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John F Cade, Daryl A Jones, Rinaldo Bellomo
The imprecision in prescribing of enteral nutrition in critically ill patients must result in occasions of overfeeding as well as underfeeding. Overfeeding could cause increased CO2 production and thus increased work of breathing and prolonged ventilator dependence. This possibility is supported by the limited relevant literature. We examined this possibility mathematically using the data in The Augmented versus Routine Approach to Giving Energy Trial (TARGET) feasibility study and in its main study protocol...
December 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Oren Zusman, Miriam Theilla, Jonathan Cohen, Ilya Kagan, Itai Bendavid, Pierre Singer
BACKGROUND: Intense debate exists regarding the optimal energy and protein intake for intensive care unit (ICU) patients. However, most studies use predictive equations, demonstrated to be inaccurate to target energy intake. We sought to examine the outcome of a large cohort of ICU patients in relation to the percent of administered calories divided by resting energy expenditure (% AdCal/REE) obtained by indirect calorimetry (IC) and to protein intake. METHODS: Included patients were hospitalized from 2003 to 2015 at a 16-bed ICU at a university affiliated, tertiary care hospital, and had IC measurement to assess caloric targets...
November 10, 2016: Critical Care: the Official Journal of the Critical Care Forum
Harris R Lieberman, Asma S Bukhari, John A Caldwell, Marques A Wilson, Caroline R Mahoney, Stefan M Pasiakos, James P McClung, Tracey J Smith
BACKGROUND: In studies assessing the effects of acute undernutrition on cognitive function, volunteers are sedentary and findings are equivocal, even though glucose concentrations fall substantially. However, military personnel and endurance athletes often are underfed when physical demands, and consequently energy expenditure, are substantial. OBJECTIVE: The objective of this study was to determine whether 2 d of near-total calorie deprivation combined with aerobic exercise degraded cognitive performance and mood...
November 2, 2016: Journal of Nutrition
Q L M Habes, P Pickkers
- Overfeeding of critically ill patients is associated with a higher incidence of infections and an increased length of ventilation. However, trophic nutrition or permissive underfeeding appears to have no negative effect on the patient and may even provide a survival benefit.- Initiation of enteral nutrition within 24-48 hours after Intensive Care Unit (ICU) admission may reduce the number of complications and increase the chance of survival.- Total parenteral nutrition is associated with a higher risk of infections than enteral nutrition...
2016: Nederlands Tijdschrift Voor Geneeskunde
L John Hoffer, Bruce R Bistrian
Critically ill people are unable to eat. What's the best way to feed them? Nutrition authorities have long recommended providing generous amounts of protein and calories to critically ill patients, either intravenously or through feeding tubes, in order to counteract the catabolic state associated with this condition. In practice, however, patients in modern intensive care units are substantially underfed. Several large randomized clinical trials were recently carried out to determine the clinical implications of this situation...
2016: F1000Research
Bryan Wilson, Katri Typpo
Appropriate nutrition is an essential component of intensive care management of children with acute respiratory distress syndrome (ARDS) and is linked to patient outcomes. One out of every two children in the pediatric intensive care unit (PICU) will develop malnutrition or have worsening of baseline malnutrition and present with specific micronutrient deficiencies. Early and adequate enteral nutrition (EN) is associated with improved 60-day survival after pediatric critical illness, and, yet, despite early EN guidelines, critically ill children receive on average only 55% of goal calories by PICU day 10...
2016: Frontiers in Pediatrics
Stephanie M Wolahan, Mayumi L Prins, David L McArthur, Courtney R Real, David A Hovda, Neil A Martin, Paul M Vespa, Thomas C Glenn
BACKGROUND: The objective was to investigate the impact of targeting tight glycemic control (4.4-6.1 mM) on endogenous ketogenesis in severely head-injured adults. METHODS: The data were prospectively collected during a randomized, within-patient crossover study comparing tight to loose glycemic control, defined as 6.7-8.3 mM. Blood was collected periodically during both tight and loose glycemic control epochs. Post hoc analysis of insulin dose and total nutritional provision was performed...
