Overfeeding carbohydrate or fat can result in fatty infiltration of the liver, and a high-fat/low-carbohydrate diet moves the metabolic state toward a ketogenic condition that could be problematic for patients with kidney or liver problems. As with underfeeding, the human body has the ability to adapt to an excess of calories from multiple macronutrient sources. In two groups of normal men fed an excess (5 MJ/d for 21 d) of carbohydrate or fat, both groups had the same level of fat storage.143 A small study performed in lean and obese women tested overfeeding with fat, glucose, fructose, or sucrose, and no significant difference in fat balance was observed.144 Elevated leptin levels were observed in short-term studies of overfeeding145 and also of overfeeding of carbohydrates but not fat.146 If there is a fat excess, then it is important to consider the type of fat and the possible consequences. For the healing wound, there is no data to suggest that an excess of saturated or monounsaturated fatty acids is either harmful or beneficial. However, an excess or imbalance in PuFA could impact the immune system. The anti-inflammatory effects of rn-3 PuFA in humans are well documented.6147 However, mice fed high levels of rn-3 PuFA (~38% of calories) had decreased production of interleukin-12 and gamma interferon by splenocytes.148 Therefore, if there is an excess of ra-3 PuFA in the diet, the anti-inflammatory benefits of these fats may turn into immunosup-pression. This result could be a complicating factor for patients who have healing wounds and are fighting local or systemic infection. Also, a high fat diet is often not advisable for burn patients because the fat may exacerbate the immunosuppres-sion often experienced by these patients.149 Likewise, an excess of rn-6 PuFA may exacerbate inflammation that needs to be brought under control.

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