PubMed · 7412946
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J H Jonxis. 1980-09-20. [Human milk].. https://pubmed.ncbi.nlm.nih.gov/7412946/
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Dietetic treatment of overweight has its limits in cases with morbid obesity (BMI > 40 kg/m2) or with disturbed eating habits (compulsive eating). In these cases surgery and cognitive treatment may play a role. Dietetic treatment is often sufficient in patients with moderate to severe overweight (BMI > 27 to 39 kg/m3). This includes in the first place identification of bad habits by evaluation of nutritional behaviour over 3 or 7 days. The most frequent mistakes are the jumping of a meal (mostly breakfast) and nibbling of snacks rich in fat between meals and omission of hypocaloric and voluminous food like fruit and vegetables. The lacking sensation of saturation which is fostered by rapid and automatic food intake, may also contribute to the maintenance of overweight. The first dietetic rules to be observed consist in a regular schedule for meals and-if necessary-snacks in between and the selection of a lipid-poor diet with particular attention to hidden fat. The meal should be turned into an enjoyable experience whenever possible without other concurrent activities.
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Enteral nutrition (EN) has several advantages over parenteral nutrition (PN) for postoperative/posttrauma patients. Modern technologies for tube-feeding have made early EN possible. Jejunal tube-feeding has advantages over gastric tube-feeding: faster metabolic recovery, less vomiting, and less risk of regurgitation and aspiration. Immediate or early EN stimulates the splanchnic and hepatic circulations, improves mucosal blood flow, prevents intramucosal acidosis and permeability disturbances, and eliminates the need for stress ulcer prophylaxis. Saliva containing important antimicrobial substances and gastric acidity are important in sepsis prevention. Chewing, saliva, and gastric acidity support gastric nitric oxide (NO) release, important for mucosal blood flow, gastrointestinal (GI) motility, mucus formation, and bacteriostasis. An oral supply of NO-donating substances and chewing of nitrate-rich food, such as lettuce or spinach, can be useful. Oral and mucosa-protective lipids are recommended. H2 blockers and saliva-inhibiting drugs are avoided. Immediate EN should be given, starting with 25 ml/hr and increasing to 100 ml/hr over 24 to 48 hours. For the immunocompromised patient special attention should be given to the purity of water. Bottled water can contain bacteria such as Pseudomonas. Food antioxidants such as glutathione, vitamin E, and beta-carotenes are important. Ingredients for the colonic mucosa are important. Approximately 10% of caloric need is satisfied by so-called colonic food (prebiotics), fermented at the level of the colonic mucosa to produce colonic mucosa nutrients and to prevent gut origin sepsis. More than 10 g of fiber per day is recommended. The fermenting flora (probiotic flora) is deranged owing to disease or antibiotic treatment, and resupply of flora is important. A new concept of ecoimmune nutrition is presented for enteral supply of mucosa-reconditioning ingredients: new surfactants, pseudomucus, fiber, amino acids such as arginine, and mucosa-adhering Lactobacillus plantarum 299.