Division of Medical Intensive Care, Department of Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
Department of Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
Turk J Med Sci. 2020 Jun 23;50(4):877-884. doi: 10.3906/sag-1911-165.
BACKGROUND/AIM: Adipokines play an important role in the regulation of metabolism. In critical illness, they alter serum levels and are suspected to worsen clinical outcomes. But the effect of the route of nutrition on adipokines is not known. The purpose of this study was to evaluate the association between the route of nutrition and adipokine levels in critically ill patients.
This prospective study was performed in an intensive care unit (ICU). Patients admitted to the ICU for least 72 h and receiving either enteral nutrition (EN) via tube feeding or parenteral nutrition (PN) were enrolled. Serum was obtained at baseline, 24 h, and 72 h for concentrations of leptin, adiponectin, resistin, glucagon–like peptide 1 (GLP–1), insulin–like growth factors 1 (IGF–1), and ghrelin.
A total of 26 patients were included in the study. Thirteen patients received EN and 13 patients received PN. In the PN group, leptin level significantly increased (P = 0.037), adiponectin and ghrelin significantly decreased during follow up (P = 0.037, P = 0.008, respectively). There was no significant change between all adipokines in the EN group and resistin, IGF–1 and GLP–1 in the PN group during follow up. Resistin levels were markedly lower in the EN group at both 24 h (P = 0.015) and 72 h (P = 0.006) while GLP–1 levels were higher in the EN group at baseline, 24 h, and 72 h (P = 0.018, P = 0.005, and P = 0.003, respectively). There were no differences in leptin, adiponectin, IGF–1, and ghrelin levels over time.
The delivery of EN in critical illness was associated with decreased resistin levels and increased GLP–1 levels. Thus, the route of nutrition may impact the clinical outcome in critical illness due to adipokines.
背景/目的：脂肪因子在代谢调节中起着重要作用。在危重病中，它们改变血清水平，被怀疑会使临床结果恶化。但是，营养途径对脂肪因子的影响尚不清楚。本研究的目的是评估危重病患者营养途径与脂肪因子水平之间的关系。
这是一项在重症监护病房（ICU）进行的前瞻性研究。纳入至少入住 ICU 72 小时并接受管饲肠内营养（EN）或肠外营养（PN）的患者。在基线、24 小时和 72 小时采集血清，以检测瘦素、脂联素、抵抗素、胰高血糖素样肽 1（GLP-1）、胰岛素样生长因子 1（IGF-1）和胃饥饿素的浓度。
共纳入 26 例患者。13 例患者接受 EN，13 例患者接受 PN。在 PN 组中，瘦素水平在随访过程中显著升高（P = 0.037），脂联素和胃饥饿素显著降低（P = 0.037，P = 0.008）。在 EN 组中，所有脂肪因子在随访期间均无明显变化，而在 PN 组中，抵抗素、IGF-1 和 GLP-1 也无明显变化。在 24 小时（P = 0.015）和 72 小时（P = 0.006）时，EN 组的抵抗素水平明显更低，而在基线、24 小时和 72 小时时，EN 组的 GLP-1 水平更高（P = 0.018，P = 0.005，P = 0.003）。瘦素、脂联素、IGF-1 和胃饥饿素水平在不同时间点无差异。
危重病患者接受 EN 治疗与抵抗素水平降低和 GLP-1 水平升高有关。因此，营养途径可能会因脂肪因子而影响危重病患者的临床结局。
