Chiu Yu-Hsiang, Sharma Anushka, Dashti Hassan S
Department of Nutrition and Food Services.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital.
Curr Opin Clin Nutr Metab Care. 2025 Mar 1;28(2):134-139. doi: 10.1097/MCO.0000000000001104. Epub 2024 Dec 23.
The human circadian system regulates several physiological processes, including metabolism, which becomes significantly disrupted during critical illness. The common use of 24-h continuous nutrition support feeding in the intensive care unit (ICU) may further exacerbate these disruptions; this review evaluates recent evidence comparing continuous and intermittent feeding schedules in critically ill adults.
Research comparing different feeding schedules in critically ill adults remains limited. Recent meta-analyses suggest that continuous and intermittent feeding schedules in the ICU have comparable adverse event profiles, including gastrointestinal intolerance. A retrospective study found that continuous feeding did not impact the 24-h glucose variation in critically ill adults, and a randomized controlled trial reported no significant differences in amino acid, lipid-based, or small molecule metabolite profiles between the two feeding regimens. Potential benefits of intermittent feeding include stimulation of muscle protein synthesis, preservation of normal hormone secretion, and improved attainment of nutritional goals.
Current evidence suggests comparable safety profiles for continuous and intermittent feeding schedules in critically ill adult patients. However, intermittent and daytime cyclic feeding are expected to align more closely with normal circadian physiology. Given the lack of existing supportive data, a dynamic approach - transitioning from continuous feeding in the early-acute metabolic phase to intermittent feeding or daytime cyclic feeding - may be appropriate.
人体昼夜节律系统调节包括新陈代谢在内的多种生理过程，而在危重症期间这些生理过程会受到显著干扰。重症监护病房（ICU）中普遍采用的24小时持续营养支持喂养可能会进一步加剧这些干扰；本综述评估了近期关于比较危重症成年患者持续喂养和间歇喂养方案的证据。
比较危重症成年患者不同喂养方案的研究仍然有限。近期的荟萃分析表明，ICU中的持续喂养和间歇喂养方案具有相似的不良事件特征，包括胃肠道不耐受。一项回顾性研究发现，持续喂养对危重症成年患者的24小时血糖变化没有影响，一项随机对照试验报告称，两种喂养方案在氨基酸、脂质或小分子代谢物谱方面没有显著差异。间歇喂养的潜在益处包括刺激肌肉蛋白质合成、维持正常激素分泌以及更好地实现营养目标。
目前的证据表明，危重症成年患者的持续喂养和间歇喂养方案具有相似的安全性。然而，间歇喂养和日间循环喂养预计与正常昼夜节律生理学更为契合。鉴于缺乏现有的支持性数据，一种动态方法——从急性代谢早期的持续喂养过渡到间歇喂养或日间循环喂养——可能是合适的。
