Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
Curr Opin Crit Care. 2019 Aug;25(4):356-362. doi: 10.1097/MCC.0000000000000617.
To balance theoretical pros and cons of intermittent feeding, in light of the current nutritional management early during critical illness.
Less aggressive nutrient administration is clinically superior in acute critical illness. This counterintuitive clinical finding may be explained by nutrient restriction activating autophagy, a process that clears intracellular damage. Intermittent feeding holds numerous theoretical benefits, such as activation of autophagy, preservation of the circadian rhythm, increased protein synthesis, and enhanced endogenous fatty acids release. RCTs investigating intermittent feeding in the ICU, however, are the most often limited to evaluation of gastrointestinal complications. Current guidelines advocate against the use of intermittent feeding, based on lack of benefit and increased risk of diarrhea, as revealed by a meta-analysis.
Benefits of intermittent feeding in the ICU are today speculative, yet its potential impact may reach far beyond the gastrointestinal tract. Only adequately powered RCTs, evaluating both gastrointestinal tolerance, metabolic impact and patient-centered effects of intermittent feeding will allow to adopt or abort this nutritional strategy.
鉴于目前危重疾病早期的营养管理，权衡间歇性喂养的理论利弊。
在急性危重病中，不那么积极的营养管理在临床上更具优势。这种违背直觉的临床发现可以通过营养限制激活自噬来解释，自噬是一种清除细胞内损伤的过程。间歇性喂养具有许多理论上的好处，如激活自噬、维持昼夜节律、增加蛋白质合成和增强内源性脂肪酸释放。然而，ICU 中间歇性喂养的 RCT 研究最常仅限于评估胃肠道并发症。目前的指南基于荟萃分析显示的缺乏益处和增加腹泻风险，不主张使用间歇性喂养。
间歇性喂养在 ICU 中的益处目前还只是推测性的，但它的潜在影响可能远远超出胃肠道。只有足够有力的 RCT 研究，评估间歇性喂养的胃肠道耐受性、代谢影响和以患者为中心的效果，才能使这种营养策略得到采纳或放弃。
