Feeding During Phases of Altered Mitochondrial Activity: A Theory

JPEN. Journal of Parenteral and Enteral Nutrition
Liam McKeeverCarol Braunschweig

Abstract

Decisions surrounding the timing and dosing of nutrition support are made for thousands of ICU patients daily and yet remain a topic of controversy. Nutrition support designed to replenish resting energy expenditure (REE) early in critical illness has led to worse clinical outcomes in at least three recent prospective randomized clinical trials. Producing sufficient energy from nutrient substrates requires use of the mitochondrial electron transport chain (ETC). This process is functionally linked to the creation of a tightly regulated series of chemical messengers known as reactive oxygen species (ROS). In health, ROS are kept at low levels by a system of mitochondrial/cellular enzymes and antioxidants, allowing ROS to act as a signal for the redox health of the cell. In inflammatory conditions, however, this system is altered, leading to changes in the physiologic function of the ETC such that its usage produces greater ROS per unit of substrate. This increased ROS is capable of deactivating antioxidant systems, as well as activating further ROS-producing pathways and stimulating localized inflammatory activity. We propose that exacerbation of this process at this time by the forced influx of exogenously acquired nutrient sub...Continue Reading

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Citations

Jul 16, 2019·Critical Care Medicine·Thomas John Papadimos, S Veena Satyapriya
Jul 16, 2019·Critical Care Medicine·Liam McKeeverCarol A Braunschweig
Jun 20, 2019·Critical Care : the Official Journal of the Critical Care Forum·Charles Chin Han LewMichelle Miller
Jan 14, 2021·Journal of Intensive Care·Hanneke Pierre Franciscus Xaverius MoonenArthur Raymond Hubert van Zanten
Jun 19, 2021·Annual Review of Nutrition·Liam McKeeverCarol Braunschweig

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