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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 Nutrition volume 72, pages 496–503 (2018)Cite this article

Subjects

A Correction to this article was published on 06 August 2018

This article has been updated

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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Change history

  • 06 August 2018

    A correction to this article has been published.

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Funding

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

Author information

Authors and 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

Authors
  1. Marlene Wewalka
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  2. Andreas Drolz
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  3. Berit Seeland
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  4. Mathias Schneeweiss
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  6. Bruno Schneeweiss
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  7. Christian Zauner
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Corresponding author

Correspondence to Marlene Wewalka.

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The authors declare that they have no conflict of interest.

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Wewalka, M., Drolz, A., Seeland, B. et al. Different enteral nutrition formulas have no effect on glucose homeostasis but on diet-induced thermogenesis in critically ill medical patients: a randomized controlled trial. Eur J Clin Nutr 72, 496–503 (2018). https://doi.org/10.1038/s41430-018-0111-4

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