Too much of a good thing the curse of overfeeding 英文参考文献.docVIP

Available online /content/11/6/176 Commentary Too much of a good thing: the curse of overfeeding Richard D Griffiths Division of Metabolic Cellular Medicine, School of Clinical Sciences, University of Liverpool, Liverpool, L69 3GA, UK Corresponding author: Richard D Griffiths, rdg@liverpool.ac.uk Published: 9 November 2007 Critical Care 2007, 11:176 (doi:10.1186/cc6165) This article is online at /content/11/6/176 ? 2007 BioMed Central Ltd See related research by Dissanaike et al., /content/11/5/R114 Abstract Why then should there be a link between nutritional excess and infection? Enteral nutrition (EN) gives a legacy of under nutrition in intensive care patients but few appreciate that parenteral nutrition (PN) carries the other risk of overfeeding if used injudiciously. Over- feeding presents a significant metabolic stress but tight glycaemic control is now masking the traditional warning signs and does not on its own negate the need to give patients the right amount at the right time. The principle calorie substrates of glucose and lipids have well defined rates of utilisation and storage. When not given in excess they are handled in a wide range of proportions in the critically ill and septic patient [3] but whether given by either the enteral or parenteral route because of insulin resis- tance do not have the same metabolic consequences as in the well state [4]. However overfeeding of either fats or glucose stresses the metabolic tolerance and compounds the impairment of storage associated with insulin resistance. Obesity and the metabolic syndrome is the chronic equivalent state, intimately linked with inflammation and complex signal- ling interactions [5]. Natural selection has refined our ability to handle acute infection and short-term starvation but has not prepared us for the excesses of modern life and intensive care practice. There