Publication Details

Title :

Effect of Permissive Underfeeding with Intensive Insulin Therapy on MCP-1, sICAM-1, and TF in Critically Ill Patients

Journal:

Nutrients

Impact Factor:

4.171

Authors:

Aljada A1, AlGwaiz GF2, AlAyadhi D3, Masuadi E4, Zahra M5, Al-Matar SH6, Al-Bawab A7, Tamimi W8, Jawdat D9, Al-Dawood A10, Sakkijha MH11, Sadat M12, Arabi YM13.

Affiliations:

1 Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia.

2 Department of Basic Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdul Aziz Medical City, Ministry of National Guard-Health Affairs, Riyadh 11481, Saudi Arabia.

3 Department of Basic Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdul Aziz Medical City, Ministry of National Guard-Health Affairs, Riyadh 11481, Saudi Arabia.

4 Research Unit, Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdul Aziz Medical City, Ministry of National Guard-Health Affairs, Riyadh 11481, Saudi Arabia.

5 Department of Basic Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdul Aziz Medical City, Ministry of National Guard-Health Affairs, Riyadh 11481, Saudi Arabia.

6 Department of Basic Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdul Aziz Medical City, Ministry of National Guard-Health Affairs, Riyadh 11481, Saudi Arabia.

7 Department of Basic Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdul Aziz Medical City, Ministry of National Guard-Health Affairs, Riyadh 11481, Saudi Arabia.

8 Department of Clinical Laboratory, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh 11481, Saudi Arabia.

9 Cord Blood Bank, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh 11481, Saudi Arabia.

10 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Riyadh 11481, Saudi Arabia.

11 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Riyadh 11481, Saudi Arabia.

12 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Riyadh 11481, Saudi Arabia.

13 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Riyadh 11481, Saudi Arabia.

Year of Publication:

2019

DOI:

10.3390/nu11050987.

Abstract:

PURPOSE:
This study examined the effect of permissive underfeeding compared to target feeding and intensive insulin therapy (IIT) compared to conventional insulin therapy (CIT) on the inflammatory mediators monocyte chemoattractant protein 1 (MCP-1), soluble intercellular adhesion molecule 1 (sICAM-1), and tissue factor (TF) in critically ill patients.

METHODOLOGY:
This was a substudy of a 2 × 2 factorial design randomized controlled trial in which intensive care unit (ICU) patients were randomized into permissive underfeeding compared to target feeding groups and into IIT compared to CIT groups (ISRCTN96294863). In this substudy, we included 91 patients with almost equal numbers across randomization groups. Blood samples were collected at baseline and at days 3, 5, and 7 of an ICU stay. Linear mixed models were used to assess the differences in MCP-1, sICAM-1, and TF across randomization groups over time.

RESULTS:
Baseline characteristics were balanced across randomization groups. Daily caloric intake was significantly higher in the target feeding than in the permissive underfeeding groups (P-value < 0.01), and the daily insulin dose was significantly higher in the IIT than in the CIT groups (P-value < 0.01). MCP-1, sICAM-1, and TF did not show any significant difference between the randomization groups, while there was a time effect for MCP-1. Baseline sequential organ failure assessment (SOFA) score and platelets had a significant effect on sICAM-1 (P-value < 0.01). For TF, there was a significant association with age (P-value < 0.01).

CONCLUSION:
Although it has been previously demonstrated that insulin inhibits MCP-1, sICAM-1 in critically ill patients, and TF in non-critically ill patients, our study demonstrated that IIT in critically ill patients did not affect these inflammatory mediators. Similarly, caloric intake had a negligible effect on the inflammatory mediators studied.