Requirements in Disease

Aside from specific vitamin-deficiency diseases and a few other specific diseases the field of nutrition generally has only recently been allowed to make real contributions in the treatment of disease. There is 

This growing importance of nutrition should not be transferred automatically to the field of vitamin requirements. The fact that it is easier, and sometimes even cheaper, to prescribe some vitamin mixture— which may not be absorbed or prove useful at all—is often used in place of serious dietary evaluation and improvement of food intake. There is some evidence, however, that requirements for some vitamins, at least, are increased above normal, even several-fold, during certain diseases and trauma. Suitable levels are still not known for certain, and again it is probable that they vary rather than being a single figure (Peterman and Goodhart, 1954). 

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Elia M. Changing concepts of nutrient requirements in disease implications for artificial nutritional support. Lancet 1995 345(8960) 1279-84. 

Since the RDA applies to healthy people, it does not provide requirements in disease states or in drug-nutrient interactions. 

Caloric requirements in disease have also been the subject of study. There is an increase in basal metabolism of about 13% for each degree (centigrade) rise in body temperature. Accordingly, all febrile illnesses increase energy needs. Basal metabolism is increased in hyperthyroidism and is often elevated in other endocrinopathies, in certain blood dyscrasias and in heart or lung diseases accompanied by severe dypsnea. Caloric undernutrition is common in these conditions which are associated with an increased energy requirement. It is also frequently encountered in illnesses in which anorexia is a prominent finding and in conditions in which calories are lost in the stool or urine, such as diarrheal diseases or diabetes mellitus,... 

Future research should elucidate many intricacies of metabolism, not only in health but in disease. Relationships between hormones and nutrients appear to be a fruitful field for exploration. That certain nutrients have important functions in stress situations is beginning to be appreciated. Little precise information relative to nutritive requirements in disease has been obtained. When more data become available, nutritional therapy may be applied with greater accuracy in the management of many path-... 

A vitamin is defined as an organic compound that is required in the diet in small amounts for the maintenance of normal metabofic integrity. Deficiency causes a specific disease, which is cured or prevented only by restoring the vitamin to the diet (Table 45-1). However, vitamin D, which can be made in the skin after exposure to sunhght, and niacin, which can be formed from the essential amino acid tryptophan, do not stricdy conform to this definition. 

Self-expanding stents with a higher radial force (e.g., WingSpan, Boston Scientific Corp.) will probably play a key role in acute stroke cases related to intracranial atherosclerotic disease. Antegrade flow is essential for the maintenance of vascular patency, as particularly evident in patients with severe proximal stenoses who commonly develop rethrombosis after vessel recanalization. Furthermore, stenting of the proximal vessels may be required in order to gain access to the intracranial thrombus with other mechanical devices or catheters. In a recent series, 23 of 25 patients (92%) with acute n = 15) or subacute n = 10) ICA occlusions were successfully revascularized with this technique. " ... 

If chronic use is required in patients with end-stage renal disease, monitor serum aluminum concentrations every... 

Diuretics are often required in addition to the sodium restriction described previously. Spironolactone and jurosemide form the basis of pharmacologic therapy for ascites. Spironolactone is an aldosterone antagonist and counteracts the effects of activation of the renin-angiotensin-aldosterone system. In hepatic disease not only is aldosterone production increased, but its half-life is prolonged because it is hepatically metabolized. Spironolactone acts to conserve the potassium that would be otherwise excreted because of elevated aldosterone levels. 

Cytotoxic chemotherapy is eventually required in most patients with metastatic breast cancer. Patients with hormone-receptor-negative tumors require chemotherapy as initial therapy of symptomatic metastases. Patients who respond initially to hormonal manipulations eventually cease to respond and go on to require chemotherapy. The median duration of response is 5 to 12 months, but some patients will have an excellent response to an initial course of chemotherapy and may live 5 to 10 years or longer without evidence of disease. In general, median survival of patients after treatment with commonly used drug combinations for metastatic breast cancer is 14 to 33 months. The median time to response has ranged from 2 to 3 months in most studies, but this period depends in large part on the site of measurable disease. The median time to appearance of response is between 3 and 6 weeks in patients whose disease is primarily in the skin and lymph nodes, 6 to 9 weeks in patients with metastatic lung involvement, 15 weeks in patients with hepatic involvement, and nearly 18 weeks in patients with bone involvement. Thus it is often the case that an immediate response to therapy is not... 

Copper is an essential micronutrient required in the growth of both plants and animals. In humans, it helps in the production of blood haemoglobin. In plants, copper is an important component of proteins found in the enzymes that regulate the rate of many biochemical reactions in plants. Plants would not grow without the presence of these specific enzymes. Research projects show that copper promotes seed production and formation, plays an essential role in chlorophyll formation and is essential for proper enzyme activity, disease resistance and regulation of water in plants (Rehm and Schmitt, 2002). 

An additional consideration that may influence the protocol used is the desired duration of subsequent expression of the gene product. In most cases of genetic disease, long-term expression of the inserted gene would be required. In other instances (e.g. some forms of cancer therapy or the use of gene therapy to deliver a DNA-based vaccine), short-term expression of the gene introduced would be sufficient/desirable. 

Modified amino acid solutions are designed for patients with altered protein requirements associated with hepatic encephalopathy, renal failure, and metabolic stress or trauma. However, these solutions are expensive and their role in disease-specific PN regimens is controversial. 

How should society take account of racial and ethnic differences in disease and illness, and of the genetic differences that may underlie some of them May it ever legitimately take those differences into account If so, what limits are required Are there ever duties to use race and ethnicity in making health policy and health care decisions In what cases would racial and ethnic categories be prohibited ... 

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