Comparison of the effects of continuous versus intermittent enteral feeding on plasma leptin and ghrelin levels in Intensive Care Units

Abstract

Objective: The aim of this prospective randomized trial is to verify whether there is an association between the methods of administration of enteral nutrition and the leptin and ghrelin hormones, which have a major role in the regulation of energy metabolism. Methods: This study enrolled 38 enteral-fed patients aged 18 to 85 in the Intensive Care Unit. The patients were prospectively randomized to receive either continuous infusion (n=19) or intermittent feeding (n=18) of enteral nutrition. In addition to routine biochemical assays, blood samples were taken from the patients for leptin and ghrelin analyses on the 1th, 7th, and 14th days of enteral nutrition. Results: There was no statistically significant difference between the groups regarding descriptive statistics and categorical variables such as underlying diseases, complications, steroid use and others (p>0.05). The decrease in the number of white blood cells and in creatinine and C-reactive protein levels over time were statistically significant (p=0.010, p=0.026, p<0.001 respectively). There was no statistically significant difference between the groups with respect to leptin and ghrelin levels (p=0.982 and p=0.054). Leptin levels did not change over time; however, the ghrelin levels of both groups were significantly higher on the 7th and 14th days than on the first day of analysis (p=0.003). Conclusion: This study revealed that both continuous and intermittent enteral nutrition feeding regimens were well tolerated in Intensive Care Unit patients showing minor complications. The method of administration of enteral nutrition alone did not affect the leptin and ghrelin levels. Randomized controlled large cohort trials are needed to to compare intermittent and continuous enteral nutrition to determine which one is more adaptable to diurnal patterns of secretion metabolic hormones.

The association between the route of nutrition and serum levels of adipokines in critical illness: a pilot study

“…In a study, critical patients who were received continuous enteral nutrition were followed for 14 days. Similarly to our findings, the level of leptin increased during follow up, but was higher than our patients [23]. In our study, the PN group had higher malnutrition risk than the EN group according to the NUTRIC score.…”

“…Similar to our study, in a study conducted in critical patients fed enterally, the level of ghrelin increased in a similar follow up period. However, the level of ghrelin was lower in our patients [23]. Because the increase in the EN group might be associated with the release of ghrelin by gastric oxyntic cells.…”

“…Patient demographic data are presented in Table 1. The median APACHE-II score was 24 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) and the median SOFA score was 4.0 (0-13.0) at admission to ICU (Table 1).…”

Safety and efficacy of continuous or intermittent enteral nutrition in patients in the intensive care unit: Systematic review of clinical evidence

“…Nutrition status, achieved with C‐EN or I‐EN, was recorded in 14 of the selected studies (11 RCT, 2 prospective, and 1 retrospective observational study) that enrolled a total of 921 patients 16,22–27,29,30,32–36 . Measured variables to describe the impact of C‐EN or I‐EN on the nutrition status included the number of days in whom “caloric prescribed goal” was achieved, daily amount of delivered feeding volume, time to achieve “caloric prescribed goal,” number of patients achieving target of caloric and protein goal, serum concentration of serum prealbumin levels or blood glucose, mean weight loss, mean daily calorie intake, glycemic variability, and insulin utilization, incretion of grelin and leptin, respiratory quotient (RQ) and resting energy expenditure (REE), change in rectus femoris cross‐sectional area, and plasma concentrations of amino acids (Table 2).…”

¿Influye la modalidad de infusión de nutrición enteral en la tolerancia gastrointestinal del paciente en estado crítico? Revisión narrativa de la literatura

“…A diferencia de lo reportado previamente, los autores documentaron una mayor frecuencia de diarrea en el grupo de infusión continua (10,2 %) en comparación con la infusión intermitente (5,5 %). Aunque se evidenciaron estas complicaciones gastrointestinales, no se observaron diferencias significativas entre ambas modalidades de NE (12) .…”