Malnutrition May Worsen the Prognosis of Critically Ill Children With Hyperglycemia and Hypoglycemia

Leite, Heitor Pons; Lima, Lúcio Flávio Peixoto de; Iglesias, Simone; Pacheco, Juliana Cristina; Carvalho, Werther Brunow de

doi:10.1177/0148607112458124

Cited by 32 publications

(23 citation statements)

References 33 publications

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“…Although the majority of healthcare professionals were aware that LOS and wound healing were affected by nutritional status, we were surprised to see that only 54% and 67% were aware of its role in the immune system and morbidity/mortality, respectively. Undernutrition in PICU has been shown in recent studies to impact on the prognosis of critically children (4,9,26). In our study, we succeeded to significantly improve general knowledge about undernutrition consequences and the confidence of the nursing team to perform nutritional assessment.…”

Section: Discussionmentioning

confidence: 89%

A Training Program for Anthropometric Measurements by a Dedicated Nutrition Support Team Improves Nutritional Status Assessment of the Critically Ill Child*

Valla

Ford-Chessel

Meyer

et al. 2015

Pediatric Critical Care Medicine

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Section: Discussionmentioning

confidence: 89%

A Training Program for Anthropometric Measurements by a Dedicated Nutrition Support Team Improves Nutritional Status Assessment of the Critically Ill Child*

Valla

Ford-Chessel

Meyer

et al. 2015

Pediatric Critical Care Medicine

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“…malnutrition; stable isotopes; insulin; glycemic clamps; oxidative stress MALNUTRITION IS STILL A MAJOR HEALTH PROBLEM facing children in the developing world today, being responsible for around 45% of all childhood deaths (11). The severest form of malnutrition is associated, apart from a profound effect on body weight, with metabolic disorders such as hepatic steatosis, both hypoglycemia and hyperglycemia, and oxidative stress (18,22,28,30). Treatment of these children is often challenging, with high inpatient mortality rates (5,20,29).…”

Section: Bandsma Rh Ackerley C Koulajian K Zhang L Van Zutphen Tmentioning

confidence: 99%

A low-protein diet combined with low-dose endotoxin leads to changes in glucose homeostasis in weanling rats

Bandsma

Ackerley

Koulajian

et al. 2015

American Journal of Physiology-Endocrinology and Metabolism

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Severe malnutrition is a leading cause of global childhood mortality, and infection and hypoglycemia or hyperglycemia are commonly present. The etiology behind the changes in glucose homeostasis is poorly understood. Here, we generated an animal model of severe malnutrition with and without low-grade inflammation to investigate the effects on glucose homeostasis. Immediately after weaning, rats were fed diets containing 5 [low-protein diet (LP)] or 20% protein [control diet (CTRL)], with or without repeated low-dose intraperitoneal lipopolysaccharide (LPS; 2 mg/kg), to mimic inflammation resulting from infections. After 4 wk on the diets, hyperglycemic clamps or euglycemic hyperinsulinemic clamps were performed with infusion of [U-(13)C6]glucose and [2-(13)C]glycerol to assess insulin secretion, action, and hepatic glucose metabolism. In separate studies, pancreatic islets were isolated for further analyses of insulin secretion and islet morphometry. Glucose clearance was reduced significantly by LP feeding alone (16%) and by LP feeding with LPS administration (43.8%) compared with control during the hyperglycemic clamps. This was associated with a strongly reduced insulin secretion in LP-fed rats in vivo as well as ex vivo in islets but signficantly enhanced whole body insulin sensitivity. Gluconeogenesis rates were unaffected by LP feeding, but glycogenolysis was higher after LP feeding. A protein-deficient diet in young rats leads to a susceptibility to low-dose endotoxin-induced impairment in glucose clearance with a decrease in the islet insulin secretory pathway. A protein-deficient diet is associated with enhanced peripheral insulin sensitivity but impaired insulin-mediated suppression of hepatic glycogenolysis.

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“…At least among critically ill children, a prospective cohort study suggested that both hyper-and hypoglycemia were associated with worsened morbidity and mortality even after adjustment for disease severity in malnourished (but not well-fed) participants. 102 A similar study in adults have not been performed, but it is conceivable that the metabolic impact of hyper-as well as hypoglycemia during critical illness may differ depending on the nutritional backdrop of the patient.…”

Section: Considering the Influence Of Nutrition On Glycemic Controlmentioning

confidence: 99%

Metabolic Management during Critical Illness: Glycemic Control in the ICU

Honiden

Inzucchi

2015

Semin Respir Crit Care Med

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Hyperglycemia is a commonly encountered metabolic derangement in the ICU. Important cellular pathways, such as those related to oxidant stress, immunity, and cellular homeostasis, can become deranged with prolonged and uncontrolled hyperglycemia. There is additionally a complex interplay between nutritional status, ambient glucose concentrations, and protein catabolism. While the nuances of glucose management in the ICU have been debated, results from landmark studies support the notion that for most critically ill patients moderate glycemic control is appropriate, as reflected by recent guidelines. Beyond the target population and optimal glucose range, additional factors such as hypoglycemia and glucose variability are important metrics to follow. In this regard, new technologies such as continuous glucose sensors may help alleviate the risks associated with such glucose fluctuations in the ICU. In this review, we will explore the impact of hyperglycemia upon critical cellular pathways and how nutrition provided in the ICU affects blood glucose. Additionally, important clinical trials to date will be summarized. A practical and comprehensive approach to glucose management in the ICU will be outlined, touching upon important issues such as glucose variability, target population, and hypoglycemia.

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Malnutrition May Worsen the Prognosis of Critically Ill Children With Hyperglycemia and Hypoglycemia

Abstract: Compared with the well nourished, malnourished patients with hyperglycemia are at a greater risk of mortality, independent of clinical severity. Hypoglycemia was shown to be associated with mortality, longer length of ICU stay, and fewer ventilator-free days only in malnourished patients.

Cited by 32 publications

References 33 publications

A Training Program for Anthropometric Measurements by a Dedicated Nutrition Support Team Improves Nutritional Status Assessment of the Critically Ill Child*

A Training Program for Anthropometric Measurements by a Dedicated Nutrition Support Team Improves Nutritional Status Assessment of the Critically Ill Child*

A low-protein diet combined with low-dose endotoxin leads to changes in glucose homeostasis in weanling rats

Metabolic Management during Critical Illness: Glycemic Control in the ICU

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