PURPOSE: The objectives of this review are to summarize the current practices and major recent advances in critical care nutrition and metabolism, review common beliefs that have been contradicted by recent trials, highlight key remaining areas of uncertainty, and suggest recommendations for the top 10 studies/trials to be done in the next 10 years.METHODS: Recent literature was reviewed and developments and knowledge gaps were summarized. The panel identified candidate topics for future trials in critical care nutrition and metabolism. Then, members of the panel rated each one of the topics using a grading system (0-4). Potential studies were ranked on the basis of average score.RESULTS: Recent randomized controlled trials (RCTs) have challenged several concepts, including the notion that energy expenditure must be met universally in all critically ill patients during the acute phase of critical illness, the routine monitoring of gastric residual volume, and the value of immune-modulating nutrition. The optimal protein dose combined with standardized active and passive mobilization during the acute phase and post-acute phase of critical illness were the top ranked studies for the next 10 years. Nutritional assessment, nutritional strategies in critically obese patients, and the effects of continuous versus intermittent enteral nutrition were also among the highest-ranking studies.CONCLUSIONS: Priorities for clinical research in the field of nutritional management of critically ill patients were suggested, with the prospect that different nutritional interventions targeted to the appropriate patient population will be examined for their effect on facilitating recovery and improving survival in adequately powered and properly designed studies, probably in conjunction with physical activity.
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This article addresses European energy policy through conventional and transformative sustainability approaches. The reader is guided towards an understanding of different renewable energy options that are available on the policy making table and how the policy choices have been shaped. In arguing that so far, European energy policy has been guided by conventional sustainability framework that focuses on eco-efficiency and ‘energy mix’, this article proposes greater reliance on circular economy (CE) and Cradle to Cradle (C2C) frameworks. Exploring the current European reliance on biofuels as a source of renewable energy, this article will provide recommendations for transition to transformative energy choices. http://dx.doi.org/10.13135/2384-8677/2331 https://www.linkedin.com/in/helenkopnina/
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A transparent and comparable understanding of the energy efficiency, carbon footprint, and environmental impacts of renewable resources are required in the decision making and planning process towards a more sustainable energy system. Therefore, a new approach is proposed for measuring the environmental sustainability of anaerobic digestion green gas production pathways. The approach is based on the industrial metabolism concept, and is expanded with three known methods. First, the Material Flow Analysis method is used to simulate the decentralized energy system. Second, the Material and Energy Flow Analysis method is used to determine the direct energy and material requirements. Finally, Life Cycle Analysis is used to calculate the indirect material and energy requirements, including the embodied energy of the components and required maintenance. Complexity will be handled through a modular approach, which allows for the simplification of the green gas production pathway while also allowing for easy modification in order to determine the environmental impacts for specific conditions and scenarios. Temporal dynamics will be introduced in the approach through the use of hourly intervals and yearly scenarios. The environmental sustainability of green gas production is expressed in (Process) Energy Returned on Energy Invested, Carbon Footprint, and EcoPoints. The proposed approach within this article can be used for generating and identifying sustainable solutions. By demanding a clear and structured Material and Energy Flow Analysis of the production pathway and clear expression for energy efficiency and environmental sustainability the analysis or model can become more transparent and therefore easier to interpret and compare. Hence, a clear ruler and measuring technique can aid in the decision making and planning process towards a more sustainable energy system.
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The design of cities has long ignored the flows that shape the city. Water has been the most visible one, but energy and materials were invisible and/or taken for granted. A little over 50 years ago, Abel Wolman was the first to illuminate the role of water flows in the urban fabric. It has long been a search for quantitative data while the flows were mostly seen as separated entities. The fact they invisibly formed the way the city appears has been neglected for many years. In this thematic issue the “city of flows” is seen as a design task. It aims to bring to the fore the role flows can play to be consciously used to make spatial decisions in how and where certain uses and infrastructure is located. Efficient and sustainable
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Evaluating protein kinetics in the critically ill population remains a very difficult task. Heterogeneity in the intensive care unit (ICU) population and wide spectrum of disease processes creates complexity in assessing protein kinetics. Traditionally, protein has been delivered in the context of total energy. Focus on energy delivery has recently come into question, as the importance of supplemental protein in patient outcomes has been shown in several recent trials. The ICU patient is prone to catabolism, immobilization, and impaired immunity, which is a perfect storm for massive loss of lean body tissue with a unidirectional flow of amino acids from muscle to immune tissue for immunoglobulin production, as well as liver for gluconeogenesis and acute phase protein synthesis. The understanding of protein metabolism in the ICU has been recently expanded with the discovery of how the mammalian target of rapamycin complex 1 is regulated. The concept of "anabolic resistance" and identifying the quantity of protein required to overcome this resistance is gaining support among critical care nutrition circles. It appears that a minimum of at least 1.2 g/kg/d with levels up to 2.0 g/kg/d of protein or amino acids appears safe for delivery in the ICU setting and may yield a better clinical outcome.
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The data of this study indicate that the acetate recovery factor, used in stable isotope research, needs to be deteremined in every subject, under similar conditions as used for the tracer-derived determination of substrate oxidation.
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The results of this study indicate that whole body metabolic and cardiovascular responses to 140 min of either steady state or variable intensity exercise at the same average intensity are similar, despite differences in skeletal muscle carbohydrate metabolism and recruitment
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Carnitine/choline acyltransferases play diverse roles in energy metabolism and neuronal signalling. Our knowledge of their evolutionary relationships, important for functional understanding, is incomplete. Therefore, we aimed to determine the evolutionary relationships of these eukaryotic transferases. We performed extensivephylogenetic and intron position analyses. We found that mammalian intramitochondrial CPT2 is most closely related to cytosolic yeast carnitine transferases (Sc-YAT1 and 2), whereas the other members of the family are related to intraorganellar yeast Sc-CAT2. Therefore, the cytosolically active CPT1 more closely resembles intramitochondrial ancestors than CPT2. The choline acetyltransferase is closely related to carnitine acetyltransferase and shows lower evolutionary rates than long chain acyltransferases. In the CPT1 family several duplications occurred during animal radiation, leading to the isoforms CPT1A, CPT1B and CPT1C. In addition, we found five CPT1-like genes in Caenorhabditis elegans that strongly group to the CPT1 family. The long branch leading to mammalian brain isoform CPT1C suggests that either strong positive or relaxed evolution has taken place on this node. The presented evolutionary delineation of carnitine/choline acyltransferases adds to current knowledge on their functions and provides tangible leads for further experimental research.
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Under- and overfeeding in Intensive Care Units (ICUs) are linked to prolonged hospitalisation, increased morbidity, and elevated mortality. This study investigates whether ICU patients were optimally nourished according to the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines. Methods: A cohort of 158 COVID-19 patients requiring intensive care for severe respiratory failure, necessitating a nuanced approach to nutritional support, was analysed. Nutritional status was determined regarding kilocalories and protein using the Energy Expenditure derived from ventilator-measured VCO2 and the adjusted Weir equation, and data on intake through enteral feeding was used. The study included ventilated patients hospitalised for over five days without Extra Corporeal Life Support (ECLS) and receiving enteral nutrition. Associations between mortality and (i) calorie intake and (ii) protein intake were examined using Chi-Square statistics. Results: Conforming to the ESPEN guidelines, 45% of patients were malnourished, and 21% were over-nourished in kilocalories. Additionally, 61% were malnourished, and 16% were over-nourished in protein. The distribution between the groups of survivors and deceased relative to each of the groups well nourished, malnourished, and over-nourished was not statistically different (p = 0.21). The protein distribution among survivors and deceased groups was not statistically different (p = 0.67) regarding correct, insufficient, or excessive protein intake. Conclusions: Based on ESPEN guidelines, most ICU patients were inadequately nourished in kilocalories and protein. However, no significant survival differences were observed across groups with varying nutritional adequacy. Further research is recommended to explore the implications of nutritional interventions in critically ill patients.
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Muscle fiber-type specific expression of UCP3-protein is reported here for the firts time, using immunofluorescence microscopy
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