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Impact of Early Parenteral Nutrition on Muscle and Adipose Tissue Compartments During Critical Illness*

Casaer, Michael P. MD, PhD1; Langouche, Lies PhD1; Coudyzer, Walter MSc2; Vanbeckevoort, Dirk MD2; De Dobbelaer, Bart Ing2; Güiza, Fabian G. PhD1; Wouters, Pieter J. MSc1; Mesotten, Dieter MD, PhD1; Van den Berghe, Greet MD, PhD1

doi: 10.1097/CCM.0b013e31828cef02
Clinical Investigations

Objective: The goal of enhanced nutrition in critically ill patients is to improve outcome by reducing lean tissue wasting. However, such effect has not been proven. This study aimed to assess the effect of early administration of parenteral nutrition on muscle volume and composition by repeated quantitative CT.

Design: A preplanned substudy of a randomized controlled trial (Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients [EPaNIC]), which compared early initiation of parenteral nutrition when enteral nutrition was insufficient (early parenteral nutrition) with tolerating a pronounced nutritional deficit for 1 week in ICU (late parenteral nutrition). Late parenteral nutrition prevented infections and accelerated recovery.

Setting: University hospital.

Patients: Fifteen EPaNIC study neurosurgical patients requiring prescheduled repeated follow-up CT scans and six healthy volunteers matched for age, gender, and body mass index.

Intervention: Repeated abdominal and femoral quantitative CT images were obtained in a standardized manner on median ICU day 2 (interquartile range, 2–3) and day 9 (interquartile range, 8–10). Intramuscular, subcutaneous, and visceral fat compartments were delineated manually. Muscle and adipose tissue volume and composition were quantified using standard Hounsfield Unit ranges.

Measurements and Main Results: Critical illness evoked substantial loss of femoral muscle volume in 1 week’s time, irrespective of the nutritional regimen. Early parenteral nutrition reduced the quality of the muscle tissue, as reflected by the attenuation, revealing increased intramuscular water/lipid content. Early parenteral nutrition also increased the volume of adipose tissue islets within the femoral muscle compartment. These changes in skeletal muscle quality correlated with caloric intake. In the abdominal muscle compartments, changes were similar, albeit smaller. Femoral and abdominal subcutaneous adipose tissue compartments were unaffected by disease and nutritional strategy.

Conclusions: Early parenteral nutrition did not prevent the pronounced wasting of skeletal muscle observed over the first week of critical illness. Furthermore, early parenteral nutrition increased the amount of adipose tissue within the muscle compartments.

Supplemental Digital Content is available in the text.

1Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium.

2Department of Radiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.

* See also p. 2439.

Drs. Casaer and Langouche contributed equally.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Supported, in part, by Research Foundation Flanders, Belgium (FWO).

Dr. Casaer is a doctoral fellow, holds a clinical fellowship, received grant support from FWO and Baxter SA, and lectured for Baxter SA. Dr. Mesotten holds a senior clinical investigatorship from the FWO, is supported by the Research Foundation Flanders, received government funding from the Methusalem Programme, and received grant support from Baxter Healthcare (non-restrictive grant). Dr. Van den Berghe holds an ERC Advance Research Grant (EU-ERC321670), is supported by the Methusalem program of the Flemish Government, and received grant support from Baxter Healtcare (non-restrictive grant). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins