IV. Providing Nutritional Support

The following methods may be used to reverse catabolic illness:

• Providing optimum nutrition early, including:

1) Adequate energy and nutrient profile

2) Adequate protein

3) Necessary micronutrients

• Using anabolic agents if needed to increase the rate of anabolic activity

• Providing exercise stimulus to muscles

Nutrition: Basic Principles

Optimum nutrition is essential to keep up with the increased calorie demands and to decrease the rate of catabolism or use of body protein for fuel. The objective is first to provide the calorie and protein demands. The second objective is to provide the appropriate nutrient mix.

Nutrient Mix :Carbohydrate calories are provided at about 60% of total calories. Excess carbohydrates however, are deleterious, leading to hyperglycemia and fat formation.

Fat calories (20% to 25% of total) are provided to reach the energy demands. Endogenous fat stores are also used, but this will not reduce protein loss. Excess fat is also deleterious, acting as a substrate for immunosuppressive mediators.

Protein: Protein requirements are 2 to 3 times the recommended daily allowance (RDA =0.8 g/kg/d), or 1.5 to 2 g/kg body weight per day. The increased protein intake decreases the net nitrogen losses by increasing the amino acid flow into the protein synthesis channel. Glutamine is the most prominent amino acid lost in muscle and should be provided in increased amounts, preferably orally (10 to 30 g/d).

Micronutrients must be given in increased quantities (5 to 10 times the RDA) to keep up with increased metabolism and quickly restore deficiencies.

Timing: It is essential to initiate nutrient support as soon as possible after a catabolic insult or with evidence of a malnourished state. Nutritional support should begin within 48 hours. A gradual restoration of optimum nutrition is necessary with evidence of severe PEM to avoid a refeeding syndrome.

 

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