Stephen A. McClave

Purpose of Review Food insecurity and gun violence are timely and relevant public health issues impacting many regions within the USA with a potential association. Terminology surrounding food access and food security can be confusing, which is important to understand when examining the relationship between these issues and gun violence. Recent Findings Food insecurity is an individual level risk factor that appears to correlate with an increased rate of exposure and future involvement in violence. Food deserts represent geographic regions with limited access to food but do not necessarily represent regions with high prevalence of food insecurity. Although both food insecurity and food deserts in urban regions have been linked with increased incidence of gun violence, a high prevalence of food insecurity was found to be more predictive. Summary A high prevalence of food insecurity in urban regions likely serves as a marker for socioeconomic disadvantage and intentional disinvestment. These regions are predictably associated with a higher incidence of interpersonal gun violence. Food deserts in rural areas have not, to date, been shown to correlate with interpersonal gun violence. Urban food insecurity and gun violence are both likely the byproduct of structural violence. Despite the significant overlap and similar contributors, the application of the public health framework in addressing these two issues has historically been quite different.

This review evaluates whether improvements have occurred in the value of predictive equations for use in designing nutritional therapeutic regimens in the ICU. The report also seeks to determine whether emerging strategies for nutrition therapy in the ICU change the need for an accurate measurement of energy requirements by indirect calorimetry. Predictive equations remain problematic for use in the critically ill patient. Inaccuracy of predictive equations introduces error in the design of a nutritional therapy regimen. The epidemic of obesity renders the calculations of requirements by predictive equations increasingly inaccurate at extremes of BMI. Certain patient populations appear to be hypometabolic, contradicting the traditional notion that critical illness increases energy expenditure. More recent data indicates that determination of which patients benefit from nutritional therapy may be based both on assessment of nutrition risk and delivery of sufficient nutrition therapy. The role of indirect calorimetry in the ICU should be expected to increase in the near future, as predictive equations may be too inaccurate to identify the appropriate goals of nutrition therapy.

Severe acute pancreatitis is a disease process distinguished by increasing oxidative stress and potential destruction of the pancreatic gland. An initial injury to the acinar cell initiates a sentinel event, which leads to a vicious cycle of inflammation and cell death by either apoptosis or necrosis. Whether the acute inflammation resolves or goes on to a pattern of chronicity may be related to genetic predisposition, failure to remove injurious agents, and innate systems for antioxidant defense. The degree to which nutrition therapy can modulate oxidative stress, maintain intestinal function, and preserve the structure of the acinar cell is truly amazing. Understanding the mechanisms involved in this complex disease process and the manner in which these mechanisms are influenced by dietary agents affords new and exciting therapeutic options for the future.

Background: Traditional practices of placing patients nil per os (NPO) or on clear liquid diet (CLD) deter delivery of optimal nutrition care and are not always supported by sound physiologic principles. Objective: This perspective survey evaluated the incidence of this practice, the reasons for such orders, and the response to intervention by the Multidisciplinary Nutrition Team (MNT). Methods: All patients admitted to University of Louisville Hospital were monitored by MNT dietitians and were candidates for the study if they were placed NPO upon CLD for ≥3 days. The MNT determined appropriateness of diet orders. Results: Out of 1192 admissions, 22.6% of the patients (n = 262, 61% male, mean age 46.1 years) were found to be NPO or on CLD for ≥3 days (mean 5.2 days NPO, 1.04 days CLD), and were entered in the study. Uncertainty regarding the reason for the specific diet order occurred more often when patients were placed on CLD than when made NPO (32.1% vs. 15.0% of cases, respectively, P < 0.05). NPO diet orders were more often deemed appropriate by the MNT than were orders for CLD (58.6% vs. 25.6%, respectively, P < 0.05). Compliance with MNT recommendations was low at 40.0%. Conclusions: Despite an active MNT, 22% of patients were made NPO or placed on CLD for a prolonged period of time. More than a third of diet orders for NPO and two thirds of orders for CLD were inappropriate and poorly justified. Improving the adequacy of nutrition therapy is hampered by noncompliance with MNT recommendations.