Comparison of the effects of continuous versus intermittent enteral feeding on plasma leptin and ghrelin levels in Intensive Care Units
Keywords:
Energy metabolism, Enteral nutrition, Ghrelin, LeptinAbstract
Objective
The aim of this prospective randomized trial is to verify whether there is an association between the methods of administration of enteral nutrition and the leptin and ghrelin hormones, which have a major role in the regulation of energy metabolism.
Methods
This study enrolled 38 enteral-fed patients aged 18 to 85 in the Intensive Care Unit. The patients were prospectively randomized to receive either continuous infusion (n=19) or intermittent feeding (n=18) of enteralnutrition. In addition to routine biochemical assays, blood samples were taken from the patients for leptin and ghrelin analyses on the 1th, 7th, and 14th days of enteral nutrition.
Results
There was no statistically significant difference between the groups regarding descriptive statistics and categorical variables such as underlying diseases, complications, steroid use and others (p>0.05). The decreasein the number of white blood cells and in creatinine and C-reactive protein levels over time were statistically significant (p=0.010, p=0.026, p<0.001 respectively). There was no statistically significant difference between
the groups with respect to leptin and ghrelin levels (p=0.982 and p=0.054). Leptin levels did not change over
time; however, the ghrelin levels of both groups were significantly higher on the 7th and 14th days than on the
first day of analysis (p=0.003).
Conclusion
This study revealed that both continuous and intermittent enteral nutrition feeding regimens were well tolerated in Intensive Care Unit patients showing minor complications. The method of administration of enteral nutrition alone did not affect the leptin and ghrelin levels. Randomized controlled large cohort trials are needed to to compare intermittent and continuous enteral nutrition to determine which one is more adaptable to diurnal patterns of secretion metabolic hormones.
References
Park HK, Ahima RS. Physiology of leptin: Energy homeostasis, neuroendocrine function and metabolism. Metabolism. 2015;64(1):24-34. https://doi.org/10.1016/j.metabol.2014.08.004
Paz-Filho G, Mastronardi CA, Licinio J. Leptin treatment: Facts and expectations. Metabolism. 2015;64(1):146-56. https://doi.org/10.1016/j.metabol.2014.07.014
Müller TD, Nogueiras R, Andermann ML, Andrews ZB, Anker SD, Argente J, et al. Ghrelin. Mol Metab. 2015;4(6):437-60. https://doi.org/10.1016/j.molmet.2015.03.005
Kasacka I, Arciszewski M, Łebkowski W. Extraordinary level of hormone and number of ghrelin cells in the stomach and duodenum of an obese woman. Acta Histochem. 2014;116(1):230-4. https://doi.org/10.1016/j.acthis.2013.05.007
Bowers DF. The initiation and progression of tube feeding. In: Zaloga GP, editor. Nutrition in critical care. Saint Louis: Mosby; 1994. p.361-9.
Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957;19(5):823-32.
Stratton RJ, Stubbs RJ, Elia M. Bolus tube feeding suppresses food intake and circulating ghrelin concentrations in healthy subjects in a shortterm placebo-controlled trial. Am J Clin Nutr. 2008;88(1):77-83.
Klok MD, Jakobsdottir S, Drent ML. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: A review. Obes Rev. 2007;8(1):21-34.
Licinio J, Negrão AB, Mantzoros C, Kaklamani V, Wong ML, Bongiorno PB, et al. Synchronicity of frequently sampled, 24-h concentrations of circulating leptin, luteinizing hormone, and estradiol in healthy women. Proc Natl AcadSci. 1998;95(5):2541-6.
Meier U, Gressner AM. Endocrine regulation of energy metabolism: Review of pathobiochemical and clinical chemical aspects of leptin, ghrelin, adiponectin, and resistin. Clin Chem. 2004;50(9):1511-25.
Schoeller DA, Cella LK, Sinha MK, Caro JF. Entrainment of the diurnal rhythm of plasma leptin to meal timing. J Clin Invest. 1997;100(7):1882-7.
Ariyasu H, Takaya K, Tagami T, Ogaw Y, Hosada K, Akamizu T, et al. Stomach is a major source of circulating ghrelin, and feding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab. 2001;86(10):4753-8.
Sato T, Nakamura Y, Shiimura Y, Ohgusu H, Kangawa K, Kojima M. Structure, regulation and function of ghrelin. J Biochem. 2012;151(2):119-28. https://doi.org/10.1093/jb/mvr134
Massanet PL, Petit L, Louart B, Corne P, Richard C, Preiser JC. Nutrition rehabilitation in the intensive care unit. JPEN J Parenter Enteral Nutr. 2015;39(4):391-400. https://doi.org/10.1177/0148607114567901
Stratton RJ, Stubbs RJ, Elia M. Short-term continuous enteral tube feding schedules do not suppress appetite and food intake in healthy men in a placebo-controlled trial. J Nutr. 2003;133(8):2570-6.
Kadamani I, Itani M, Zahran E, Taha N. Incidence of aspiration and gastrointestinal complications in critically ill patients using continuous versus bolus infusion of enteral nutrition: A pseudo-randomised controlled trial. Aust Crit Care. 2014;27(4):188-93.
https://doi.org/10.1016/j.aucc.2013.12.001
Tavares de Araujo VM, Gomes PC, Caporossi C. Enteral nutrition in critical patients; should the administration be continuous or intermittent? Nutr Hosp. 2014;29(3):563-7. https://doi.org/10.3305/nh.2014.29.3.7169
David A, Lloyd J, Powell-Tuck J. Artificial nutrition: Principles and practice of enteral feeding. Clin Colon Rectal Surg. 2004;17(2):107-18. https://doi.org/10.1055/s-2004-828657
Aguilera-Martinez R, Ramis-Ortega E, Carratala-Munuera C, Fernandez-Medina JM, Saiz-Vinuesa MD, Barrado-Narvion MJ. Effectiveness of continuous enteral nutrition versus intermittent enteral nutrition in intensive care patients: A systematic review. JBI Database System Rev Implement Rep. 2014;12(1):281-317.
Yousry A. Continuous versus bolus infusion of enteral nutrition in intensive care unit. AAMJ. 2012;10(3):Suppl-2.
Serpa LF, Kimura M, Faintuch J, Ceconello I. Effects of continuous versus bolus infusion of enteral nutrition in critical patients. Rev Hosp Clin Fac Med São Paulo. 2003;58(1):9-14.
Yousef AA, Amr YM, Suliman GA. The diagnostic value of serum leptin monitoring and its correlation with tumor necrosis factor-alpha in critically ill patients: A prospective observational study. Crit Care. 2010;14(2):R33. https://doi.org/10.1186/cc8911
Tzanela M, Orfanos SE, Tsirantonaki M, Kotanidou A, Sotiropoulou Ch, Christophoraki M, et al. Leptin alterations in the course of sepsis in humans. In Vivo. 2006;20(4):565-70.
Yu PJ, Cassiere HA, Dellis SL, Manetta F, Kohn N, Hartman AR. Impact of preoperative prealbumin on outcomes after cardiac surgery. J Parenter Enteral Nutr. 2015;39(7):870-4. https://doi.org/10.1177/0148607114536735
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Özgür YAĞAN, Nilay TAŞ, Sema Nur AYYILDIZ, Murat KARAKAHYA, Tevfik NOYAN
This work is licensed under a Creative Commons Attribution 4.0 International License.
