Sagun Eylul, Akyol Asli, Kaymak Cetin
Faculty of Health Sciences, Department of Nutrition and Dietetics, Hacettepe University, Ankara, 06100, Turkey.
Gülhane Faculty of Medicine, Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Training and Research Hospital, Intensive Care Unit, Ankara, 06230, Turkey.
Nutr Rev. 2025 Mar 1;83(3):e1146-e1157. doi: 10.1093/nutrit/nuae078.
Circadian rhythms in humans are biological rhythms that regulate various physiological processes within a 24-hour time frame. Critical illness can disrupt the circadian rhythm, as can environmental and clinical factors, including altered light exposure, organ replacement therapies, disrupted sleep-wake cycles, noise, continuous enteral feeding, immobility, and therapeutic interventions. Nonpharmacological interventions, controlling the ICU environment, and pharmacological treatments are among the treatment strategies for circadian disruption. Nutrition establishes biological rhythms in metabolically active peripheral tissues and organs through appropriate synchronization with endocrine signals. Therefore, adhering to a feeding schedule based on the biological clock, a concept known as "chrononutrition," appears to be vitally important for regulating peripheral clocks. Chrononutritional approaches, such as intermittent enteral feeding that includes overnight fasting and consideration of macronutrient composition in enteral solutions, could potentially restore circadian health by resetting peripheral clocks. However, due to the lack of evidence, further studies on the effect of chrononutrition on clinical outcomes in critical illness are needed. The purpose of this review was to discuss the role of chrononutrition in regulating biological rhythms in critical illness, and its impact on clinical outcomes.
人类的昼夜节律是在24小时时间框架内调节各种生理过程的生物节律。危重病会扰乱昼夜节律，环境和临床因素也会如此，包括光照改变、器官替代疗法、睡眠-觉醒周期紊乱、噪音、持续肠内喂养、活动受限以及治疗干预。非药物干预、控制重症监护病房环境和药物治疗是昼夜节律紊乱的治疗策略。营养通过与内分泌信号适当同步，在代谢活跃的外周组织和器官中建立生物节律。因此，遵循基于生物钟的喂养计划，即“时间营养学”这一概念，对于调节外周生物钟似乎至关重要。时间营养方法，如包括夜间禁食的间歇性肠内喂养以及考虑肠内溶液中的宏量营养素组成，可能通过重置外周生物钟来恢复昼夜节律健康。然而，由于缺乏证据，需要进一步研究时间营养学对危重病临床结局的影响。本综述的目的是讨论时间营养学在调节危重病生物节律中的作用及其对临床结局的影响。
