In devising this program with our Nestle colleagues we have attempted not
only to review some of the new developments and pressing problems in clinical
nutrition and metabolism, but also to develop some unifying themes running
across the nutritional spectrum, from undernutrition to obesity, and from
starvation and weight loss to acute medical and surgical illness.
The world is now confronted with a set of medical problems of nutritional
origin with which it has never previously had to contend, i.e. both undernutrition
of various types and a huge and rapidly escalating burden of diseases
crudely classified as relating to overnutrition.
Over the last century, there has been a rapid decrease in the incidence of
many infectious diseases. Over the same period, the prevalence of several
noninfectious diseases, e.g. obesity, type-2 diabetes, and coronary heart disease,
has increased dramatically to the point that we are facing an epidemic of noncommunicable
Insulin is the major anabolic hormone in the human body. Secreted by the
cells of the pancreatic islets, typically in response to a meal, it is fundamental
in maintaining normal glucose homeostasis.
With remarkable intuition, John Hunter  in 1794 described the response
to injury as follows: ‘Impressions are capable of producing or increasing
natural actions and are then called stimuli
Through the explosion of therapeutic possibilities within the setting of
intensive care medicine, patients can nowadays survive previously lethal disease
Insulin resistance is a common metabolic problem characterized by an
impaired physiological response to insulin. It is a key factor in the pathogenesis
of type-2 diabetes and is present in more than 50% of patients with the
Intervention studies provide robust evidence of the efficacy of lifestyle
intervention, based on diet and exercise, in improving insulin sensitivity and
reducing the risk of developing type-2 diabetes in individuals with impaired
glucose tolerance (IGT) [1–3].
Muscle protein content is regulated acutely (minutes to hours) by
modulation of the rates of protein synthesis and degradation. In physiological
conditions, a small fraction of muscle protein content is lost in the postabsorptive
state, whereas it is immediately regained with the following meal.
Fatty acid isomers – and we will be mainly dealing with trans fatty acids in
this review – may have two origins. These can be natural fatty acids but they
may also be formed during technological treatments such as hydrogenation,
refining or frying of oils [1, 2].
It is now well established that an inflammatory component contributes to
the pathogenesis of obesity-linked diabetes and cardiovascular diseases.
First proposed by Hotamisligil et al.
In the United States and other developed countries, approximately 1 in
4 adults has hypertension or high blood pressure, a major risk factor for
coronary heart disease, stroke and renal disease .
By definition, all of the major minerals and essential trace elements are
necessary for health, and the range of these elements implies that they are
part of all aspects of cellular function.
The understanding of fluid and electrolyte balance in the clinical setting is
often poor and prescribing is usually left to the most junior member of the
team [1, 2].
Back in the 5th century BC, Empedocles suggested that the biosphere was
composed of four elements: earth, wind, fire and water. These four components
of life are currently known under names different from those dear to
the early philosophers.
Humans are multicellular organisms designed to provide continuous nutrition
to all constituent cells by means of nutrient homeostasis through genomicnutrient-
The decoding of the human genome is already being heralded as one of
science’s greatest achievements and is viewed as the point of departure for
the next generation of life science research to understand human health and
cure human disease .