Clinical Trials Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2021; 27(29): 4900-4912
Published online Aug 7, 2021. doi: 10.3748/wjg.v27.i29.4900
Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis
Jia-Kui Sun, Shuai Nie, Yong-Ming Chen, Jing Zhou, Xiang Wang, Su-Ming Zhou, Xin-Wei Mu
Jia-Kui Sun, Shuai Nie, Yong-Ming Chen, Xiang Wang, Xin-Wei Mu, Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
Jing Zhou, Su-Ming Zhou, Department of Geriatric Intensive Care Unit, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province People’s Hospital), Nanjing 210006, Jiangsu Province, China
Author contributions: Sun JK, Nie S, and Chen YM contributed equally to this work; Wang X, Zhou SM, and Mu XW were co-corresponding authors; Sun JK, Wang X, and Zhou SM designed the study and drafted the manuscript; Sun JK, Nie S, and Chen YM collected the clinical samples and data; Sun JK, Nie S, and Zhou J performed the experiments and statistical analysis; Zhou J and Mu XW participated in study design and coordination and helped to perform the experiments; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81701881; and Nanjing Medical Science and Technology Development Foundation, No. YKK17102.
Institutional review board statement: The study protocol was approved by the Institutional Ethics Committee of Nanjing First Hospital (Approval Number: KY20180713-01)
Clinical trial registration statement: This study is also registered at Clinical Trials.gov (ID: NCT03791866).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Wei Mu, MD, Professor, Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, Jiangsu Province, China. njdrmxw2012@163.com
Received: March 28, 2021
Peer-review started: March 28, 2021
First decision: June 3, 2021
Revised: June 9, 2021
Accepted: July 13, 2021
Article in press: July 13, 2021
Published online: August 7, 2021
Processing time: 129 Days and 0.7 Hours
Abstract
BACKGROUND

Intestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of sepsis. However, few studies have investigated the effects of enteral underfeeding on gastrointestinal function in sepsis. Moreover, no consensus on goal enteral caloric intake has been reached in sepsis.

AIM

To investigate the effects of different goal caloric requirements of enteral nutrition on the gastrointestinal function and outcomes in the acute phase of sepsis.

METHODS

Patients were randomly assigned to receive 30% (defined as group A), 60% (group B), or 100% (group C) of goal caloric requirements of enteral nutrition in this prospective pilot clinical trial. The acute gastrointestinal injury (AGI) grades, incidence of feeding intolerance (FI), daily caloric intake, nutritional and inflammatory markers, and biomarkers of mucosal barrier function were collected during the first 7 d of enteral feeding. The clinical severity and outcome variables were also recorded.

RESULTS

A total of 54 septic patients were enrolled. The days to goal calorie of group C (2.55 ± 0.82) were significantly longer than those of group A (3.50 ± 1.51; P = 0.046) or B (4.85 ± 1.68; P < 0.001). The FI incidence of group C (16.5%) was higher than that of group A (5.0%) or B (8.7%) (P = 0.009). No difference in the incidence of FI symptoms was found between groups A and B. The serum levels of barrier function biomarkers of group B were significantly lower than those of group A (P < 0.05) on the 7th day of feeding. The prealbumin and IL-6 levels of group A were lower than those of group B (P < 0.05) on the 7th day of feeding. No significant differences in the clinical outcome variables or 28-d mortality were found among the three groups.

CONCLUSION

Early moderate enteral underfeeding (60% of goal requirements) could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of FI symptoms in sepsis. However, further large-scale prospective clinical trials and animal studies are required to test our findings. Moreover, the effects of different protein intake on gastrointestinal function and outcomes should also be investigated in future work.

Keywords: Enteral feeding; Enteral nutrition; Gastrointestinal function; Intestinal mucosal barrier; Sepsis

Core Tip: Few studies have investigated the effects of enteral underfeeding on gastrointestinal function in sepsis. Moreover, no consensus on goal enteral caloric intake has been reached in sepsis. In this study, we investigated the effects of different goal caloric requirements (30%, 60%, and 100%) of enteral nutrition on the gastrointestinal (including intestinal mucosal barrier) function in the acute phase of sepsis. We found that early moderate enteral underfeeding (60% of goal requirements) could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of feeding intolerance symptoms in sepsis.