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Inflammation: An Expanding Universe
Gordon L. Jensen, MD, PhD
Department of Nutrition Sciences, The Pennsylvania State University,
University Park, Pennsylvania
Correspondence: Gordon L. Jensen, MD, PhD, Department of Nutrition Sciences,
The Pennsylvania State University, 126 Henderson South, University Park, PA
16802.
On the occasion of my Presidential Address for the American Society for
Parenteral and Enteral Nutrition (A.S.P.E.N.) at Clinical Nutrition Week on
February 14, 2006, I presented a provocative examination of future
opportunities in clinical nutrition by exploring the key role of inflammation
at the interface of nutrition and
medicine.1 This
vision of the future has met with a highly receptive audience of nutrition
practitioners throughout the world. Inflammation has been a prime focus of
recent sessions at the A.S.P.E.N. Clinical Nutrition Week, the American
Society for Nutrition meeting at Experimental Biology, the American Dietetic
Association's Food and Nutrition Conference Expo, and the European Society for
Parenteral and Enteral Nutrition's Congress. The list of inflammatory clinical
conditions with nutrition implications continues to grow. This issue of
Nutrition in Clinical Practice touches on some of these conditions,
with critical implications for nutrition intervention and management.
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Glycemic Control
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Hyperglycemia appears to be a cytokine-mediated indicator of active
inflammatory response. Indeed, acute onset of hyperglycemia is often a
harbinger of brewing infection or other inflammatory event. Nutrition support
interventions have the potential to foster poor glycemic control and to fuel
inflammatory pathways. Although
studies2–4
have been mixed in findings, there may be opportunity to secure enhanced
clinical outcomes with improved glycemic control. It is possible that insulin
therapy is actually an anti-inflammatory intervention.
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Neurodegeneration
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There has been growing interest in the role of inflammation in a host of
neurodegenerative diseases. Alzheimer's and Parkinson's diseases have
attracted particular attention. Oxidative stress has been implicated as a
potential causal factor in epidemiologic studies finding that consumption of
diets rich in antioxidant and anti-inflammatory agents may lower the risk of
developing these age-related neurodegenerative diseases. Trials are under way,
testing nutrition interventions as both preventive and therapeutic
measures.5–7
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Home Parenteral Nutrition (PN)
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Chronic use of home PN may well be associated with a smoldering low level
inflammatory
state,8,9
but this is difficult to fully discern in view of underlying potential
contributory factors that include chronic medical conditions, subclinical
infections, associated hepatic dysfunction, and poor glycemic control.
Nonetheless, the possibility that PN may itself fuel inflammatory pathways and
contribute to immune suppression lends priority to the push to develop novel
PN formulations that will not have these undesirable effects and to the
application of clinical practice guidelines that promote the transition of
patients receiving PN to enteral nutrition at first opportunity.
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What Do We Really Mean?
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There is a pressing need to understand malnutrition syndromes in light of
our current understanding of inflammatory response. It is now evident that
much of what has historically been designated protein-calorie malnutrition in
acute and chronic care settings is often at least partially a manifestation of
inflammatory response that results in an altered metabolic
state.1,10,11
Indeed, a call for the development of new consensus definitions for
malnutrition syndromes has arisen at recent international meetings. It will
extremely helpful if we can all speak a common nutrition language. Clinical
nutrition will involve so much more than protein and calories. Modulation of
inflammation with specific nutrients and functional foods offers the
opportunity for nutrition practitioners to be part of the future medical team
that brings highly individualized patient care to the bedside. This vision can
guide an exciting research agenda, with both basic and translational
portfolios.
- Jensen GL. Inflammation as the key interface of the medical and
nutrition universes: a provocative examination of the future of clinical
nutrition and medicine. JPEN J Parenter Enteral Nutr.2006; 30:453
–463.[Abstract/Free Full Text]
- van den Berghe G, Wouters PJ, Weekers F, et al. Intensive insulin
therapy in critically patients. N Engl J Med.2001; 345:1359
–1367.[Abstract/Free Full Text]
- van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin
therapy in the medical ICU. N Engl J Med.2006; 354:449
–461.[Abstract/Free Full Text]
- Gandhi GY, Nuttall GA, Abel MD, et al. Intensive intraoperative
insulin therapy versus conventional glucose management during cardiac surgery:
a randomized trial. Ann Intern Med.2007; 146:233
–243.[Abstract/Free Full Text]
- Luchsinger JA, Noble JM, Scarmeas N. Diet and Alzheimer's disease.
Curr Neurol Neurosci Rep.2007; 7:366
–372.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Reynolds A, Laurie C, Lee Mosley R, Gendelman HE. Oxidative stress
and the pathogenesis of neurodegenerative disorders. Int Rev
Neurobiol. 2007;82:297
–325.[Web of Science][Medline]
[Order article via Infotrieve]
- Lau FC, Shukitt-Hale B, Joseph JA. Nutritional intervention in
brain aging: reducing the effects of inflammation and oxidative stress.
Subcell Biochem.2007; 42:299
–318.[Medline]
[Order article via Infotrieve]
- Ling P, Khaodhiar L, Bistrian BR, et al. Inflammatory mediators in
patients receiving long-term home parenteral nutrition. Dig Dis
Sci. 2001;46:2484
–2489.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Hise ME, Compher C, Harlan L, et al. Inflammatory mediators and
immune function are altered in home parenteral nutrition patients.
Nutrition.2006; 22:97
–103.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Roubenoff R, Heymsfield SB, Kehayias JJ, Cannon JG, Rosenberg IH.
Standardization of nomenclature of body composition in weight loss.
Am J Clin Nutr.1997; 66:192
–206.[Free Full Text]
- Zoico E, Roubenoff R. The role of cytokines in regulating protein
metabolism and muscle function. Nutr Rev.2002; 60:39
–51.[Web of Science][Medline]
[Order article via Infotrieve]
Nutrition in Clinical Practice, Vol. 23, No. 1,
1-2 (2008)
DOI: 10.1177/011542650802300101
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Glycemic Control
Neurodegeneration