Advertisement

The Curse of Overfeeding and the Blight of Underfeeding

  • N.-H. W. Loh
  • R. D. Griffiths

Abstract

Evolution has refined our ability to cope with acute trauma, sepsis and, most importantly, the consequences of short term starvation. Our ancestor when severely ill or injured probably did not eat and either coped with the acute insult and rapidly got better or died. The years of natural selection have not prepared us for modern intensive care management and excess nutrient provision and hyperglycemia. Overfeeding carries a significant metabolic stress and has been associated with prolonged mechanical ventilation, infection risk, and delayed hospital discharge [1]. Difficulties in predicting energy requirements in intensive care further compound the effects of nutrition and overfeeding. In the critically ill, the reality is that enteral nutrition frequently under-delivers the desired calories and micronutrients due to gut intolerance while parenteral nutrition carries a significant risk of overfeeding if used injudiciously. Indeed, historically, particularly in North America dating from 1969, parenteral nutrition took the form of ‘hyperalimentation’ where excessive carbohydrate calories as the sole non-protein energy source were delivered in the belief that it would reverse the negative nitrogen balance [2]. Not until 1981 was it realized that there were advantages during ventilator support of substituting some of the energy source for lipids [3]. Lipids, however, have featured in European nutrition since their development by Schuberth and Wretlind in 1961 [4].

