Fat

Adults Feeding regimens that simply overfeed with a normal diet lead to problems in the recovery phase; muscle wasting persists together with central obesity. Reduction in fat administration largely prevents these problems if protein calories replace lipid calories (Figure 4). Fat cannot be excluded from the diet; a minimum fat content of 4% of total calories will ensure a supply of essential fatty acids. A diet containing 15% fat will meet such requirements as well as provide a delivery medium for fat-soluble vitamins. Dietary fat is largely composed of long-chain triacylglycer-ols (LCTs), and excess LCTs are associated with hepatic steatosis, reticuloendothelial system blockage, and immunosuppression. Varying the composition of the fats supplied to burns patients may alleviate some of these problems. Medium-chain fatty acids, particularly n-3 PUFA found in fish oil, appear beneficial in maximizing whole body protein synthesis in an animal model of burn injury. There is a decrease in plasma n-6 fatty acids after burn injury, so replacement with n-3 PUFA results in the production of prostanoid and eicosanoid series associated with less immunosup-pression than those arising from n-6 PUFA metabolism. The use of low-fat feed, supplemented with n-3 PUFAs, reduces protein catabolism and increases IGF-1, particularly 2 or 3 weeks

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Figure 4 Pie charts demonstrating the difference in proportion of carbohydrate, fat, and protein calories required by burns patients (right) compared to normal patients (left).

postburn. Limiting fat to 15% total calorie intake reduces wound infection rate, improves healing rate, reduces the incidence of pneumonia, improves nutritional markers, and reduces hospital stay. Such benefits have been seen both with and without the addition of n-3 PUFAs.

Children A fat intake of 2 or 3% of total calories is the minimum recommended for the prevention of essential fatty acid deficiency in pediatric patients. For intravenous fat administration in infants, a maximum of 4 g/kg lean body weight is suggested.

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