Fecal energy losses in enterally fed intensive care patients: An explorative study using bomb calorimetry

Schijndel, R.J.M. Strack van; Wierdsma, N.J.; Heijningen, E.M.B. van; Weijs, P.J.M.; Groot, S.D.W. de; Girbes, Armand R.J.

doi:10.1016/j.clnu.2005.11.012

Cited by 31 publications

(16 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Glucose absorption is substantially reduced in the critically ill, even in patients who have normal emptying [48][49][50]. Limited data suggest that fat absorption may also be reduced, even when delivered directly to the small intestine [51,52]. The reasons for impaired absorption are unclear but may relate to mucosal abnormalities such as oedema, atrophy, or reduced perfusion.…”

Section: Intestinal Absorptionmentioning

confidence: 99%

Gastrointestinal motility and prokinetics in the critically ill

Chapman

Nguyen²,

Fraser³

2007

Current Opinion in Critical Care

View full text Add to dashboard Cite

show abstract

Section: Intestinal Absorptionmentioning

confidence: 99%

Gastrointestinal motility and prokinetics in the critically ill

Chapman

Nguyen²,

Fraser³

2007

Current Opinion in Critical Care

View full text Add to dashboard Cite

show abstract

“…In a former study, we demonstrated that malabsorption is a commonly occurring and neglected clinical problem, contributing to a negative energy balance in one of three ICU patients with diarrhea, and from these data, a fecal weight of > 250 g/day was proposed as a biomarker of malabsorption [27]. This previous small series was extended in the present study to validate fecal weight as a biomarker and to characterize in detail the extent and type of fecal nutrient losses in ICU patients.…”

Section: Introductionmentioning

confidence: 99%

Malabsorption and nutritional balance in the ICU: fecal weight as a biomarker: a prospective observational pilot study

et al. 2011

View full text Add to dashboard Cite

IntroductionMalabsorption, which is frequently underdiagnosed in critically ill patients, is clinically relevant with regard to nutritional balance and nutritional management. We aimed to validate the diagnostic accuracy of fecal weight as a biomarker for fecal loss and additionally to assess fecal macronutrient contents and intestinal absorption capacity in ICU patients.MethodsThis was an observational pilot study in a tertiary mixed medical-surgical ICU in hemodynamically stable adult ICU patients, without clinically evident gastrointestinal malfunction. Fecal weight (grams/day), fecal energy (by bomb calorimetry in kcal/day), and macronutrient content (fat, protein, and carbohydrate in grams/day) were measured. Diagnostic accuracy expressed in terms of test sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and receiver operator curves (ROCs) were calculated for fecal weight as a marker for energy malabsorption. Malabsorption was a priori defined as < 85% intestinal absorption capacity.ResultsForty-eight patients (63 ± 15 years; 58% men) receiving full enteral feeding were included. A cut-off fecal production of > 350 g/day (that is, diarrhea) was linked to the optimal ROC (0.879), showing a sensitivity and PPV of 80%, respectively. Specificity and NPV were both 96%. Fecal weight (grams/day) and intestinal energy-absorption capacity were inversely correlated (r = -0.69; P < 0.001). Patients with > 350 g feces/day had a significantly more-negative energy balance compared with patients with < 350 g feces/day (loss of 627 kcal/day versus neutral balance; P = 0.012).ConclusionsA fecal weight > 350 g/day in ICU patients is a biomarker applicable in daily practice, which can act as a surrogate for fecal energy loss and intestinal energy absorption. Daily measurement of fecal weight is a feasible means of monitoring the nutritional status of critically ill patients and, in those identified as having malabsorption, can monitor responses to changes in dietary management.

show abstract

“…Nevertheless, results from the intramuscular studies are relevant because many acute and hospitalized patients suffer significant malabsorption and/or are not able to take food and medication enterally. 123,124 The need for pediatric studies evaluating 10 000 IU/kg using the enteral route is reinforced by evidence from adult studies that show significant differences in short-term response between enteral and intramuscular routes. 125,126 The current review also examined whether high-dose loading regimens were associated with vitamin D-related adverse events and toxicity.…”

mentioning

confidence: 99%

Rapid Normalization of Vitamin D Levels: A Meta-Analysis

et al. 2015

View full text Add to dashboard Cite

BACKGROUND: Vitamin D deficiency may represent a modifiable risk factor to improve outcome in severe illness. The efficacy of high-dose regimens in rapid normalization of vitamin D levels is uncertain. METHODS:We conducted a systematic review of pediatric clinical trials administering high-dose vitamin D to evaluate 25-hydroxyvitamin D (25[OH]D) response and characteristics associated with final 25(OH)D levels by using Medline, Embase, and the Cochrane Central Register of Controlled Trials, including reference lists of systematic reviews and eligible publications. Uncontrolled and controlled trials reporting 25(OH)D levels after high-dose ($1000 IU) ergocalciferol or cholecalciferol were selected. Two reviewers independently extracted and verified predefined data fields. RESULTS:We identified 88 eligible full-text articles. Two of 6 studies that administered daily doses approximating the Institute of Medicine's Tolerable Upper Intake Level (1000-4000 IU) to vitamin D-deficient populations achieved group 25(OH)D levels .75 nmol/L within 1 month. Nine of 10 studies evaluating loading therapy (.50 000 IU) achieved group 25(OH)D levels .75 nmol/L. In meta-regression, baseline 25(OH)D, regimen type, dose, age, and time factors were associated with final 25(OH)D levels. Adverse event analysis identified increased hypercalcemia risk with doses .400 000 IU, but no increased hypercalcemia or hypercalciuria with loading doses ,400 000 IU (or 10 000 IU/kg). Few studies in adolescents evaluated loading dose regimens .300 000 IU.CONCLUSIONS: Rapid normalization of vitamin D levels is best achieved by using loading therapy that considers disease status, baseline 25(OH)D, and age (or weight). Loading doses .300 000 IU should be avoided until trials are conducted to better evaluate risk and benefit. Dr McNally conceptualized and designed the study, carried out the initial analysis, drafted the initial manuscript, and revised the manuscript for important intellectual content; Mr Iliriani, Dr Pojsupap, and Ms O'Hearn designed the data collection instrument, determined study eligibility, acquired data, and revised the article critically for important intellectual content; Dr Sampson conceptualized and designed the search strategy, acquired data, drafted the initial manuscript, and revised the manuscript for important intellectual content; Drs McIntyre, Fergusson, and Menon conceptualized and designed the study, interpreted the data, and critically revised the manuscript for important intellectual content; and all authors approved the final manuscript as submitted.The systematic review was registered with PROSPERO (identifier CRD42013006677). Normalization of vitamin D status has the potential to speed recovery and improve outcomes in multiple acutely unwell pediatric populations. Most of the guidelines and clinical practice surrounding vitamin D dosing involves a daily intake of ,1000 IU. 6,7 Because these standard dosing strategies target healthy children and require months to restore normal levels, they are not applicab...

show abstract

Fecal energy losses in enterally fed intensive care patients: An explorative study using bomb calorimetry

Cited by 31 publications

References 11 publications

Gastrointestinal motility and prokinetics in the critically ill

Gastrointestinal motility and prokinetics in the critically ill

Malabsorption and nutritional balance in the ICU: fecal weight as a biomarker: a prospective observational pilot study

Rapid Normalization of Vitamin D Levels: A Meta-Analysis

Contact Info

Product

Resources

About