . . . . 9Body imaging . . . . . . . . . . . . . . . . . . . . . . 10Discussion . . . . . . . . . . . . . . . . . . . . . . . . . 10Bioelectrical Impedance Analysis . . . . . 12Basic principle of the method . . . . . . . . 12Factors which influence BIAmeasurement . . . . . . . . . . . . . . . . . . . . . . 141.2.2.3. BIA as marker of tissue health . . . . . . . 151.2.2.4. BIA methods used in clinicalpractice . . . . . . . . . . . . . . . . . . . . . . . . . . . 161.3. Diagnosis of malnutrition –Screening and Assessment . . . . . . . . . . 181.3.1. Definition of Malnutrition . . . . . . . . . . . 181.3.1.1 Malnutrition – Undernutrition . . . . . . . . . 181.3.1.2. Interaction between undernutritionand inflammation . . . . . . . . . . . . . . . . . . 181.3.1.3. Malnutrition – Overnutrition . . . . . . . . 191.3.2. Screening for malnutrition . . . . . . . . . . . 201.3.3. Nutritional Assessment . . . . . . . . . . . . . 201.3.4. Techniques used in nutritionalassessment . . . . . . . . . . . . . . . . . . . . . . . . . 231.3.4.1. Anthropometry . . . . . . . . . . . . . . . . . . . . 231.3.4.2. Advanced measures of function . . . . . . 241.3.4.3. Laboratory Tests . . . . . . . . . . . . . . . . . . . . 241.4. The influence of malnutrition onfunction . . . . . . . . . . . . . . . . . . . . . . . . . . 271.4.1. Cognitive function . . . . . . . . . . . . . . . . . . 281.4.2. Muscle function . . . . . . . . . . . . . . . . . . . . 281.4.3. Cardiovascular function . . . . . . . . . . . . . 28Basics in Clinical Nutrition 5.indd enal function . . . . . . . . . . . . . . . . . . . . . 28Respiratory function . . . . . . . . . . . . . . . . 29Gastrointestinal tract . . . . . . . . . . . . . . . 29Thermoregulation . . . . . . . . . . . . . . . . . . 29Immune system . . . . . . . . . . . . . . . . . . . . 29Wound healing . . . . . . . . . . . . . . . . . . . . . 30Quality of life . . . . . . . . . . . . . . . . . . . . . . 30Overnutrition – functional andclinical consequences . . . . . . . . . . . . . . . 311.5.1. Physiology of adipose tissue . . . . . . . . . . 311.5.2. Acute overfeeding . . . . . . . . . . . . . . . . . . 331.5.3. Chronic overfeeding – Obesity . . . . . . . 331.5.3.1. Aetiology of obesity . . . . . . . . . . . . . . . . . 331.5.3.2. Classification of obesity . . . . . . . . . . . . . 351.5.3.3. Obesity and metaboliccomplications . . . . . . . . . . . . . . . . . . . . . . 351.5.3.4. Metabolic syndrome . . . . . . . . . . . . . . . . 361.5.4. Treatment of obesity . . . . . . . . . . . . . . . . 361.6. Prevalence of malnutrition . . . . . . . . . 391.6.1. Malnutrition . . . . . . . . . . . . . . . . . . . . . . . 391.6.2. Identifying malnutrition . . . . . . . . . . . . . 401.6.3. Prevalence of malnutrition . . . . . . . . . . . 411.6.3.1. Underweight and BMI in differentcountries and world regions . . . . . . . . . 411.6.3.2. Prevalence of Malnutrition ina European Country (UnitedKingdom (UK)) . . . . . . . . . . . . . . . . . . . . 431.6.3.3. Geographic location (geographicinequalities) . . . . . . . . . . . . . . . . . . . . . . . 451.6.3.4. Distribution of malnutrition accordingto individual characteristics . . . . . . . . . . 461.6.4. Causes of malnutrition (undernutrition)and evidence for treatment . . . . . . . . . . . 461.7. Nutritional requirements for healthat rest and upon exercise . . . . . . . . . . . . 481.7.1. Adult subjects . . . . . . . . . . . . . . . . . . . . . . 481.7.1.1. Macronutrients . . . . . . . . . . . . . . . . . . . . . 481.7.1.2. Micronutrients . . . . . . . . . . . . . . . . . . . . . 535.8.2019 11:45:01
