Flower, L;
Haines, RW;
McNelly, A;
Bear, DE;
Koelfat, K;
Damink, SO;
Hart, N;
... Puthucheary, Z; + view all
(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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Montgomery_Supplementary_material_JPEN_Final_Version.pdf - Accepted Version Access restricted to UCL open access staff until 20 September 2022. Download (379kB) |
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Montgomery_IvC_UCR_JPEN_Final_Version.pdf - Accepted Version Access restricted to UCL open access staff until 20 September 2022. Download (1MB) |
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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