Glycemic Effects of a Low‐Carbohydrate Enteral Formula Compared With an Enteral Formula of Standard Composition in Critically Ill Patients: An Open‐Label Randomized Controlled Clinical Trial

Steen, Sigrid C. van; Rijkenberg, Saskia; Sechterberger, Marjolein K.; DeVries, J. Hans; Voort, Peter H. J. van der

doi:10.1002/jpen.1045

Cited by 25 publications

(48 citation statements)

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“…Van Steen et al 13 conducted a randomized controlled, open-label study of patients who were critically ill and assigned patients to receive either an LCHF formula (n = 52) or a standard formula (n = 49). 13 Adult patients were enrolled regardless of preexisting diabetes mellitus or whether they were hyperglycemic upon ICU admission. 13 Of the 107 patients enrolled, 46.7% (n = 50) completed the 72-hour study period with a sample of n = 101 analyzed per intention-to-treat analysis (ITT).…”

Section: Literature Reviewmentioning

confidence: 99%

“…13 Adult patients were enrolled regardless of preexisting diabetes mellitus or whether they were hyperglycemic upon ICU admission. 13 Of the 107 patients enrolled, 46.7% (n = 50) completed the 72-hour study period with a sample of n = 101 analyzed per intention-to-treat analysis (ITT). 13 Blood glucose was measured via continuous glucose monitoring (CGM) and was compared with point-of-care device and blood gas measurements; the frequency of the measurements was not described.…”

Section: Literature Reviewmentioning

confidence: 99%

“…6 However, recent randomized controlled trials have been published since these guidelines were established and may provide stronger evidence to support or refute the use of these formulas. [13][14][15][16] The purpose of this review is to examine literature published since the publication of the 2013 ASPEN clinical guidelines for adult patients with hyperglycemia to determine whether LCHF enteral formulas, as compared with standard formulas, improve glycemic control, as assessed by lower mean blood glucose levels, decreased glycemic variability, and lower insulin requirements, in patients who are critically ill.…”

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confidence: 99%

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Low‐carbohydrate, high‐fat enteral formulas for managing glycemic control in patients who are critically ill: A review of the evidence

et al. 2021

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Hyperglycemia is associated with increased morbidity and mortality. Lowcarbohydrate, high-fat (LCHF) enteral formulas are marketed to improve glycemic control; however, given the multifactorial mechanisms contributing to hyperglycemia in patients who are critically ill, the effect that LCHF formulas may have on improving glycemic control in this patient population is unclear. Current guidelines for the use of LCHF formulas among patients who are critically ill are limited by a lack of evidence. This review explores recent research published in the past 7 years to determine whether LCHF enteral formulas improve glycemic control compared with standard enteral formulas in patients who are critically ill. Four randomized controlled trials met the inclusion criteria for this review. Their results suggest that LCHF formulas may improve glycemic control in patients who are critically ill with diabetes mellitus and/or who are hyperglycemic. Further large-scale randomized controlled trials are warranted to validate these findings among different subgroups of patients with critical illness. The potential benefits of LCHF formulas need to be weighed against specific limitations, including that LCHF formulas typically do not contain sufficient protein to meet the recommended needs of patients who are critically ill. K E Y W O R D Scritical illness, enteral nutrition, hyperglycemia, low-carbohydrate diet INTRODUCTION/BACKGROUNDThe American Diabetes Association (ADA) defines hyperglycemia in hospitalized patients as a blood glucose level of >140 mg/dl. 1 Hyperglycemia is associated with increased morbidity and mortality and is widely prevalent among patients who are critically ill. 2 Large retrospective studies of patients in intensive care units (ICUs) have cited prevalence rates ranging from 32% to 46%. 3,4

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Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

mentioning

confidence: 99%

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Low‐carbohydrate, high‐fat enteral formulas for managing glycemic control in patients who are critically ill: A review of the evidence

et al. 2021

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“…При обследовании около 120 пациентов на фоне ИВЛ и зондового ЭП обнаружено, что при «клетчаточном» ЭП (фибринизированная пищевая смесь) гораздо реже развиваются желудочно-кишечные осложнения (45% и 73% соответственно), преимущественно диарея. Это позволяет избежать частых перерывов в питании, вызывающих белково-энергетический дефицит [60,61].…”

Section: совершенствование методики и состава эп при его использовании в интенсивной медицинеunclassified

