Starvation as an adaptive response by Harris
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Transcript of Starvation as an adaptive response by Harris
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Starvation is an adaptive response
Evolution - Adaptation & Critical Illness
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‘Starvation is an adaptive response’
Challenge
Should we always feed early?
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Through their Eyes
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Survival of the fittest
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Evolution and critical care?
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I’m not hungry – I feel sick
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• Stress response & anorexia
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Mother knows best
Wear a jumper you’ll
catch cold
Starve a fever feed a cold
Sitting on cold concrete causes piles
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• But is anorexia a good thing?
Digestion is Catabolic
Anorexia stimulates Autophagy
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Auto-phagy
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Macro-Autophagy
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43 Days & 1 Mars Bar
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EPaNIC v Early PN
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EPaNIC
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Early PN
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Through their Eyes
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‘Starvation results in death’
What Do I Do?
We should tailor how we feed
‘Anorexia is an adaptive response’
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References1: Signals generating anorexia in acute illness. Langhans W. Proceedings of
Nutrition society 2007;66:321-330
2: Leptin in Anorexia and Cachexia syndrome. Engineer D, Garcia J. International Journal of Peptides 2012;287457:13
3: Autophagy and Adaptive Immunity. Crotzer V, Blum J. Immunology 2010;131:9-17
4: Early versus late Parenteral Nutrition in critically ill Adults. Caesar M et al. N Engl J Med 2011;365:506-17
5: Early Parenteral Nutrition in Critically Ill Patients with short-term relative contraindications to Early Enteral Nutrition. Doig G et al. JAMA 2013;309(20):2130-2138