L'usage de l'insuline comme agent anabolisant doit-il être préconisé chez le sujet dénutri ou agressé?

This review focuses on the positive insulin role in the stimulation of protein anabolism in malnourished and catabolic patients. Many experimental humans models are available: - controlled studies in patients able to tolerate a given glucose load with and without insulin supply, - controlled studies that varie both insulin and glucose load while maintaining a constant energy supply, - studies with different levels of insulin and glucose supply, - studies on insulin response and role in the anabolic drive elicited by nutritional intake. The second section reviews clinical results concerning the metabolic nutritional support of injured catabolic patients to establish the optimal composition of the non-protein calorie component of the treatment, according to the anabolic drive hypothesis. Studies addessing moderately stressed patients with variable malnutrition and severely stressed patients were selected. Moreover, considering together the selected 42 study groups in catabolic patients, a clinically satisfactory result (i.e. the marginally negative balance) was reached in 13 of 22 mixed systems (< 60% kcal in glucose) and in 18 of 20 glucose systems. Thus, the insulin mediated anabolic drive action is elicited also in catabolic patients.