Pulse Brain · Growing Health Evidence Index
Tier 2 — RCT / large cohortPeer-reviewed

Effect of intermittent or continuous feeding and amino acid concentration on urea‐to‐creatinine ratio in critical illness

Luke Flower, Ryan W. Haines, Angela McNelly, Danielle E. Bear, Kiran V.K. Koelfat, Steven W.M. Olde Damink, Nicholas Hart, Hugh Montgomery, John R. Prowle, Zudin Puthucheary

Journal of Parenteral and Enteral Nutrition · 2021

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Summary

This secondary analysis of a UK intensive care trial examined whether intermittent feeding regimens attenuate muscle protein catabolism compared with continuous feeding. Patients receiving intermittent feeding demonstrated a significantly flatter urea-to-creatinine ratio trajectory over 10 days, suggesting reduced muscle wasting despite no independent correlation between absolute amino acid or protein concentrations and the catabolic marker. The findings suggest that the temporal pattern of nutrient delivery, rather than absolute nutrient dose, may influence muscle protein metabolism in critical illness.

UK applicability

These findings are directly applicable to UK critical care practice, as the study was conducted in UK intensive care units. The results may inform future guidelines on enteral nutrition delivery protocols for mechanically ventilated patients, though clinical implementation would require consideration of patient tolerance, feeding access, and broader metabolic outcomes beyond the urea-to-creatinine ratio.

Key measures

Serum urea-to-creatinine ratio (millimole per millimole) from day 0 to day 10; essential amino acid concentrations; protein intake; k-means clustering of urea-to-creatinine ratio trajectories

Outcomes reported

The study measured serum urea-to-creatinine ratio trajectories over 10 days as a marker of muscle catabolism in critically ill patients assigned to intermittent or continuous enteral feeding regimens. Secondary analysis examined associations between amino acid concentrations and urea-to-creatinine ratio to explore potential anabolic advantages of feeding pattern.

Theme
Nutrition & health
Subject
Micronutrients & dietary adequacy
Study type
Research
Study design
Secondary analysis of a multicenter randomised controlled trial
Source type
Peer-reviewed study
Status
Published
Geography
United Kingdom
System type
Human clinical
DOI
10.1002/jpen.2258
Catalogue ID
BFmowc2679-o2lv69

Topic tags

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