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Intermittent or continuous feeding

any difference during the first week?

Van Dyck, Lisa; Casaer, Michaël P.

Current Opinion in Critical Care: August 2019 - Volume 25 - Issue 4 - p 356–362
doi: 10.1097/MCC.0000000000000617
METABOLIC SUPPORT: Edited by Mette M. Berger
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Purpose of review To balance theoretical pros and cons of intermittent feeding, in light of the current nutritional management early during critical illness.

Recent findings Less aggressive nutrient administration is clinically superior in acute critical illness. This counterintuitive clinical finding may be explained by nutrient restriction activating autophagy, a process that clears intracellular damage. Intermittent feeding holds numerous theoretical benefits, such as activation of autophagy, preservation of the circadian rhythm, increased protein synthesis, and enhanced endogenous fatty acids release. RCTs investigating intermittent feeding in the ICU, however, are the most often limited to evaluation of gastrointestinal complications. Current guidelines advocate against the use of intermittent feeding, based on lack of benefit and increased risk of diarrhea, as revealed by a meta-analysis.

Summary Benefits of intermittent feeding in the ICU are today speculative, yet its potential impact may reach far beyond the gastrointestinal tract. Only adequately powered RCTs, evaluating both gastrointestinal tolerance, metabolic impact and patient-centered effects of intermittent feeding will allow to adopt or abort this nutritional strategy.

Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium

Correspondence to Michaël P. Casaer, MD, PhD, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium. Tel: +32 16 348786; fax: +32 16 344015; e-mail: michael.casaer@uzleuven.be

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