INTRODUCTION: Nutrition therapy becomes one of the fundamental conditions of a successful outcome in malnourished patients and in critically ill patients. The administration of enteral feeding in critically ill patients is mostly performed by continuous or cyclic feeding. On the contrary, the potential benefits of intermittent feeding include increased muscle protein synthesis. This review outlines the theory of a possible anabolic effect of intermittent feeding. The authors describe their experience with implementation of this method of administration in the intensive care unit including the follow-up of possible complications and adverse effects. METHODS: Six patients with intermittent feeding were followed retrospectively during the study period. In addition to demographic data, potential complications related to intermittent enteral feeding (aspiration pneumonia, increased gastric residual volume, abdominal discomfort, osmotic diarrhoea) were evaluated. RESULTS: The average time of intermittent feeding was 8 days. The sum of intermittent feeding days was 63. No aspiration followed by pneumonia was detected during this period. The gastric residual volume did not increase, either. Abdominal discomfort and osmotic diarrhoea were not observed in any patient. CONCLUSION: Although continuous and cyclic enteral feeding in critically ill patients remains the standard and the most common practice, it is considered as a non-physiological method with possible negative consequences for the patient. On the other hand, intermittent feeding is theoretically associated with respecting of the circadian rhythm and with activation of autophagy. Intermittent feeding increases muscle protein synthesis and supports the release of fatty acids. As shown by our observational study, intermittent administration of enteral nutrition in intensive care can be implemented without any adverse effects; however, it is more time consuming for the nurses.

• Klíčová slova
• Protein synthesis, enteral nutrition, intensive care, intermittent feeding, muscle atrophy,
• MeSH
• enterální výživa * MeSH
• jednotky intenzivní péče MeSH
• kritický stav MeSH
• lidé MeSH
• péče o pacienty v kritickém stavu * MeSH
• pozorovací studie jako téma MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Background: Intermittent fasting may be an effective tool for weight loss, but it is still unclear from previous studies to date whether it is as effective as a continuous energy restriction in terms of reducing adipose tissue and whether it leads to unwanted muscle loss. Objectives: The aim of this study was to compare the effect of intermittent fasting (IF) with continuous energy restriction (CER) on the body weight and body composition and to assess the effect of intermittent fasting also in isolation from the energy restriction. Methods: After completion of a three-week dietary intervention, differences in the weight loss and differences in the body composition were compared between three groups. The first group consumed 75% of their calculated energy intake requirements in a six-hour time window. The second group consumed 75% of their calculated energy intake requirements without a time window and the third group consumed 100% of their calculated energy intake requirements in a six-hour time window. The changes in the weight and body composition were assessed by BIA. Results: Of the 95 randomized participants, 75 completed the intervention phase of the study. The highest mean weight loss was achieved by the IF with ER (energy restriction) group (2.3 ± 1.4 kg), followed by the CER group (2.2 ± 1.1 kg); the difference between the groups did not reach statistical significance. The lowest mean weight loss was observed in the IF without ER group (1.1 ± 1.2 kg), the difference reaching statistical significance compared to the IF with ER (p=0.003) and CER (p=0.012) groups. The highest mean adipose tissue loss was observed in the CER group (1.5 ± 1.2 kg) followed by the IF with ER group (1.3 ± 1.1 kg), with no statistically significant differences between the groups. A mean adipose tissue loss was found in the IF without ER group (0.9 ± 1.1 kg) with no statistically significant differences compared to the IF with ER and CER groups. The highest mean fat-free mass loss was found in the IF with ER group (1.1 ± 1.0 kg), followed by the CER group (0.65 ± 0.91 kg) with no statistically significant differences. The IF without ER group showed the lowest mean fat-free mass loss (0.2 ± 1.3 kg), which reached statistical significance compared to the IF with ER group (p=0.027). Conclusion: The results showed a comparable effect in the weight loss and body fat reduction regardless of the timing of the food intake. The diet quality, together with the energy intake, appeared to be one of the most important factors influencing the body composition.