XVIII Basics in Clinical Nutrition1.7.2. Nutritional needs of infants, childrenand adolescents . . . . . . . . . . . . . . . . . . . . 551.7.2.1. Nutrient requirements for growthand development . . . . . . . . . . . . . . . . . . . 551.7.2.2. Nutrient requirements . . . . . . . . . . . . . . 572. Nutritional Physiologyand Biochemistry . . . . . . . . . . . . . 692.1.2.1.1.2.1.2.2.1.3.2.1.4.2.1.5.2.2.Appetite and its control . . . . . . . . . . . . .Peripheral signals . . . . . . . . . . . . . . . . . . .Homeostatic control of feeding . . . . . . .Hedonic control of feeding . . . . . . . . . . .Loss of appetite during disease . . . . . . .Summary . . . . . . . . . . . . . . . . . . . . . . . . . .Digestion and absorptionof nutrients . . . . . . . . . . . . . . . . . . . . . . .2.2.1. Principal sites of digestionand absorption . . . . . . . . . . . . . . . . . . . . .2.2.2. The small intestine . . . . . . . . . . . . . . . . . .2.2.2.1. Carbohydrates . . . . . . . . . . . . . . . . . . . . .2.2.2.2. Lipids . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2.2.2.3. Proteins . . . . . . . . . . . . . . . . . . . . . . . . . . .2.2.2.4. Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . .2.2.2.5. Water, electrolytes, and traceelements . . . . . . . . . . . . . . . . . . . . . . . . . .2.2.3. The absorptive functionsof the colon . . . . . . . . . . . . . . . . . . . . . . .2.2.3.1. Water and electrolytes . . . . . . . . . . . . . . .2.2.3.2. Metabolic and digestive functions . . . .2.3. Energy metabolism . . . . . . . . . . . . . . . .2.3.1. Calorimetry for the measurement ofenergy expenditure . . . . . . . . . . . . . . . . .2.3.2. Components of energy expenditure,measurement, and determinants . . . . . .2.3.3. Disease-related alterations in energyexpenditure . . . . . . . . . . . . . . . . . . . . . . . .2.4. Carbohydrate metabolism . . . . . . . . . .2.4.1. Carbohydrates in normalmetabolism . . . . . . . . . . . . . . . . . . . . . . . .2.4.2. Regulation of glucose metabolism . . . .2.4.3. Effects of stress on glucosemetabolism . . . . . . . . . . . . . . . . . . . . . . . .2.4.4. Metabolic responses to criticalillness . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2.5. Lipid metabolism . . . . . . . . . . . . . . . . . .2.5.1. Basic pathways in lipid metabolism . . .2.5.2. Lipid metabolism in fastingconditions . . . . . . . . . . . . . . . . . . . . . . . . .Basics in Clinical Nutrition 5.indd 92949595982.5.3. Influence of surgical stress, sepsis,and organ failure . . . . . . . . . . . . . . . . . . . 992.6. Protein and amino acidmetabolism . . . . . . . . . . . . . . . . . . . . . . 1012.6.1. Physiology . . . . . . . . . . . . . . . . . . . . . . . . 1012.6.2. Protein turnover . . . . . . . . . . . . . . . . . . . 1022.6.3. Metabolism of amino acids . . . . . . . . . 1042.6.4. Whole body protein synthesis and/orbreakdown . . . . . . . . . . . . . . . . . . . . . . . 1042.6.5. Methods for measuring proteinmetabolism . . . . . . . . . . . . . . . . . . . . . . . 1082.7. Water and electrolytes in healthand disease . . . . . . . . . . . . . . . . . . . . . . . 1122.7.1. Water and fluid compartments . . . . . . 1122.7.2. Flux of fluid through thegastrointestinal tract . . . . . . . . . . . . . . . 1142.7.3. Role of the kidney . . . . . . . . . . . . . . . . . 1142.7.4. External fluid balance . . . . . . . . . . . . . . 1162.7.5. Effects of starvation and injury . . . . . . 1162.7.6. Electrolytes . . . . . . . . . . . . . . . . . . . . . . . 1172.8. Physiological functions anddeficiency states of trace elementsand vitamins . . . . . . . . . . . . . . . . . . . . . 1232.8.1. Trace elements . . . . . . . . . . . . . . . . . . . . 1232.8.1.1. Zinc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1232.8.1.2. Copper . . . . . . . . . . . . . . . . . . . . . . . . . . . 1232.8.1.3. Iron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1242.8.1.4. Selenium . . . . . . . . . . . . . . . . . . . . . . . . . 1242.8.1.5. Chromium . . . . . . . . . . . . . . . .
Basics in Clinical Nutrition 5.indd 9 5.8.2019 11:45:01. X BASICS IN CLINICAL NUTRITION Gil Hardy, PhD, FRSC Professor of Pharmaceutical Nutrition Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand Laszlo Harsanyi, MD, PhD Profess
