Intermittent feeding and circadian rhythm in critical illness

Imre W K Kouw, Leonie K Heilbronn, Arthur R H van Zanten, Imre W K Kouw, Leonie K Heilbronn, Arthur R H van Zanten

Abstract

Purpose of review: Circadian rhythms, i.e., periodic oscillations in internal biological processes, modulate metabolic processes such as hormonal signalling, nutrient absorption, and xenobiotic detoxification. Meal timing is a strong entraining cue for peripheral clocks in various organs, and eating out of circadian phases can impair glucose, gastrointestinal, and muscle metabolism. Sleep/wake cycles and circadian rhythms are extremely disrupted during critical illness. Timing of nutritional support may help preserve circadian rhythms and improve post-Intensive Care Unit (ICU) recovery. This review summarises circadian disruptors during ICU admission and evaluates the potential benefits of intermittent feeding on metabolism and circadian rhythms.

Recent findings: Rhythmic expression of core clock genes becomes rapidly disturbed during critical illness and remains disturbed for weeks. Intermittent, bolus, and cyclic enteral feeding have been directly compared to routine continuous feeding, yet no benefits on glycaemic control, gastrointestinal tolerance, and muscle mass have been observed and impacts of circadian clocks remain untested.

Summary: Aligning timing of nutritional intake, physical activity, and/or medication with circadian rhythms are potential strategies to reset peripheral circadian rhythms and may enhance ICU recovery but is not proven beneficial yet. Therefore, selecting intermittent feeding over continuous feeding must be balanced against the pros and cons of clinical practice.

Conflict of interest statement

There are no conflicts of interest.

Author contribution: I.W.K.K., L.K.H., and A.R.H.V.Z. were responsible for conceptualisation, data curation, and original draft writing and review and editing of the final manuscript.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

Figures

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FIGURE 1
Clinical and environmental factors in the ICU that impact circadian rhythms.

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Source: PubMed

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