Impact of early parenteral nutrition on muscle and adipose tissue compartments during critical illness

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 678-689-Adipocyte Biology
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-687
Lies Langouche*1, Michael Casaer1, Walter Coudyzer2, Dirk Vanbeckevoort2, Bart De Dobbelaer2, Fabian Giza1, Pieter J Wouters1, Dieter Mesotten1 and Greet Van den Berghe3
1KU Leuven, Belgium, 2University Hosptial Leuven, Belgium, 3KU Leuven, Leuven, Belgium
The goal of enhanced nutrition in critically ill patients is to improve outcome by reducing lean tissue wasting. However, such effect has not been proven. This study aimed to assess the effect of early administration of parenteral nutrition (PN) on muscle volume and composition by repeated quantitative computer tomography (qCT). For this, we performed a pre-planned substudy of a randomized-controlled-trial (EPaNIC) which compared early initiation of PN when enteral nutrition was insufficient [early PN] with tolerating a pronounced nutritional deficit for one week in ICU [late PN]. Late PN prevented infections and accelerated recovery (1).

We studied 15 EPaNIC-study neurosurgical patients requiring pre-scheduled repeated follow-up CT-scans and 6 healthy volunteers matched for age, gender and BMI. Repeated abdominal and femoral qCT images were obtained in a standardized manner on median ICU day 2 (IQR 2-3) and day 9 (8-10). Intramuscular, subcutaneous and visceral fat compartments were delineated manually. Muscle and adipose tissue volume and composition were quantified using standard Hounsfield Unit (HU) ranges.

Critical illness evoked substantial loss of femoral muscle volume in one week’s time, irrespective of the nutritional regimen. Early PN reduced the quality of the muscle tissue, as reflected by the attenuation, revealing increased intramuscular water/lipid content. Early PN also increased the volume of adipose tissue islets within the femoral muscle compartment. These changes in skeletal muscle quality correlated with caloric intake. In the abdominal muscle compartments, changes were similar, albeit smaller. Femoral and abdominal subcutaneous adipose tissue compartments were unaffected by disease and nutritional strategy.

In conclusion, early PN did not prevent the pronounced wasting of skeletal muscle observed over the first week of critical illness. Moreover, early PN increased the amount of adipose tissue within the muscle compartments.

(1) Casaer et al, New Eng J of Med 2011; 365: 506-517

Nothing to Disclose: LL, MC, WC, DV, BD, FG, PJW, DM, GV

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