Different enteral nutrition formulas have no effect on glucose homeostasis but on diet-induced thermogenesis in critically ill medical patients: a randomized controlled trial.

Eur J Clin Nutr 2018 04 19;72(4):496-503. Epub 2018 Feb 19.

Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Intensive Care Unit, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Background/objectives: Hyperglycemia is common in critically ill patients and associated with increased mortality. It has been suggested that different nutrition formulas may beneficially influence glucose levels in surgical intensive care patients. In this prospective randomized clinical cohort study we investigated glucose homeostasis in response to different enteral nutrition formulas in medical critically ill patients.

Subjects/methods: 60 medical critically ill patients were randomized to receive continuous fat-based (group A, n = 30) or glucose-based enteral nutrition (group B, n = 30) for seven days. Indirect calorimetry was performed to determine energy demand at baseline and on days 3 and 7. Glucose levels and area under the curve (AUC), insulin demand, glucose variability, and calorie and substrate intake per 24 h were assessed for 7 days.

Results: Over the course of 7 days patients had similar average daily glucose (p = 0.655), glucose AUC (A: 758 (641-829) mg/dl/day vs B: 780 (733-845) mg/dl/day, p = 0.283), similar overall insulin demand (A: 153.5 (45.3-281.5) IE vs B: 167.9 (82.3-283.8) IE, p = 0.525), and received similar amounts of enteral nutrition per 24 h. Resting energy expenditure was similar at baseline (A: 1556 (1227-1808) kcal/day vs B: 1563 (1306-1789) kcal/day, p = 0.882) but energy expenditure increased substantially over time in group A (p < 0.0001), but not in group B (p = 0.097).

Conclusion: Fat-based and glucose-based EN influence glucose homeostasis and insulin demand similarly, yet diet-induced thermogenesis was substantially higher in critically ill patients receiving fat-based enteral nutrition.

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41430-018-0111-4DOI Listing
April 2018
13 Reads

Publication Analysis

Top Keywords

enteral nutrition
16
critically ill
16
nutrition formulas
12
ill patients
8
glucose levels
8
medical critically
8
glucose homeostasis
8
energy expenditure
8
insulin demand
8
group n = 30
8
patients randomized
8
glucose
7
patients
5
calorie substrate
4
glucose variability
4
demand glucose
4
variability calorie
4
assessed daysresults
4
days patients
4
patients average
4

References

(Supplied by CrossRef)

KG Kreymann et al.
Clin Nutr 2006

P Singer et al.
Clin Nutr 2009

C Faisy et al.
Br J Nutr 2009

P Singer et al.
Intensive Care Med 2011

R Anbar et al.
World Rev Nutr Diet 2013

KM Dungan et al.
Lancet 2009

A Zauner et al.
Metabolism 2007

L Tappy et al.
Crit Care Med 1998

G Huschak et al.
Intensive Care Med 2005

JR Gall Le et al.
JAMA 1993

JL Vincent et al.
Crit Care Clin 2000

Similar Publications