INTRODUCTION
Ketogenic feeding (KF) may have health-related benefits for healthy individuals and does not appear to cause negative effects on moderate-to-vigorous intensity exercise. It may also be relevant to muscle wasting and recovery from injury in sports science, and in increasing muscle performance under physiological stress. Critically ill patients represent an extreme phenotype of metabolic and physiological stress, and lose muscle mass rapidly. We performed a randomised controlled feasibility study to see if Intensive Care Unit (ICU) patients can be recruited into a study of enteral KF; if feed can be prepared, administered, and tolerated; and if it raises plasma and urine ketone body levels. Metabolomic analysis of plasma and urine samples sought to identify changes in the nutritional metabolic pathways during ketogenic versus standard feeding.
METHODS
Patients recruited ≥ 48hrs after ICU admission in two UK ICUs; randomised to 10d KF or standard feed (SF) enterally. Inclusion: (i) > 18yrs old (ii) prescribed enteral feed (iii) likely to have mechanical ventilation > 48hrs, to be on ICU ≥ 5d, surviving ≥ 10d (iv) multi-organ failure (SOFA score > 2 in > 2 areas). ClinicalTrials.gov NCT04101071[1]. Data were collected for feasibility of recruitment, retention (receipt of 10d randomised feed and those on ICU ≥ 5d if 350mls) were similar in SF and KF arms; episodes of diarrhoea (3d in a row) were more prevalent with KF than SF (76.92% vs. 52.33%, respectively). Daily blood glucose concentration remained ≥ 3.9mmol/L in all KF patients but was ≥ 10mmol/L in a greater proportion of SF than KF patients (57.48% vs. 26.85%, respectively). KF was associated with mild plasma ketosis (up to 2.7mmol/L) and a greater urinary ketosis (up to 8mmol/L). Metabolomics data highlighted key groups of metabolites changing due to the intervention.
CONCLUSIONS
Enteral KF in ICU patients is safe, tolerated and does induce ketone body production, although the availability of ready-made feed would improve feasibility. Additional insights provided via the application of unbiased approaches, such as metabolomics, could help yield significant biological insight for novel interventional nutritional research in the future.
Biomedical Basis of Elite Performance 2022 (University of Nottingham, UK) (2022) Proc Physiol Soc 49, PC44
Poster Communications: Alternative Substrates in the Critically Ill Subject (ASICS): A feasibility study and Metabolomic Analysis
Angela McNelly1, Anne Langan2, Danielle E Bear3,4, Tim Martin5, Kieron Rooney6, Simon Eaton7, Simon Heales8, Philip J. Atherton9, Daniel J. Wilkinson9, Rupert Pearse1,5, John Prowle1,5, Hugh Montgomery10,11, Zudin Puthucheary1,5
1 William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London 2 Department of Dietetics, Adult Critical Care Unit, Royal London Hospital 3 Department of Nutrition and Dietetics St Thomas’ NHS Foundation Trust 4 Kings College London 5 Adult Critical Care Unit, Royal London Hospital 6 Department of Critical Care, Bristol Royal Infirmary 7 Developmental Biology & Cancer, UCL Great Ormond Street Institute of Child Health, London 8 Genetic & Genomic Medicine Department, UCL Great Ormond Street Institute of Child Health, London 9 Medical Research Council/Arthritis Research UK Centre for Musculoskeletal Aging, University of Nottingham 10 Centre for Human Health & Performance, University College London 11 UCL Hospitals NHS Foundation Trust
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Where applicable, experiments conform with Society ethical requirements.