Article | Published:

Clinical nutrition

Different enteral nutrition formulas have no effect on glucose homeostasis but on diet-induced thermogenesis in critically ill medical patients: a randomized controlled trial

European Journal of Clinical Nutritionvolume 72pages496503 (2018) | Download Citation

Abstract

Background/Objectives

Hyperglycemia is common in critically ill patients and associated with increased mortality. It has been suggested that different nutrition formulas may beneficially influence glucose levels in surgical intensive care patients. In this prospective randomized clinical cohort study we investigated glucose homeostasis in response to different enteral nutrition formulas in medical critically ill patients.

Subjects/Methods

60 medical critically ill patients were randomized to receive continuous fat-based (group A, n = 30) or glucose-based enteral nutrition (group B, n = 30) for seven days. Indirect calorimetry was performed to determine energy demand at baseline and on days 3 and 7. Glucose levels and area under the curve (AUC), insulin demand, glucose variability, and calorie and substrate intake per 24 h were assessed for 7 days.

Results

Over the course of 7 days patients had similar average daily glucose (p = 0.655), glucose AUC (A: 758 (641–829) mg/dl/day vs B: 780 (733–845) mg/dl/day, p = 0.283), similar overall insulin demand (A: 153.5 (45.3–281.5) IE vs B: 167.9 (82.3–283.8) IE, p = 0.525), and received similar amounts of enteral nutrition per 24 h. Resting energy expenditure was similar at baseline (A: 1556 (1227–1808) kcal/day vs B: 1563 (1306–1789) kcal/day, p = 0.882) but energy expenditure increased substantially over time in group A (p < 0.0001), but not in group B (p = 0.097).

Conclusion

Fat-based and glucose-based EN influence glucose homeostasis and insulin demand similarly, yet diet-induced thermogenesis was substantially higher in critically ill patients receiving fat-based enteral nutrition.

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Acknowledgements

Funding

This study was supported by a scientific grant of Fresenius Kabi, Austria.

Author information

Affiliations

  1. Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Intensive Care Unit, Waehringer Guertel 18-20, 1090, Vienna, Austria

    • Marlene Wewalka
    • , Andreas Drolz
    • , Berit Seeland
    • , Mathias Schneeweiss
    • , Monika Schmid
    •  & Christian Zauner
  2. Department of Internal Medicine, LKH Kirchdorf, Hausmanningerstrasse 8, 4560, Kirchdorf, Austria

    • Bruno Schneeweiss

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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Marlene Wewalka.

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DOI

https://doi.org/10.1038/s41430-018-0111-4