@article{242c12790b414dae980a0130991b1571,
title = "Effect of intermittent or continuous feeding and amino acid concentration on urea-to-creatinine ratio in critical illness",
abstract = "Background We sought to determine whether peaks in essential amino acid (EAA) concentration associated with intermittent feeding may provide anabolic advantages when compared with continuous feeding regimens in critical care. Methods We performed a secondary analysis of data from a multicenter trial of UK intensive care patients randomly assigned to intermittent or continuous feeding. A linear mixed-effects model was developed to assess differences in urea-creatinine ratio (raised values of which can be a marker of muscle wasting) between arms. To investigate metabolic phenotypes, we performed k-means urea-to-creatinine ratio trajectory clustering. Amino acid concentrations were also modeled against urea-to-creatinine ratio from day 1 to day 7. The main outcome measure was serum urea-to-creatinine ratio (millimole per millimole) from day 0 to the end of the 10-day study period. Results Urea-to-creatinine ratio trajectory differed between feeding regimens (coefficient -.245; P = .002). Patients receiving intermittent feeding demonstrated a flatter urea-to-creatinine ratio trajectory. With k-means analysis, the cluster with the largest proportion of continuously fed patients demonstrated the steepest rise in urea-to-creatinine ratio. Neither protein intake per se nor serum concentrations of EAA concentrations were correlated with urea-to-creatinine ratio (coefficient = .088 [P = .506] and coefficient P = .122], respectively). Conclusion Intermittent feeding can mitigate the rise in urea-to-creatinine ratio otherwise seen in those continuously fed, suggesting that catabolism may have been, to some degree, prevented.",
keywords = "critical care, intensive care, metabolism, muscle wasting, nutrition, MUSCLE PROTEIN-SYNTHESIS, INTENSIVE-CARE-UNIT, SURVIVORS",
author = "L. Flower and R.W. Haines and A. McNelly and D.E. Bear and K. Koelfat and S.O. Damink and N. Hart and H. Montgomery and J.R. Prowle and Z. Puthucheary",
note = "Funding Information: This work was supported in part by the ASPEN Rhoads Research Foundation. H.E.M. has a patient issued for “The Use of Inhibitors of the Renin‐Angiotensin System,” which relates in part to the prevention of muscle wasting. The other authors have declared they have no funding information relevant to this article to disclose. Funding Information: D.E.B. reports speaker fees from Nutricia, Baxter Healthcare, B. Braun, and Fresenius Kabi; advisory board fees from Baxter Healthcare, Nestl{\'e} Nutrition, Fresenius Kabi, Abbott Nutrition, Cardinal Health, and Avanos; and conference attendance support from B. Braun, outside the submitted work. N.H. reports unrestricted grants from Philips and ResMed, outside the direct area of work commented on here, with the funds held and managed by Guy's and St Thomas{\textquoteright} NHS Foundation Trust; financial support from Philips for the development of MYOTRACE technology that has a patent filed in Europe (US pending), outside the area of work commented on here; personal fees for lecturing from Philips‐Respironics, Philips, ResMed, and Fisher‐Paykel, both within and outside the area of work commented on here, and is on the Pulmonary Research Advisory Board for Philips, outside the area of work commented on here, with the funds for this role held by Guy's and St Thomas{\textquoteright} NHS Foundation Trust. Z.A.P. reports personal fees from Nutricia, Faraday Pharmaceuticals, Lyric Pharmaceuticals, Fresenius Kabi, Nestl{\'e}, Orion, and GlaxoSmithKline, outside the submitted work. The other authors have declared they have no conflict of interests relevant to this article to disclose. Publisher Copyright: {\textcopyright} 2021 American Society for Parenteral and Enteral Nutrition.",
year = "2022",
month = may,
doi = "10.1002/jpen.2258",
language = "English",
volume = "46",
pages = "789--797",
journal = "Journal of Parenteral and Enteral Nutrition",
issn = "0148-6071",
publisher = "Wiley",
number = "4",
}