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 essential amino acids provides substrate for anabolism of central organs, vital in the response to trauma. This results in a diminished availability of amino acids for re-synthesis of protein, inducing a net catabolic response. Therapy should thus be based upon the notion that inhibition of the stress response is not desirable, and that the substrate mix that the body produces and utilizes during the stress response should be mimicked. The hormonal milieu should also be maintained or enhanced. Depleted patients may be incapable of producing sufficient substrate and hormones to generate an adequate host response, and the future may witness endeavours to furnish both in acute disease, in which host response is necessary and should be stimulated. The contrary may be true in chronic inflammatory disease where an imbalance between pro-inflammatory and anti-inflammatory mediators may lead to detrimental prolonged inflammation, In this case, diminishing inflammatory activity may be desirable, Fibre and antioxidants have potential value in future nutritional 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 phase response. DNA technology will contribute substantially to research, to the elucidation of the pathogenesis of disease and in the more distant future to the therapy of metabolic and nutritional disease