Substrate Utilization in the Critically Ill (Letter to the Editor)
Abstract
We read the recent paper Effect of Calorically Dense Enteral Nutrition Formulas on Outcome in Critically Ill Trauma and Surgical Patients with some interest, as this has been an investigative interest of our group. The findings are very intriguing and fit our bias regarding substrate utilization in the critically ill. One of the key and perhaps most compelling differences between nor-mocaloric and calorically dense formulae is simply the fat content; the only method to increase caloric density is to increase the lipid component in relation to carbohydrate and protein. In this study, close to double the amount of fat was delivered to the calorically dense group. Substrate delivery and utilization during critical illness, then, comes to the forefront in deciphering the results of this study. Should fat be delivered as the primary substrate, and is this beneficial or harmful? It was shown previously that glucose/carbohydrate appears to be the preferential substrate in critical illness related to poor utilization of fat with impaired oxidation and inefficient transport between pools, which would argue against the use of fat in this population as a testable hypothesis.
Document Details
- Document Type
- Technical Report
- Publication Date
- Feb 01, 2009
- Accession Number
- ADA630391
Entities
People
- Beth A. Shields
- Charles E Wade
- Steven Wolf
Organizations
- United States Army Institute of Surgical Research