NUTRITION AND THE INTENSIVE CARE UNIT: Edited by Peter J.M. Weijs and Stephen A. McClavePreservation of autophagy should not direct nutritional therapyMcClave, Stephen A.a; Weijs, Peter J.M.bAuthor Information aDepartment of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA bDepartments of Nutrition and Dietetics, Internal medicine, and Intensive Care Medicine, Vu University Medical Center and Department of Nutrition and Dietetics, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands Correspondence to Stephen A. McClave, MD, Professor of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville School of Medicine, Louisville, KY 40202, USA. Tel: +1 502 852 7963; fax: +1 502 852 0846; e-mail: [email protected] Current Opinion in Clinical Nutrition and Metabolic Care: March 2015 - Volume 18 - Issue 2 - p 155-161 doi: 10.1097/MCO.0000000000000144 Buy Metrics Abstract Purpose of review Recent reports in the literature have proposed that forced mandatory feeding should be avoided in the first week of critical illness to preserve autophagy, in order to maximize responses to oxidative stress, preserve organ function, and improve outcomes. Recent findings Autophagy is a well recognized physiologic process that serves a housekeeping role for the cell to eliminate large protein aggregates and as a survival mechanism in starvation for generating energy (ATP) and promoting protein synthesis to maintain cell structure. In the critical care setting, autophagy may have important roles in modulating immune function, fighting infection, and preventing organ failure. The effect of feeding on autophagy is complex, poorly understood, and difficult to predict. Summary The argument to withhold feeding to preserve autophagy is poorly substantiated and should not interfere with the delivery of early enteral nutrition to the critically ill patient in that first week following admission to the ICU. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.