Nutraceuticals in critical care nutrition.

Abstract

The importance of nutritional support in surgical patients cannot be overstated, particularly in the realm of intensive care settings. Prevention of mucosal atrophy and stimulation of the gut-associated lymphoid tissue (GALT) by early enteral feeding in postoperative surgical patients has only recently become part of our standard of care. Feeding the gut is clearly a stimulant for the immune system, and plays a key role in lower infection rates measured in patients receiving enteral as opposed to parenteral nutrition. This association between nutrition and infection has been known for centuries. The World Health Organization report in 1968 clearly defined this association and began to set goals in clinical nutrition [1]. The understanding of the gastrointestinal (GI) tract as a major component of the human immune system and a key modulator of the organism’s response to stress and injury has subsequently opened the door to an exciting new field of specialized enteral preparations sometimes referred to as nutraceuticals. The recent expansion of our understanding of stress metabolism and the systemic inflammatory response has influenced critical care nutrition on two levels. First, as stated above, is the importance of the provision of enteral macronutrients, namely a patient’s requirement for protein, carbohydrate, and lipids. Secondly, research in nutraceuticals seems to have focused on various combinations of micronutrients and ‘conditionally’ essential nutrients. Nutraceuticals are felt to function in cellular metabolic pathways where increased demands associated with the stress response benefit from supplementation. These nutrients may be the key to fine-tuning enteral formulas for specific clinical scenarios. For centuries, man has sought the therapeutic benefits of naturally occurring substances as components of the human diet, acknowledging the