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Nutrients 2017, 9(9), 1032; doi:10.3390/nu9091032

The Metabolic Response to Stress and Infection in Critically Ill Children: The Opportunity of an Individualized Approach

1
Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
2
Branch of Medical Statistics, Biometry, and Epidemiology “G. A. Maccacaro”, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
3
Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, 20122 Milan, Italy
4
Pediatric Intermediate Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
5
Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
6
Unit of Human Nutrition and Health, Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, 00161 Rome, Italy
*
Author to whom correspondence should be addressed.
Received: 31 May 2017 / Revised: 6 September 2017 / Accepted: 14 September 2017 / Published: 18 September 2017
(This article belongs to the Special Issue Nutrients, Infectious and Inflammatory Diseases)
View Full-Text   |   Download PDF [238 KB, uploaded 20 September 2017]

Abstract

The metabolic response to stress and infection is closely related to the corresponding requirements of energy and nutrients. On a general level, the response is driven by a complex endocrine network and related to the nature and severity of the insult. On an individual level, the effects of nutritional interventions are highly variable and a possible source of complications. This narrative review aims to discuss the metabolic changes in critically-ill children and the potential of developing personalized nutritional interventions. Through a literature search strategy, we have investigated the importance of blood glucose levels, the nutritional aspects of the different phases of acute stress response, and the reliability of the available tools to assess the energy expenditure. The dynamics of metabolism during stressful events reveals the difficult balance between risk of hypo- or hyperglycemia and under- or overfeeding. Within this context, individualized and accurate measurement of energy expenditure may help in defining the metabolic needs of patients. Given the variability of the metabolic response in critical conditions, randomized clinical studies in ill children are needed to evaluate the effect of individualized nutritional intervention on health outcomes. View Full-Text
Keywords: nutrition; indirect calorimetry; glycemic control; acute phase; ketosis; intensive care nutrition; indirect calorimetry; glycemic control; acute phase; ketosis; intensive care
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

De Cosmi, V.; Milani, G.P.; Mazzocchi, A.; D’Oria, V.; Silano, M.; Calderini, E.; Agostoni, C. The Metabolic Response to Stress and Infection in Critically Ill Children: The Opportunity of an Individualized Approach. Nutrients 2017, 9, 1032.

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