Summary
This eight-centre randomised controlled trial examined whether intermittent bolus feeding produces distinct metabolic signatures compared to continuous feeding in critically ill patients. Principal component analysis revealed no broad metabolic patterns distinguishing the two feeding regimens across sampling timepoints or over 10 days; however, time-dependent decreases in amino acids (glutamine, alanine), ketone bodies (acetone, 3-hydroxybutyrate), fatty acid markers (carnitine), and carbohydrate metabolites (maltose, citric acid) were observed, with increasing organ failure severity associated with enhanced ketone body metabolism.
UK applicability
Findings are directly applicable to UK ICU practice, where enteral feeding strategy selection remains clinically contentious. The metabolomic findings may inform evidence-based feeding protocols in NHS critical care units, though the lack of clear metabolic superiority of either approach suggests clinical decisions should consider other patient-level factors.
Key measures
Targeted metabolomic analysis of 24 amino acid, 19 lipid-based, and 44 small molecule metabolite features; quadriceps muscle mass; organ failure severity
Outcomes reported
The study characterised changes in amino acid, lipid, and carbohydrate metabolite concentrations in critically ill patients receiving either intermittent (bolus, 6× daily) or continuous enteral feeding over 10 days of ICU admission. Blood metabolomic analysis via nuclear magnetic resonance spectroscopy was performed on 594 samples from 75 patients.
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