Cardenas Diana, Ochoa Juan B
Nutrition Unit, Institut Gustave Roussy, Villejuif, France.
Intensive Care Medicine, Hunterdon Medical Center, New Jersey, USA.
Clin Nutr. 2023 Mar;42(3):380-383. doi: 10.1016/j.clnu.2023.01.014. Epub 2023 Jan 31.
The current clinical nutrition paradigm is that decreased caloric intake, resulting in a caloric deficit, is central to the development disease-related malnutrition (DRM). In following with this paradigm, one should assume that nutrition interventions with artificially administered nutrition (food substitution paradigm) aimed at preventing a caloric deficit should result in the prevention and/or successful treatment of DRM. However, clear evidence demonstrates that the DRM observed in diverse illnesses is at least partially resistant to nutrition interventions aimed at preventing the development of a caloric deficit. Simply put, DRM cannot be prevented nor resolved through a nutrition intervention aimed solely on replacing what the person cannot or will not eat. It is time to stop oversimplifying nutrition therapy in clinical nutrition interventions as a food substitution issue, focusing instead on developing and testing innovative hypotheses aimed at a mechanistic understanding of how DRM develops. Through this effort, new paradigms should evolve. The aim of this opinion paper is to provide an overview of why we need a shift in the current paradigm.
当前的临床营养模式认为，热量摄入减少导致热量不足，是疾病相关营养不良（DRM）发生的核心因素。按照这一模式，人们会认为，旨在预防热量不足的人工营养干预措施（食物替代模式）应能预防和/或成功治疗DRM。然而，确凿的证据表明，在多种疾病中观察到的DRM至少部分地对旨在预防热量不足的营养干预措施具有抗性。简而言之，仅通过旨在替代患者不能或不愿食用食物的营养干预措施，无法预防或解决DRM。现在是时候停止将临床营养干预中的营养治疗简单地归结为食物替代问题了，而应转而致力于提出并验证创新性假设，以从机制上理解DRM的发生过程。通过这一努力，新的模式应该会应运而生。本观点论文的目的是概述我们为何需要转变当前的模式。
