High-fat low-carbohydrate enteral feeding enriched with olive oil and acute respiratory failure: A double-blind, randomized, controlled trial

ICU nutrition research: did the evidence get better? Remaining sources of bias

PURPOSE OF REVIEW

To assess the quality of recently published (18 months from date of article request) randomized trials/systematic reviews of such trials that addressed the use of nutritional support in critically ill patients.

RECENT FINDINGS

Eligible papers were published between October 1, 2022 and April 7, 2024, only enrolled adults, described a comparison of a nutritional intervention to something else, and reported a clinically relevant outcome. Thirteen randomized trials and four systematic reviews of randomized trials were identified. Quality was assessed by determining the risks of bias of each trial. Two of these trials were at low risk of bias, six were rated as having some concern(s) about bias, and five were at high risk of bias. The four systematic reviews included 55 randomized trials; four were at low risk, 31 had some concerns, and 20 were at high risk. No randomized trial comparing nutritional support to a true control (no nutritional support) was identified in this search; seven older trials, all small and containing risks of bias, failed to demonstrate any consistent differences in clinical outcomes.

SUMMARY

The quality of the trials underlying the use of nutritional support in the intensive care unit is not very high.

Nutrition in chronic inflammatory conditions: Bypassing the mucosal block for micronutrients

Nutritional Immunity is one of the most ancient innate immune responses, during which the body can restrict nutrients availability to pathogens and restricts their uptake by the gut mucosa (mucosal block). Though this can be a beneficial strategy during infection, it also is associated with non-communicable diseases-where the pathogen is missing; leading to increased morbidity and mortality as micronutritional uptake and distribution in the body is hindered. Here, we discuss the acute immune response in respect to nutrients, the opposing nutritional demands of regulatory and inflammatory cells and particularly focus on some nutrients linked with inflammation such as iron, vitamins A, Bs, C, and other antioxidants. We propose that while the absorption of certain micronutrients is hindered during inflammation, the dietary lymph path remains available. As such, several clinical trials investigated the role of the lymphatic system during protein absorption, following a ketogenic diet and an increased intake of antioxidants, vitamins, and minerals, in reducing inflammation and ameliorating disease.

Role of Olive Bioactive Compounds in Respiratory Diseases

Respiratory diseases recently became the leading cause of death worldwide, due to the emergence of COVID-19. The pathogenesis of respiratory diseases is centred around inflammation and oxidative stress. Plant-based alongside synthetic drugs were considered as therapeutics due to their proven nutraceutical value. One such example is the olive, which is a traditional symbol of the MedDiet. Olive bioactive compounds are enriched with antioxidant, anti-inflammatory, anticancer and antiviral properties. However, there are few studies relating to the beneficial effect of olive bioactive compounds on respiratory diseases. A vague understanding of its molecular action, dosage and bioavailability limits its usefulness for clinical trials about respiratory infections. Hence, our review aims to explore olive bioactive compound's antioxidant, anti-inflammatory and antiviral properties in respiratory disease defence and treatment. Molecular insight into olive compounds' potential for respiratory system protection against inflammation and ensuing infection is also presented. Olive bioactive compounds mainly protect the respiratory system by subsiding proinflammatory cytokines and oxidative stress.