A single-blinded randomised clinical trial of permissive underfeeding in patients requiring parenteral nutrition.
OBJECTIVE
The importance of adequate nutritional support is well established, but characterising what 'adequate nutrition' represents remains contentious. In recent years there has been increasing interest in the concept of 'permissive underfeeding' where patients are intentionally prescribed less nutrition than their calculated requirements. The aim of this study was to evaluate the effect of permissive underfeeding on septic and nutrition related morbidity in patients requiring short term parenteral nutrition (PN).


METHODS
This was a single-blinded randomised clinical trial of 50 consecutive patients requiring parenteral nutritional support. Patients were randomized to receive either normocaloric or hypocaloric feeding (respectively 100% vs. 60% of estimated requirements). The primary end point was septic complications. Secondary end points included the metabolic, physiological and clinical outcomes to the two feeding protocols.


RESULTS
Permissive underfeeding was associated with fewer septic complications (3 vs. 12 patients; p = 0.003), and a lower incidence of the systemic inflammatory response syndrome (9 vs. 16 patients; p = 0.017). Permissively underfed patients had fewer feed related complications (2 vs. 9 patients; p = 0.016).


CONCLUSIONS
Permissive underfeeding in patients requiring short term PN appears to be safe and may results in reduced septic and feed-related complications.


BACKGROUND
NCT01154179 TRIAL REGISTRY: http://clinicaltrials.gov/ct2/show/NCT01154179.
The Combined Gastroenterology Research Unit, Scarborough General Hospital, Woodlands Drive, Scarborough YO12 6QL, United Kingdom.
Anwar Elias
AE
Owais
The Combined Gastroenterology Research Unit, Scarborough General Hospital, Woodlands Drive, Scarborough YO12 6QL, United Kingdom.
Syed Irfan
SI
Kabir
The Combined Gastroenterology Research Unit, Scarborough General Hospital, Woodlands Drive, Scarborough YO12 6QL, United Kingdom.
Clare
C
Mcnaught
The Combined Gastroenterology Research Unit, Scarborough General Hospital, Woodlands Drive, Scarborough YO12 6QL, United Kingdom. Electronic address: marcelgatt@gmail.com.
Marcel
M
Gatt
The Combined Gastroenterology Research Unit, Scarborough General Hospital, Woodlands Drive, Scarborough YO12 6QL, United Kingdom; Postgraduate Medical Institute, The University of Hull, Hull HU6 7RX, United Kingdom.
John
J
MacFie
D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D023381:Endpoint Determination; D002149:Energy Intake; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000379:methods*; D018805:Sepsis / Q000401:mortality / Q000517:prevention & control; D016037:Single-Blind Method
Artificial nutrition; Human; Hypocaloric feeding; Parenteral nutrition; Permissive underfeeding; Randomised clinical trial