Enteral and Parenteral Nutrition

Authored by: Zhaoping Li , David Heber

Handbook of Nutrition and Food

Print publication date:  July  2013
Online publication date:  April  2016

Print ISBN: 9781466505711
eBook ISBN: 9781466505728
Adobe ISBN:

10.1201/b15294-71

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Abstract

While humans are well adapted to uncomplicated starvation with the ability to survive for up to 6 months with adequate fluid and electrolytes, acute or chronic critical illness can activate the immune system and impair the adaptation to starvation leading to various nutritional deficits, including sarcopenia and weakness, impaired immune function, and premature death. 1 5 In fact, the loss of greater than 50% of pre-illness lean body mass is incompatible with life due to the immune impairment that accompanies this protein loss, leading to complicating infections and sepsis often from bacteria or viruses that could be removed if immune function were intact. A prominent cause of death in severely malnourished patients and one of the most common causes of death in adults and especially in children under the age of 5 years in developing countries is infection secondary to malnutrition. Up to 50% of patients hospitalized in general medical and surgical wards are also malnourished, but often do not display the outward signs of reduced body weight so typical of malnutrition in free-living adults. As discussed elsewhere in this text, evidence of protein–calorie malnutrition such as hypoalbuminemia is a harbinger of poor survival from a wide range of medical conditions in hospitalized patients and increasingly in community or home settings as patients are provided nutritional support outside the hospital. The early assessment of nutritional status leading to the early provision of nutrients is key in the multidisciplinary management of malnutrition in illness.

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