The Curse of Overfeeding and the Blight of Underfeeding

  • N.-H. W. Loh
  • R. D. Griffiths


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].


Parenteral Nutrition Intensive Care Unit Patient Enteral Nutrition Intensive Insulin Therapy Rest Energy Expenditure 
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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

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