Modern Approaches to Enteral Nutrition in Intensive Care

Поцхверия

Гольдфарб

Маткевич

et al. 2021

Neotložnaâ med. pomoŝʹ

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The analysis of the literature data allowed us to establish that today enteral nutrition (EN) is unanimously recognized by specialists as the preferred method of nutritional therapy, which significantly affects the course of critical conditions (CC). The use of EN now affects almost the entire nosology that forms the cohort of such patients. To the least extent, the scientific analysis of the possibilities of EN touched acute poisoning, where, given the special danger to life of their severe forms, there are great prospects for further research of this kind. It is especially emphasized that EN mainly in the first 24-48 hours from the onset of the disease mostly affects the achievement of positive results of treatment of CC, accompanied by an improvement in metabolic processes in organs and tissues. There is great interest in studying the pathogenesis of CC by assessing changes in homeostasis indicators using modern laboratory and instrumental control, which strengthens the scien-tific basis of EN. At the same time, it also contributes to the disclosure of his sanogenesis. Considering that, along with immunological shifts, the formation of oxidative stress and hemorheological disorders is of particular importance in the pathogenesis of CC, being to a large extent involved in the development of endogenous intoxication and their irrevers-ibility, studies on EN in this field are promising, which, in our opinion, are still are very limited, and in relation to hemorheology, according to the data available to us, are not represented at all. There are also no generalized up-to-date data on the economic component of EN. Further improvement of EN, as well as the corresponding organizational measures, it seems, can bring this method to a higher level of efficiency and, accordingly, safety, which, combined with the economic advantages of EN, will expand the possibilities of its implementation in clinical practice.AIM OF STUDY Standardization of staged treatment of patients with severe concomitant closed abdominal trauma.

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“…However, no favorable effect was seen on GV parameters, thus questioning whether lowcarbohydrate feeds alone could be used as GTSN. 49 The benefits of such GTSN feeds/formulae are primarily due to their unique blends of amino acids, complex carbohydrates, and fats and are achieved by either directly stimulating insulin secretion or stimulating glucagon-like peptide (GLP)-1 secretion. 42…”

Section: Glycemia-targeted Specialized Nutritionmentioning

confidence: 99%

Practice Guidelines for Enteral Nutrition Management in Dysglycemic Critically Ill Patients: A Relook for Indian Scenario

Mehta

Mithal

Kulkarni

et al. 2019

Indian Journal of Critical Care Medicine

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Background and aim: Intensive-care practices and settings differ for India in comparison to other countries. While guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to nutritional management of EN in dysglycemic patients, specific to patients in Indian critical care settings. Advisory board meetings were arranged to develop the practice guidelines specific to the Indian context, for the use of EN in dysglycemic critically ill patients and to overcome challenges in this field. Materials and methods: Two advisory board meetings were organized to review various existing guidelines, meta-analyses, randomized controlled trials (RCTs), controlled trials and review articles, for their contextual relevance and strength. Three rounds of Delphi voting were done to arrive at consensus on certain recommendations. A systematic grading of practice guidelines by the advisory board was done based on strength of the consensus voting and reviewed supporting evidences. Results: Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding prediction and assessment of dysglycemia (DG), acceptable glycemic targets in such settings, general nutritional aspects pertaining to DG nutrition, and nutrition in various superspecialty cases in critical care settings, where DG is commonly encountered. Conclusion: This paper summarizes the optimum EN practices for managing DG in critically ill patients. The practical solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance for EN management in dysglycemic critically ill patients. These guidelines also outline the model glycemic control task force and its roles in nutrition care as well as an intensive care unit DG nutrition protocol.

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Glycemic Effects of a Low‐Carbohydrate Enteral Formula Compared With an Enteral Formula of Standard Composition in Critically Ill Patients: An Open‐Label Randomized Controlled Clinical Trial

Abstract: LCF showed a trend toward a modestly reduced mean glucose and significantly lower insulin requirements as compared with standard feeding but had no effect on glucose variability or time in target range.

Cited by 25 publications

References 52 publications

Low‐carbohydrate, high‐fat enteral formulas for managing glycemic control in patients who are critically ill: A review of the evidence

Low‐carbohydrate, high‐fat enteral formulas for managing glycemic control in patients who are critically ill: A review of the evidence

Modern Approaches to Enteral Nutrition in Intensive Care

Practice Guidelines for Enteral Nutrition Management in Dysglycemic Critically Ill Patients: A Relook for Indian Scenario

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