Effect of high-fat, low-carbohydrate enteral formula versus standard enteral formula in hyperglycemic critically ill patients: a randomized clinical trial
- 20 Downloads
High-fat, low-carbohydrate diets may attenuate the hyperglycemia in critically ill patients. This study was performed to compare the effects of high-fat, low-carbohydrate enteral nutrition on glycemic control and clinical outcomes in new identified hyperglycemic patients. Eighty-eight new identified hyperglycemic patients with no history of diabetes or diagnosed hyperglycemia were randomly allocated to a standard (protein 20%, fat 30%, and carbohydrate 50%) or high-fat (protein 20%, fat as equal amount of olive and sunflower 45%, and carbohydrate 35%) kitchen formulas. Duration of intervention was 15 days. Baseline characteristics of patients were the same. Forty-one patients in the high fat and 39 patients in the standard group completed the study. Mean blood glucose, mean infused insulin, final blood glucose, and final infused insulin were not differed significantly between groups. Repeated measure showed that the average blood glucose declined in the high-fat formula group, as well as standard one, but with more decline at the end of the first week, and with a higher rate in the high-fat formula group. The mean blood triglyceride level on the final day was lower in the high-fat formula group (p = 0.001). There were no significant differences between groups in clinical outcomes. Although the high-fat formula declined blood glucose and triglyceride levels more than the standard group, yet the decrease in blood glucose was not significant. Also, it has no significant effect on clinical outcomes.
KeywordsOlive Lipid ICU Ventilator
Our thanks go to Shahid Beheshti University of Medical Science and Urmia University of Medical Science Vice Chancellor of Research and Technology for their help in providing study field and giving study ethics approval for execution. Thanks to all patients guardians, nurses, staff, physicians, and ICU attendants for their cooperation in the study protocol accomplishment.
Funding of this study was provided by the Urmia University of Medical Sciences.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of informed consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
- 3.Gale SC, Sicoutris C, Reilly PM, Schwab CW, Gracias VH. Poor glycemic control is associated with increased mortality in critically ill trauma patients. Am Surg. 2007;73(5):454–60.Google Scholar
- 4.Hasanloei MAV, Shariatpanahi ZV, Vahabzadeh D, Vahabzadeh Z, Nasiri L, Shargh A. Non-diabetic hyperglycemia and some of its correlates in ICU hospitalized patients receiving enteral nutrition. Maedica. 2017;12:174.Google Scholar
- 5.Monnier L, Mas E, Ginet C, Michel F, Villon L, Cristol J-P, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006;295(14):1681–7.Google Scholar
- 6.Mori Y, Ohta T, Tanaka T, Morohoshi Y, Matsuura K, Yokoyama J, et al. Effects of a low-carbohydrate diabetes-specific formula in type 2 diabetic patients during tube feeding evaluated by continuous glucose monitoring. e-SPEN. 2011;6(2).Google Scholar
- 9.León-Sanz M, García-Luna PP, Planas M, Sanz-París A, Gómez-Candela C, Casimiro C. Glycemic and lipid control in hospitalized type 2 diabetic patients: evaluation of 2 enteral nutrition formulas (low carbohydrate-high monounsaturated fat vs high carbohydrate). J Parenter Enter Nutr. 2005;29(1):21–9.Google Scholar
- 10.Alish CJ, Garvey WT, Maki KC, Sacks GS, Hustead DS, Hegazi RA, et al. A diabetes-specific enteral formula improves glycemic variability in patients with type 2 diabetes. Diabetes Technol Ther. 2010;12(6):419–25.Google Scholar
- 13.Mesejo A, Acosta J, Ortega C, Vila J, Fernández M, Ferreres J, et al. Comparison of a high-protein disease-specific enteral formula with a high-protein enteral formula in hyperglycemic critically ill patients. Clin Nutr. 2003;22(3):295–305.Google Scholar
- 14.Wewalka M, Drolz A, Schmid M, Zauner C, editors. Glucose hemeostasis in critically ill patients is not affected by different enteral nutrition formulas intensive care medicine. New York, NY: Springer 233 Spring ST; 2014.Google Scholar
- 17.Mesejo A, Montejo-González JC, Vaquerizo-Alonso C, Lobo-Tamer G, Zabarte-Martinez M, Herrero-Meseguer JI, et al. Diabetes-specific enteral nutrition formula in hyperglycemic, mechanically ventilated, critically ill patients: a prospective, open-label, blind-randomized, multicenter study. Crit Care. 2015;19(1):390.Google Scholar
- 19.Wewalka M, Drolz A, Zauner C. Influence of fat-based versus glucose-based enteral nutrition formulas on glucose homeostasis. Crit Care. 2013;17(Suppl 2):250.Google Scholar
- 20.Tomoyoshi Mohri HM, Kubo N, Inadome N, Nakamori Y, Fujimi S, Yoshioka T. <The effect on glycemic control of a low-carbohydrate, high-fat enteral formulain critically ill patients admitted to a trauma and critical care center.pdf>. JJAAM. 2011;22:871–7.Google Scholar
- 23.Vaisman N, Lansink M, Rouws CH, van Laere KM, Segal R, Niv E, et al. Tube feeding with a diabetes-specific feed for 12 weeks improves glycaemic control in type 2 diabetes patients. Clin Nutr. 2009;28(5):549–55.Google Scholar