Flower, L; Haines, RW; McNelly, A; Bear, DE; Koelfat, K; Damink, SO; Hart, N; ... Puthucheary, Z; + view all Flower, L; Haines, RW; McNelly, A; Bear, DE; Koelfat, K; Damink, SO; Hart, N; Montgomery, H; Prowle, JR; Puthucheary, Z; - view fewer (2021) Effect of intermittent or continuous feeding and amino acid concentration on urea-to-creatinine ratio in critical illness. Journal of Parenteral and Enteral Nutrition 10.1002/jpen.2258. (In press).

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Abstract

BACKGROUND: We sought to determine whether peaks in essential amino acid (EAA) concentration associated with intermittent feeding may provide anabolic advantages when compared with continuous feeding regimens in critical care. METHODS: We performed a secondary analysis of data from a multicenter trial of UK intensive care patients randomly assigned to intermittent or continuous feeding. A linear mixed-effects model was developed to assess differences in urea-creatinine ratio (raised values of which can be a marker of muscle wasting) between arms. To investigate metabolic phenotypes, we performed k-means urea-to-creatinine ratio trajectory clustering. Amino acid concentrations were also modeled against urea-to-creatinine ratio from day 1 to day 7. The main outcome measure was serum urea-to-creatinine ratio (millimole per millimole) from day 0 to the end of the 10-day study period. RESULTS: Urea-to-creatinine ratio trajectory differed between feeding regimens (coefficient -.245; P = .002). Patients receiving intermittent feeding demonstrated a flatter urea-to-creatinine ratio trajectory. With k-means analysis, the cluster with the largest proportion of continuously fed patients demonstrated the steepest rise in urea-to-creatinine ratio. Neither protein intake per se nor serum concentrations of EAA concentrations were correlated with urea-to-creatinine ratio (coefficient = .088 [P = .506] and coefficient <.001 [P = .122], respectively). CONCLUSION: Intermittent feeding can mitigate the rise in urea-to-creatinine ratio otherwise seen in those continuously fed, suggesting that catabolism may have been, to some degree, prevented.

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