Association between enteral macronutrient delivery and inflammatory response in critically ill children.
Adolescent
Child
Child, Preschool
Critical Illness
/ epidemiology
Cytokines
/ blood
Dietary Carbohydrates
/ administration & dosage
Dietary Fats
/ administration & dosage
Enteral Nutrition
/ adverse effects
Humans
Infant
Infant, Newborn
Inflammation
/ epidemiology
Nutrients
/ administration & dosage
Prospective Studies
Respiration, Artificial
Treatment Outcome
Critical illness
Cytokines
Enteral feeding
Macronutrients
Malnutrition
Underfeeding
Journal
Clinical nutrition (Edinburgh, Scotland)
ISSN: 1532-1983
Titre abrégé: Clin Nutr
Pays: England
ID NLM: 8309603
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
27
04
2018
revised:
17
09
2018
accepted:
02
10
2018
pubmed:
26
10
2018
medline:
26
9
2020
entrez:
25
10
2018
Statut:
ppublish
Résumé
An important goal of nutrition support in paediatric critical illness is minimising catabolism. While focussing on providing full energy requirements, macronutrient balance is often neglected. Studies suggest that there is interplay between nutrition and inflammation. We aimed to assess the amount of enteral macronutrients delivered compared to estimated requirements, and the association between delivered macronutrients and systemic inflammation in critically ill children. We prospectively evaluated energy and macronutrient intake in critically ill children who required at least 72 h of mechanical ventilation. Data on enteral energy and macronutrient intake was collected and expressed as a percentage of the estimated requirements. Circulating levels of inflammatory cytokines were measured by ELISA and association assessed with delivery of macronutrients from the previous 24 h. A total of 87 children (0-16 years) were included in this study. By day 3 the median (IQR) intake of energy, fat, carbohydrate (CHO) and protein were 75% (50-103), 85% (43-120), 63% (42-102) and 45% (23-65) respectively. We have also shown that delivery of enteral fat and protein was associated with elevation in the levels of tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6). The inflammatory response in critically ill children is influenced by the amount of enteral fat and protein delivered. Our data suggests that within the feed delivered, fat is often higher than protein and CHO. It is crucial to take into account the proportion of macronutrients required and not only aim to achieve the energy goal.
Sections du résumé
BACKGROUND AND AIMS
An important goal of nutrition support in paediatric critical illness is minimising catabolism. While focussing on providing full energy requirements, macronutrient balance is often neglected. Studies suggest that there is interplay between nutrition and inflammation. We aimed to assess the amount of enteral macronutrients delivered compared to estimated requirements, and the association between delivered macronutrients and systemic inflammation in critically ill children.
METHOD
We prospectively evaluated energy and macronutrient intake in critically ill children who required at least 72 h of mechanical ventilation. Data on enteral energy and macronutrient intake was collected and expressed as a percentage of the estimated requirements. Circulating levels of inflammatory cytokines were measured by ELISA and association assessed with delivery of macronutrients from the previous 24 h.
RESULTS
A total of 87 children (0-16 years) were included in this study. By day 3 the median (IQR) intake of energy, fat, carbohydrate (CHO) and protein were 75% (50-103), 85% (43-120), 63% (42-102) and 45% (23-65) respectively. We have also shown that delivery of enteral fat and protein was associated with elevation in the levels of tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6).
CONCLUSION
The inflammatory response in critically ill children is influenced by the amount of enteral fat and protein delivered. Our data suggests that within the feed delivered, fat is often higher than protein and CHO. It is crucial to take into account the proportion of macronutrients required and not only aim to achieve the energy goal.
Identifiants
pubmed: 30352749
pii: S0261-5614(18)32471-3
doi: 10.1016/j.clnu.2018.10.001
pii:
doi:
Substances chimiques
Cytokines
0
Dietary Carbohydrates
0
Dietary Fats
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2287-2296Informations de copyright
Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.