It can be successfully argued that, teleologically, the acute phase response
has been of fundamental importance in the survival of life as we know
Inflammation is part of the immune response, whose function is to combat
pathogens and restore health following injury and surgery. Inflammation also
occurs in a less helpful role during cancer, exposure to environmental pollutants,
radiation, and allergens, and during chronic inflammatory disease.
Inflammation is the body’s immediate response to infection or injury. It
is typified by redness, swelling, heat and pain. These occur as a result of
increased blood flow, increased permeability across blood capillaries which
permits large molecules (e.g. complement, antibodies, cytokines) to leave
the bloodstream and cross the endothelial wall, and increased movement
of leukocytes from the bloodstream into the surrounding tissue.
Chronic inflammation of the intestinal tract remains a common cause of
morbidity, reduced quality of life and, in certain cases, may be fatal. Despite
intensified research efforts and significant advancements, our understanding
of the mechanisms underlying many conditions such as ischemia reperfusion
injury of the gut, inflammatory bowel disease (IBD) and sepsis of gut origin
In the struggle for life, humans as every mammal and other living species,
have to face two main dangers: (1) the competition against other individuals
or other living species, including parasites, bacteria and viruses, and (2) the
extreme toxicity of oxygen.
The aims of nutritional support administered to acutely ill patients have
markedly evolved with time, from supplying huge amounts of calories and
nitrogen (in an attempt to abolish the catabolic response and to guarantee
weight gain) to providing a limited and balanced intake of macro- and micronutrients
in order to maintain or restore an adequate composition of different
body compartments .
Body protein homeostasis primarily depends on protein intake, even if
other dietary factors, such as the energy content of the diet also play a role.
However, protein intake can affect protein homeostasis in a variety of ways
The systemic inflammatory response is a critical component of the innate
immune system in man that develops in a stereotypical manner to injury,
inflammation, and infection.
Efficacy of nutritional support can be defined in two main ways: the first
relates to the production of new body tissue or the prevention of loss of
existing tissue, this could either be growth in a child or repair or maintenance
in an adult, and the second relates to how well the various body tissues
Extensive progress has been made in techniques of artificial nutrition of
critical care patients. Nutritional support has progressively evolved from
an adjuvant to a supportive life-saving therapy, like mechanical ventilation,
hemodynamic support or dialysis.
With the increasing number of patients safely receiving long-term total
parenteral nutrition (TPN), it has become clear that there is a group of patients,
in whom treatment is totally dependent on TPN for a prolonged period of
Modern clinical science asks for prospective randomized trials to assess
the efficacy of treatment modalities. These trials can then be combined in a
meta-analysiswhich, depending on the quality of the studies (level of evidence:
1 = best, 2, 3 or 4 = worst), can lead to recommendations with varying grades.
A grade-A recommendation relies on studies of the highest quality (prospective,
randomized, double-blind, sufficient power, homogenous populations,
single modality intervention, hypothesis testing, clinical endpoints), and is
therefore stronger than grade-B, C and D recommendations, which rely on
studies of decreasing quality .
For the purpose of this article, ‘specialized nutrition support’ means using
nutrient formulations that have particular adaptations deemed either to alter
the inflammatory response or correct a conditional deficiency.
In a 70-kg man, skeletal muscle accounts for 40–50% of the total body
mass. A loss of the muscle mass due to the net breakdown of muscle proteins
is a common feature of many acute and long-term illnesses.
Once a little-studied scientific area, today the study of body composition is
of intense interest to investigators exploring between individual phenotypic
differences and the rich heterogeneity in shape and form that exists across
the human lifespan.
The treatment of diseases encompasses a nutritional approach from ancient
times, however it was only 200 years ago that the fundamentals of biochemistry,
physiology and organic chemistry were firmly solidified as science.
In the practice of nutritional intervention as it relates to the sick patient,
the future is today! Predicting future developments in nutritional intervention
depends on technical innovations, yet to be realized, which will facilitate the
implementation of advances in nutritional support.
The common characteristic of the past 3 days has been the high quality of
the presentations, the intensity of the ensuing discussions, fueled by speakers
and delegates alike, the many take-home messages for our practices and the
inevitable, but crucial in workshops of this nature, sobering questions that
remain in need of urgent answers in the field we addressed.