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Critical Care  2002 

Recently published papers: We are what we eat?

DOI: 10.1186/cc1527

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Anonymous English proverbOver the past few months yet more information bombards us. Several papers have concentrated on nutrition and markers thereof, in an attempt to make sense of much data.Current interest in blood glucose levels focuses on examining patients' glucose tolerance to predict outcomes. This is particularly pertinent to high-dependency and coronary care practice, as well as intensive care unit (ICU) work. The DIGAMI study highlighted the long-term post-myocardial infarction (MI) risk in patients with a deranged glycometabolic state [1]. Similarly, the intensive care population has been scrutinized with regard to glycometabolic control in septic critically ill patients. Strict glycaemic control in such individuals is now hopefully commonplace, with the aim of improving survival. This has prompted much work to delineate those individuals with impaired glycometabolic control, and the same group presented further evidence that abnormal glucose metabolism is associated with a high prevalence of acute MI [2]. A total of 181 consecutive nondiabetic patients admitted with acute MI were given standard glucose tolerance testing at discharge and 3 months later. Fewer than 35% of patients had normal glucose tolerance at 3 months of follow up. It would appear likely, then, that early detection of impaired glycometabolic control might improve outcome by allowing introduction of secondary preventative measures. This probably has little immediate relevance to the ICU, but for those of us who are involved in coronary care it is worthwhile bearing in mind that an HbA1c on admission may well indicate long-term risk and is a relatively quick and inexpensive test.Nutritional support is often regarded as the Cinderella of the intensivist's armamentarium, probably because it does not generate the same excitement as the latest test for inflammatory mediators or suchlike. However, rather like toothache, it is best not ignored. Intense debate continues as to the preferred rout


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