A pilot study of alternative substrates in the critically Ill subject using a ketogenic feed

Bioenergetic failure caused by impaired utilisation of glucose and fatty acids contributes to organ dysfunction across multiple tissues in critical illness. Ketone bodies may form an alternative substrate source, but the feasibility and safety of inducing a ketogenic state in physiologically unstabl...

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Vydáno v:Nature communications Ročník 14; číslo 1; s. 8345 - 14
Hlavní autoři: McNelly, Angela, Langan, Anne, Bear, Danielle E., Page, Alexandria, Martin, Tim, Seidu, Fatima, Santos, Filipa, Rooney, Kieron, Liang, Kaifeng, Heales, Simon J., Baldwin, Tomas, Alldritt, Isabelle, Crossland, Hannah, Atherton, Philip J., Wilkinson, Daniel, Montgomery, Hugh, Prowle, John, Pearse, Rupert, Eaton, Simon, Puthucheary, Zudin A.
Médium: Journal Article
Jazyk:angličtina
Vydáno: London Nature Publishing Group UK 15.12.2023
Nature Publishing Group
Nature Portfolio
Témata:
101/58
692/308/153
692/308/2779/109/1940
692/308/575
Adult
Amino acids
Bioenergetics
Clinical trials
Critical Illness
Diarrhea
Enteral feeding
Enteral nutrition
Failure
Fatty acids
Feasibility studies
Feeding
Glucose
Homeostasis
Hospitals
Humanities and Social Sciences
Humans
Illnesses
Intensive Care Units
Ketone Bodies
Ketones
Ketosis
Metabolism
multidisciplinary
Pilot Projects
Retention
Safety
Science
Science (multidisciplinary)
Substrates
ISSN:2041-1723, 2041-1723
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Shrnutí:Bioenergetic failure caused by impaired utilisation of glucose and fatty acids contributes to organ dysfunction across multiple tissues in critical illness. Ketone bodies may form an alternative substrate source, but the feasibility and safety of inducing a ketogenic state in physiologically unstable patients is not known. Twenty-nine mechanically ventilated adults with multi-organ failure managed on intensive care units were randomised (Ketogenic n  = 14, Control n  = 15) into a two-centre pilot open-label trial of ketogenic versus standard enteral feeding. The primary endpoints were assessment of feasibility and safety, recruitment and retention rates and achievement of ketosis and glucose control. Ketogenic feeding was feasible, safe, well tolerated and resulted in ketosis in all patients in the intervention group, with a refusal rate of 4.1% and 82.8% retention. Patients who received ketogenic feeding had fewer hypoglycaemic events (0.0% vs. 1.6%), required less exogenous international units of insulin (0 (Interquartile range 0-16) vs.78 (Interquartile range 0-412) but had slightly more daily episodes of diarrhoea (53.5% vs. 42.9%) over the trial period. Ketogenic feeding was feasible and may be an intervention for addressing bioenergetic failure in critically ill patients. Clinical Trials.gov registration: NCT04101071. Critical illness leads to altered metabolic states and bioenergetic failure caused by impaired utilisation of glucose, fatty acids and amino acids. Here the authors show ketogenic diets may provide a safe and acceptable alternative metabolic fuel enabling energy production and maintaining tissue homeostasis.
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ISSN:2041-1723
2041-1723
DOI:10.1038/s41467-023-42659-8