October 19, 2016: Neurocritical Care
Zhongheng Zhang, Qian Li, Lingzhi Jiang, Bo Xie, Xiaowei Ji, Jiahong Lu, Ronglin Jiang, Shu Lei, Shihao Mao, Lijun Ying, Di Lu, Xiaoshui Si, Jianxin He, Mingxia Ji, Jianhua Zhu, Guodong Chen, Yadi Shao, Yinghe Xu, Ronghai Lin, Chao Zhang, Weiwen Zhang, Jian Luo, Tianzheng Lou, Xuwei He, Kun Chen, Renhua Sun
INTRODUCTION: Enteral feed is an important component of nutritional therapy in critically ill patients and underfeeding has been associated with adverse outcomes. The article developed an enteral feeding protocol and planed a before-and-after comparative trial to explore whether implementation of enteral feeding protocol was able to improve clinical outcomes. METHODS AND ANALYSIS: The study will be conducted in intensive care units (ICUs) of ten tertiary care academic centers...
August 2016: Annals of Translational Medicine
Yaseen M Arabi, Abdulaziz S Aldawood, Hasan M Al-Dorzi, Hani M Tamim, Samir H Haddad, Gwynne Jones, Lauralyn McIntyre, Othman Solaiman, Maram H Sakkijha, Musharaf Sadat, Shihab Mundekkadan, Anand Kumar, Sean M Bagshaw, Sangeeta Mehta
RATIONALE: The optimal nutritional strategy for critically ill adults at high nutritional risk is unclear. OBJECTIVE: In patients with different baseline nutritional risk, we examined the effect of permissive underfeeding with full protein intake compared to standard feeding on 90-day mortality. METHODS: This is a post-hoc analysis of the PermiT (Permissive Underfeeding versus Target Enteral Feeding in Adult Critically Ill Patients) trial...
September 2, 2016: American Journal of Respiratory and Critical Care Medicine
Siew Ling Tey, Edwin Ming En Chia, Ciarán G Forde
Numerous studies have examined energy compensation following overfeeding regimes whereas much less is known about the impact of acute underfeeding on energy compensation and fewer still have compared energy reduction and addition in the same group of individuals. This study compared the effects of consuming lunches with varying energy content (7.2-fold difference) on subsequent energy intake. A total of 27 healthy males took part in this randomized, crossover study with five treatments: 163kcal (very low energy meal, VLEM), 302kcal (low energy meal, LEM), 605kcal (control), 889kcal (high energy meal, HEM), and 1176kcal (very high energy meal, VHEM) served as a noodle soup...
October 15, 2016: Physiology & Behavior
Anders Skallerup, Louis Nygaard, Søren Schou Olesen, Lars Vinter-Jensen, Marianne Køhler, Henrik Højgaard Rasmussen
BACKGROUND AND AIMS: Intestinal failure (IF) is a serious and common complication of short bowel syndrome with patients depending on parental nutrition (PN) support. Effective nutrition management requires an accurate estimation of the patient's basal metabolic rate (BMR) to avoid underfeeding or overfeeding. However, indirect calorimetry, considered the gold standard for BMR assessment, is a time- and resource-consuming procedure. Consequently, several equations for prediction of BMR have been developed in different settings, but their accuracy in patients with IF are yet to be investigated...
June 29, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
Stephen A McClave, Panna Codner, Jayshil Patel, Ryan T Hurt, Karen Allen, Robert G Martindale
Recent clinical trials have challenged the concept that aggressive full feeding as close to goal requirements as possible is necessary in the first week following admission to the intensive care unit. While the data suggesting that permissive underfeeding is better than full feeds are methodologically flawed, other data do indicate that in certain well-defined patient populations, outcomes may be similar. The most important issues for clinicians in determining optimal nutrition therapy for critically ill patients are to carefully determine nutrition risk and differentiate nutrition from nonnutrition benefits of early enteral feeding...
August 2016: Nutrition in Clinical Practice
Carole Delavaud, Mohammed Bengoumi, Bernard Faye, Didier Levieux, Yves Chilliard
No abstract text is available yet for this article.
