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Prenatal programming of postnatal obesity: fetal nutrition and the regulation of leptin synthesis and secretion before birth

Published online by Cambridge University Press:  07 March 2007

Isobel Davidson
Affiliation:
Dietetics, Nutrition & Biological Sciences, Queen Margaret University College, Edinburgh EH12 8TS, UK
Sara Smith
Affiliation:
Dietetics, Nutrition & Biological Sciences, Queen Margaret University College, Edinburgh EH12 8TS, UK
Corresponding
E-mail address:
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Abstract

The introduction of the process of nutritional screening into clinical standards has been driven by the increasing awareness of the prevalence of undernutrition in acute and primary care, along with its associated morbidity and mortality. However, the increasing prevalence of obesity in the general population suggests that an increased number of patients admitted to hospital will be obese. Increased morbidity has also been reported in the injured obese patient and may be associated with poor nutritional support. This situation may occur because the profound metabolic disturbances accompanying trauma in this group are not recognised, and subsequent feeding practices are inappropriate. Screening tools currently classify patients by using simple markers of assessment at the whole-body level, such as BMI. Subsequently, patients are identified as at risk only if they are undernourished. Such comparisons would by definition classify injured obese patients as at minimal or no nutritional risk, and they would therefore be less likely to be re-screened. This approach could result in potential increases in morbidity, length of rehabilitation and consequent length of hospital stay. It is likely that the identification of potential risk in obese injured patients goes beyond the measurement of such indices as BMI and percentage weight loss, which are currently utilised by the majority of screening processes.

Type
BAPEN Symposium 1: Malnutrition in obesity
Copyright
Copyright © The Nutrition Society 2004

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