• Klíčová slova
• body fat mass, energy restriction, intermittent fasting, skeletal muscle mass, time-restricted feeding, visceral fat,
• MeSH
• antropometrie MeSH
• dospělí MeSH
• energetický příjem * fyziologie   MeSH
• hmotnostní úbytek * fyziologie   MeSH
• index tělesné hmotnosti MeSH
• kalorická restrikce * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• obezita dietoterapie   patofyziologie   MeSH
• omezení příjmu potravy * fyziologie   MeSH
• přerušované hladovění MeSH
• složení těla * fyziologie   MeSH
• tělesná hmotnost fyziologie   MeSH
• tuková tkáň MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

• Klíčová slova
• ACCLIMATIZATION *, BODY WEIGHT *, COLD *, EXPERIMENTAL LAB STUDY *, FASTING *, FOOD *, RATS *,
• MeSH
• aklimatizace * MeSH
• krysa rodu Rattus MeSH
• nízká teplota * MeSH
• omezení příjmu potravy * MeSH
• potraviny * MeSH
• tělesná hmotnost * MeSH
• tělesné váhy a míry * MeSH
• výzkum * MeSH
• Check Tag
• krysa rodu Rattus MeSH
• Publikační typ
• časopisecké články MeSH

Nutritional support is associated with improved clinical outcomes in critically ill patients; however, loss of muscle mass during critical illness leads to weakness, delayed return to work, and increased healthcare consumption. Animal data have suggested that intermittent feeding decreases protein catabolism. This study was aimed at determining whether the mode of enteral nutrition administration might lead to differences in meeting nutritional goals, tolerance, and complications. A prospective, randomized, single-center clinical trial was conducted in four intensive care units in the Czech Republic. Critically ill adult patients with high nutritional risk were randomized to continuous or intermittent enteral nutrition administration through a tolerance-driven protocol. The primary outcome was the time to reach the energetic target. Secondary outcomes included assessment of tolerance (high gastric residual volume, vomitus, and diarrhea), complications (aspiration or ventilator-associated pneumonia), and 28-day mortality. A total of 300 patients were randomized, and 294 were analyzed: 148 in the continuous arm and 146 in the intermittent arm. Regarding the primary outcome, log-rank test indicated that the intermittent group, compared with continuous group, had a statistically significantly shorter time (p = 0.009) and greater diarrhea occurrence (7 (4.7%) vs. 16 (11%), p = 0.049). No statistically significant differences in ventilator-associated pneumonia incidence (18 (12.2%) vs. 18 (12.3%), p = 0.965), 28-day mortality (46 (31.1%) vs. 40 (27.4%), p = 0.488), and other secondary outcomes were observed between groups. Thus, intermittent enteral nutrition was superior to continuous enteral nutrition in terms of time to reach the energetic target with the tolerance-driven administration protocol but was associated with higher diarrhea incidence. No statistically significant differences in the other secondary outcomes were observed.

• Klíčová slova
• Critical care, Diarrhea, Enteral nutrition, Gastric residual volume, Intensive care unit, Ventilator-associated pneumonia,
• MeSH
• časové faktory MeSH
• dospělí MeSH
• enterální výživa * metody   MeSH
• jednotky intenzivní péče * MeSH
• kritický stav * terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nutriční stav MeSH
• prospektivní studie MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

After 8 weeks of intermittent fasting, mice fed both a standard laboratory diet and a high-fat diet became hyperphagic and showed an increased amount of glycogen storage in the liver. An important effect of the adaptation to intermittent feeding with a high-fat diet seems to be an activation of the oxidation of lipids. Lipid oxidation prevails over lipogenesis so that the protein levels in the liver and skeletal muscle are preserved and maintained constant.

• MeSH
• dietní tuky farmakologie   MeSH
• glykogen metabolismus   MeSH
• játra účinky léků   metabolismus   MeSH
• kosterní svaly účinky léků   metabolismus   MeSH
• metabolismus lipidů * MeSH
• myši inbrední C57BL MeSH
• myši inbrední CBA MeSH
• myši MeSH
• omezení příjmu potravy MeSH
• proteiny metabolismus   MeSH
• složení těla účinky léků   fyziologie   MeSH
• velikost orgánu účinky léků   MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• dietní tuky MeSH
• glykogen MeSH
• proteiny MeSH

• Klíčová slova
• COLLAGEN *, FASTING *,
• MeSH
• kolagen * MeSH
• krysa rodu Rattus MeSH
• omezení příjmu potravy * MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• kolagen * MeSH

Nutrition is an important part of the critical care. The goals of this prospective clinical study were to create a scoring system for the assessment of patient nutritional status and to compare continuous and intermittent bolus feeding of enteral nutrition (EN). A total of 38 patients (21 dogs and 17 cats) were divided into Group C (continuous feeding; 23 patients) and Group I (intermittent feeding; 15 patients). The following variables were recorded for each patient in both groups: gastrointestinal (GI) complications, changes in body weight (BW), body condition score (BCS), muscle condition score (MCS), veterinary nutritional status score (VetNSS), length of hospitalisation and outcome. The normality of the data was assessed using the Shapiro-Wilk test. Fisher's exact test, Mann-Whitney, Wilcoxon signed-rank tests, and the t-test were used in statistical analyses. Significant changes were found in VetNSS and BW between the 1st and 5th day in Group C. The VetNSS seems to be useful for monitoring the nutritional status of hospitalised patients. Anorectic dogs and cats can be successfully supported with either continuous or intermittent feeding methods with a similar risk of GI complications and outcomes.

• Klíčová slova
• complications, nutritional score, nutritional support, outcome, tube feeding,
• Publikační typ
• časopisecké články MeSH

• MeSH
• centrální nervový systém fyziologie   MeSH
• fyziologie výživy * MeSH
• krysa rodu Rattus MeSH
• omezení příjmu potravy * MeSH
• tělesná hmotnost MeSH
• věkové faktory MeSH
• vyšší nervová činnost MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Enteral nutrition is part of the treatment of critically ill patients. Administration of enteral nutrition may be associated with signs of intolerance, such as high gastric residual volumes, diarrhea, and vomiting. Clinical trials regarding the effects of the mode of administration of enteral nutrition on the occurrence of these complications have yielded conflicting results. This trial aims to investigate whether the mode of administration of enteral nutrition affects the time to reach nutritional targets, intolerance, and complications. METHODS: COINN is a randomized, monocentric study for critically ill adult patients receiving enteral nutrition. Patients will be randomly assigned to two groups receiving (1) continuous or (2) intermittent administration of enteral nutrition. Enhancement of enteral nutrition will depend on signs of tolerance, mainly the gastric residual volume. The primary outcome will be the time to reach the energetic target. Secondary outcomes will be the time to reach the protein target, tolerance, complications, hospital and ICU lengths of stay, and 28-day mortality. DISCUSSION: This trial aims to evaluate whether the mode of application of enteral nutrition affects the time to reach nutritional targets, signs of intolerance, and complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT03573453. Registered on 29 June 2018.

• Klíčová slova
• Critical care, Diarrhea, Enteral nutrition, Gastric residual volume, Intensive care unit,
• MeSH
• dospělí MeSH
• enterální výživa * škodlivé účinky   MeSH
• jednotky intenzivní péče MeSH
• kritický stav * MeSH
• lidé MeSH
• průjem MeSH
• randomizované kontrolované studie jako téma MeSH
• zvracení MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH

Golden hamsters (Mesocricetus auratus) were subjected to intermittent fasting for six weeks, for three of which their environmental temperature was reduced to 4 degrees C. They were compared with a control group (fed ad libitum and kept at 22 degrees C), a group subjected six weeks only to intermittent fasting at 22 degrees C and a group fed ad libitum for six weeks, but exposed to a temperature of 4 degrees C after the third week. The effect of these various nutritional and temperature regimens on growth, on food consumption, on the formation of liver glycogen and lipid reserves and on energy metabolism was studied. Adaptation to cold raised the hamsters' food intake above the hyperphagia level observed during intermittent fasting. Cold and intermittent fasting acted synergically in raising basal oxygen consumption values and reducting the amount of body lipids. They acted antagonistically on the liver glycogen concentration; when they were used simultaneously, the effect of intermittent fasting preponderated.

• MeSH
• energetický metabolismus * MeSH
• jaterní glykogen metabolismus   MeSH
• křečci praví fyziologie   MeSH
• křeček rodu Mesocricetus fyziologie   MeSH
• metabolismus lipidů MeSH
• nízká teplota * MeSH
• omezení příjmu potravy * MeSH
• přijímání potravy MeSH
• sexuální faktory MeSH
• spotřeba kyslíku * MeSH
• tělesná hmotnost * MeSH
• tuková tkáň fyziologie   MeSH
• zvířata MeSH
• Check Tag
• křečci praví fyziologie   MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• jaterní glykogen MeSH