June 3, 2016: Comparative Biochemistry and Physiology. Part A, Molecular & Integrative Physiology
Diego Arenas Moya, Alejandra Plascencia Gaitán, Denisse Ornelas Camacho, Humberto Arenas Márquez
Hospital malnutrition is a relevant clinical issue present in about 50% of patients that is associated with increased morbidity, mortality, and cost of care. Because of the relation of malnutrition with chronic and acute inflammatory processes secondary to disease, nutrition therapy is considered an important medical treatment. However, there is little discussion about the impact of another critical issue related to hospital malnutrition, that is, lack of appropriate food or nutrition therapy given to the patients...
June 2016: Nutrition in Clinical Practice
Lizl Veldsman, Guy A Richards, Renee Blaauw
OBJECTIVE: Optimal protein delivery in the intensive care unit (ICU) may offer a significant mortality benefit, whereas energy overfeeding leads to worse outcomes. The aim of the present study was to assess actual protein versus energy delivery in a multidisciplinary adult ICU. METHODS: We conducted a retrospective review of ICU charts to determine total protein delivery and energy delivery, inclusive of non-nutritional energy sources (NNES), from admission until a maximum of 7 d...
September 2016: Nutrition
Claire Grant, Edward Mark Smith, Laura Elizabeth Green
A 2-year prospective, longitudinal study of 10 suckler sheep flocks in Great Britain was run to identify factors associated with acute mastitis (AM) and chronic mastitis, and their impact on lamb growth rate. Data were collected on AM, intramammary masses (IMM; a marker for chronic mastitis), udder and teat conformation, teat lesions, body condition, ewe nutrition, litter size, lamb weight and general flock management. Each flock was visited twice each year, approximately 4 weeks before lambing and 9 weeks into lactation, for two years and all ewes present at a visit were examined...
May 1, 2016: Preventive Veterinary Medicine
Yara M F Moreno, Daniela B Hauschild, Eliana Barbosa, Nilzete L Bresolin, Nilesh M Mehta
BACKGROUND: Optimal nutrition therapy (NT) delivery is associated with improved outcomes in critically ill children. However, avoidable barriers impede delivery of optimal energy and protein in the pediatric intensive care unit (PICU). This study aims to describe the gap between energy and protein prescription and actual intake. METHODS: Single-center prospective cohort study, including consecutive children (age: 1 month to 15 years) admitted to the PICU in southern Brazil...
October 2016: Nutrition in Clinical Practice
Mariëlle van Zelst, Myriam Hesta, Kerry Gray, Karen Beech, An Cools, Lucille G Alexander, Gijs Du Laing, Geert P J Janssens
There is a growing concern for the long-term health effects of selenium (Se) over- or underfeeding. The efficiency of utilization of dietary Se is subject to many factors. Our study in dogs evaluated the effect of diet type (canned versus kibble) and dietary protein concentration on Se digestibility and bioactivity. Canned and kibble diets are commonly used formats of dog food, widely ranging in protein concentration. Twenty-four Labrador retrievers were used and four canned and four kibble diets were selected with crude protein concentrations ranging from 10...
2016: PloS One
Manuel Salas, Carmen Torrero, Mirelta Regalado, Lorena Rubio
In altricial species, early pre- and neonatal undernutrition interferes with the neuronal organization of several brain structures that have critical time windows for synaptic organization, including the prefrontal cortex. In Golgi-Cox stained tissue the basilar dendritic arbor of pyramidal neurons in the anterior cingulate cortex of early underfed adult lactating dams was evaluated. The anterior cingulate of the rat plays a major role in the execution of sexual, maternal and visual attentional control and other cognitive responses...
2015: Acta Neurobiologiae Experimentalis
Stephen A McClave, John K DiBaise, Gerard E Mullin, Robert G Martindale
The value of nutrition therapy for the adult hospitalized patient is derived from the outcome benefits achieved by the delivery of early enteral feeding. Nutritional assessment should identify those patients at high nutritional risk, determined by both disease severity and nutritional status. For such patients if they are unable to maintain volitional intake, enteral access should be attained and enteral nutrition (EN) initiated within 24-48 h of admission. Orogastric or nasogastric feeding is most appropriate when starting EN, switching to post-pyloric or deep jejunal feeding only in those patients who are intolerant of gastric feeds or at high risk for aspiration...
March 2016: American Journal of Gastroenterology
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