Keywords

Parenteral Nutrition Intensive Care Unit Patient Enteral Nutrition Intensive Insulin Therapy Rest Energy Expenditure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Krishnan JA, Parce PB, Martinez A, Dietta GB, Brower RG (2003) Caloric intake in medical ICU patients. Consistency of care with guidelines and relationship to clinical outcomes. Chest 124: 297–305CrossRefPubMedGoogle Scholar
  2. 2.
    Dudrick SJ, Wilmore DW, Vars HM, Rhoades JE (1969) Can intravenous feeding as the sole means of nutrition support growth in the child and restore weight loss in an adult? An affirmative answer. Ann Surg 169: 974–984CrossRefPubMedGoogle Scholar
  3. 3.
    Askanazi J, Nordenström J, Rosenbaum SH, et al (1981) Nutrition for the patient with respiratory failure: Glucose versus fat. Anesthesiology 54: 373–377CrossRefPubMedGoogle Scholar
  4. 4.
    Schuberth O, Wretlind A (1961) Intravenous infusion of fat emulsions phosphatides and emulsifying agents. Acta Physiol Scand (Suppl): 278: 1–21Google Scholar
  5. 5.
    Uehara M, Plank LD, Hill GL (1999) Components of energy expenditure in patients with severe sepsis and major trauma: A basis for clinical care. Crit Care Med 27: 1295–1302CrossRefPubMedGoogle Scholar
  6. 6.
    Hoher JA, Zimermann Teixera PJ, da S Moreira J (2008) Comparison between ventilation modes: How does activity level affect energy expenditure estimates? JPEN J Parenter Enteral Nutr 32: 176–183CrossRefPubMedGoogle Scholar
  7. 7.
    Berger M, Chiolero R (2007) Hypocaloric feeding: Pros and cons. Curr Opin Crit Care 13: 180–186CrossRefPubMedGoogle Scholar
  8. 8.
    Boitano M (2006) Hypocaloric feeding of the critically ill. Nutr Clin Pract 21: 617–622CrossRefPubMedGoogle Scholar
  9. 9.
    Griffiths RD (2007) Too much of a good thing: the curse of overfeeding. Crit Care 11: 176CrossRefPubMedGoogle Scholar
  10. 10.
    Anbar R, Theilla M, Fisher H, Madar Z, Coehn J, Singer P (2008) Decrease in hospital mortality in tight calorie balance control study: the preliminary results of the TICACOS study. Clin Nutri 3 (Suppl 1): 11 (abst)Google Scholar
  11. 11.
    Griffiths RD (2004) Is parenteral nutrition really that risky in the intensive care unit? Curr Opin Clin Nutr Metab Care 7: 175–181CrossRefPubMedGoogle Scholar
  12. 12.
    Dissanaike S, Shelton M, Warner K, et al (2007) The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition. Crit Care 11:R114CrossRefPubMedGoogle Scholar
  13. 13.
    Peter J, Moran J, Phillips-Hughes J (2005) A metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit Care Med 33: 213–220CrossRefPubMedGoogle Scholar
  14. 14.
    Tappy L, Schwarz JM, Schneiter P, et al (1998) Effects of isoenergetic glucose-based or lipidbased parenteral nutrition on glucose metabolism, de novo lipogenesis, and respiratory gas exchanges in critically ill patients. Crit Care Med 26: 860–867CrossRefPubMedGoogle Scholar
  15. 15.
    Tappy L, Berger M, Schwarz JM, et al (1999) Hepatic and peripheral glucose metabolism in intensive care patients receiving continuous high-or low-carbohydrate enteral nutrition. JPEN J Parenter Enteral Nutr 23: 260–267CrossRefPubMedGoogle Scholar
  16. 16.
    Hotamisligil GS (2006) Inflammation and metabolic disorders. Nature 444: 860–867CrossRefPubMedGoogle Scholar
  17. 17.
    Levin BR, Lipsitch M, Bonhoeffer S (1999) Population biology, evolution, and infectious disease: convergence and synthesis. Science 283: 806–809CrossRefPubMedGoogle Scholar
  18. 18.
    Shoelson SE, Lee J, Goldfine AB (2006) Inflammation and insulin resistance. J Clin Invest 116: 1793–1801CrossRefPubMedGoogle Scholar
  19. 19.
    Antonione R, Agostini F, Guarnieri G, Giolo G (2008) Positive energy balance accelerates muscle atrophy and increases erythrocyte glutathione turnover rate during 35 days bed rest. Clin Nutri 3 (suppl 1): 175 (abst)Google Scholar
  20. 20.
    Van den Berghe G, Wouters P, Weekers F, et al (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345: 1359–1367CrossRefPubMedGoogle Scholar
  21. 21.
    Wiener RS, Wiener DC, Larson RJ (2008) Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA 300: 933–944CrossRefPubMedGoogle Scholar
  22. 22.
    Brunkhorst FM, Engel C, Bloos F, et al (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358: 125–139CrossRefPubMedGoogle Scholar
  23. 23.
    Van den Berghe G, Wilmer A, Milants I, et al (2006) Intensive insulin therapy in mixed medical/ surgical intensive care unit: Benefits versus harm. Diabetes 55: 3151–3159CrossRefPubMedGoogle Scholar
  24. 24.
    Carlson G (2004) Insulin resistance in human sepsis: implications for the nutritional and metabolic care of the critically ill surgical patient. Ann R Coll Surg Eng 86: 75–81CrossRefGoogle Scholar
  25. 25.
    Ahrens CL, Barletta JF, Kanji S, et al (2005) Effect of low-calorie parenteral nutrition on the incidence and severity of hyperglycaemia in surgical patients: A randomized, controlled trial. Crit Care Med 33: 2507–2512CrossRefPubMedGoogle Scholar
  26. 26.
    Sandstrom R, Drott C, Hyltander A, et al (1993) The effect of post-operative intravenous feeding (TPN) on outcome following major surgery evaluated in a randomized study. Ann Surg 217: 185–195PubMedGoogle Scholar
  27. 27.
    Veterans Affairs Total Parenteral Nutrition Cooperative Study Group (1991) Perioperative total parenteral nutrition in surgical patients. N Engl J Med; 325:525–532CrossRefGoogle Scholar
  28. 28.
    McCowen KC, Friel C, Sternberg J, et al (2000) Hypocaloric total parenteral nutrition: Effectiveness in prevention of hyperglycemia and infectious complications — A randomized clinical trial. Crit Care Med 28: 3606–3611CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • N.-H. W. Loh
    • 1
  • R. D. Griffiths
    • 1
  1. 1.Pathophysiology Unit School of Clinical SciencesUniversity of LiverpoolLiverpoolUK

Personalised recommendations