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Publication Detail
Effect of intermittent or continuous feeding and amino acid concentration on urea-to-creatinine ratio in critical illness
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Article
  • Authors:
    Flower L, Haines RW, McNelly A, Bear DE, Koelfat K, Damink SO, Hart N, Montgomery H, Prowle JR, Puthucheary Z
  • Publication date:
    01/05/2022
  • Journal:
    Journal of Parenteral and Enteral Nutrition
  • Status:
    Published
  • Print ISSN:
    0148-6071
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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