Clinical nutrition: the future

Greater understanding of the function of the stress response is required to devise meaningful nutritional therapy. Breakdown of muscle and some essent ial amino acids provides substrate for anabolism of central organs, vital i n the response to trauma. This results in a diminished availability of amin o acids for re-synthesis of protein, inducing a net catabolic response. The rapy should thus be based upon the notion that inhibition of the stress res ponse is not desirable, and that the substrate mix that the body produces a nd utilizes during the stress response should be mimicked. The hormonal mil ieu should also be maintained or enhanced. Depleted patients may be incapab le of producing sufficient substrate and hormones to generate an adequate h ost response, and the future may witness endeavours to furnish both in acut e disease, in which host response is necessary and should be stimulated. Th e contrary may be true in chronic inflammatory disease where an imbalance b etween pro-inflammatory and anti-inflammatory mediators may lead to detrime ntal prolonged inflammation, In this case, diminishing inflammatory activit y may be desirable, Fibre and antioxidants have potential value in future n utritional regimens, as does harnessing the ability of acute phase proteins to serve a scavenging function. Increased capillary escape of immune cells and plasma proteins may allow repair in tissues damaged during the acute p hase response. DNA technology will contribute substantially to research, to the elucidation of the pathogenesis of disease and in the more distant fut ure to the therapy of metabolic and nutritional disease. (C) 2001 Harcourt Publishers Ltd.