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Golin A, Jesus SRD, Alves BP, Schott M, Marques AR, Santos LDD, Fleck J, Rocha JBTD, Colpo E. Night fasting as an alternative to improve nutritional support and glycaemic control in hospitalised patients with exclusive enteral nutrition. ENDOCRINOL DIAB NUTR 2023; 70:429-437. [PMID: 37356878 DOI: 10.1016/j.endien.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/11/2022] [Indexed: 06/27/2023]
Abstract
BACKGROUND Enteral nutrition (EN) assists in the nutritional status of hospitalised patients unable to feed orally. The aim of this study was to determine which method-continuous EN or discontinuous EN, a diet in which the infusion is discontinued for 4h during the night,-is more effective in meeting nutrient recommendations and improving glycaemic control and biochemical parameters related to protein anabolism. METHODS Patients were divided into two groups: discontinuous (EN administered in mL/h, 18h/day, 4-h night fasting) and continuous (EN administered in mL/h, 22h/day). All patients with EN receive the diet over a 22-h daily period, in which the diet is suspended for two hours/day for daily hospital routines such as bathing, and physiotherapy, and followed for seven days. Evaluated data: prescribed and administered volume, calories, protein, and fibre; capillary blood glucose; erythrogram; serum albumin. RESULTS 52 patients were followed-up, with 23 (44.2%) in the discontinuous group and 29 (55.8%) in the continuous group. Compared with the continuous group, the discontinuous group received volumes closer to those prescribed, equal or higher calories, and more protein. The capillary glucose values were within the reference range in the discontinuous group, while the continuous group presented elevated values. Both groups presented hypoalbuminaemia, haemoglobin, and haematocrit below the reference values; however, in the discontinuous group, the serum albumin values improved during hospitalisation relative to the continuous. CONCLUSIONS The method involving discontinuation of EN for 4h was more effective in meeting nutrient recommendations compared with the continuous method. Additionally, in the discontinuous group, we observed a better control of glycaemia when compared to that of the continuous group.
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Affiliation(s)
- Anieli Golin
- Master in Health Science and Life Science, and Department of Nutrition, Universidade Franciscana, Santa Maria, RS, Brazil
| | - Sibila Reck de Jesus
- Master in Health Science and Life Science, and Department of Nutrition, Universidade Franciscana, Santa Maria, RS, Brazil
| | - Bruna Pessoa Alves
- Master in Health Science and Life Science, and Department of Nutrition, Universidade Franciscana, Santa Maria, RS, Brazil
| | - Mairin Schott
- Master in Health Science and Life Science, and Department of Nutrition, Universidade Franciscana, Santa Maria, RS, Brazil
| | | | | | - Juliana Fleck
- Department of Pharmacy, Universidade Franciscana, Santa Maria, RS, Brazil
| | | | - Elisângela Colpo
- Master in Health Science and Life Science, and Department of Nutrition, Universidade Franciscana, Santa Maria, RS, Brazil.
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Richter J, Herzog N, Janka S, Baumann T, Kistenmacher A, Oltmanns KM. Twice as High Diet-Induced Thermogenesis After Breakfast vs Dinner On High-Calorie as Well as Low-Calorie Meals. J Clin Endocrinol Metab 2020; 105:5740411. [PMID: 32073608 DOI: 10.1210/clinem/dgz311] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/03/2020] [Indexed: 02/13/2023]
Abstract
BACKGROUND The question of whether there is daytime time variation in diet-induced thermogenesis (DIT) has not been clearly answered. Moreover, it is unclear whether a potential diurnal variation in DIT is preserved during hypocaloric nutrition. OBJECTIVE We hypothesized that DIT varies depending on the time of day and explored whether this physiological regulation is preserved after low-calorie compared with high-calorie intake. DESIGN Under blinded conditions, 16 normal-weight men twice underwent a 3-day in-laboratory, randomized, crossover study. Volunteers consumed a predetermined low-calorie breakfast (11% of individual daily kilocalorie requirement) and high-calorie dinner (69%) in one condition and vice versa in the other. DIT was measured by indirect calorimetry, parameters of glucose metabolism were determined, and hunger and appetite for sweets were rated on a scale. RESULTS Identical calorie consumption led to a 2.5-times higher DIT increase in the morning than in the evening after high-calorie and low-calorie meals (P < .001). The food-induced increase of blood glucose and insulin concentrations was diminished after breakfast compared with dinner (P < .001). Low-calorie breakfast increased feelings of hunger (P < .001), specifically appetite for sweets (P = .007), in the course of the day. CONCLUSIONS DIT is clearly higher in the morning than in the evening, irrespective of the consumed calorie amount; that is, this physiological rhythmicity is preserved during hypocaloric nutrition. Extensive breakfasting should therefore be preferred over large dinner meals to prevent obesity and high blood glucose peaks even under conditions of a hypocaloric diet.
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Affiliation(s)
- Juliane Richter
- Section of Psychoneurobiology, Center of Brain, Behavior and Metabolism, University of Lubeck, Lubeck, Germany
| | - Nina Herzog
- Section of Psychoneurobiology, Center of Brain, Behavior and Metabolism, University of Lubeck, Lubeck, Germany
| | - Simon Janka
- Section of Psychoneurobiology, Center of Brain, Behavior and Metabolism, University of Lubeck, Lubeck, Germany
| | - Thalke Baumann
- Section of Psychoneurobiology, Center of Brain, Behavior and Metabolism, University of Lubeck, Lubeck, Germany
| | - Alina Kistenmacher
- Section of Psychoneurobiology, Center of Brain, Behavior and Metabolism, University of Lubeck, Lubeck, Germany
| | - Kerstin M Oltmanns
- Section of Psychoneurobiology, Center of Brain, Behavior and Metabolism, University of Lubeck, Lubeck, Germany
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Zitting KM, Vujovic N, Yuan RK, Isherwood CM, Medina JE, Wang W, Buxton OM, Williams JS, Czeisler CA, Duffy JF. Human Resting Energy Expenditure Varies with Circadian Phase. Curr Biol 2018; 28:3685-3690.e3. [PMID: 30416064 PMCID: PMC6300153 DOI: 10.1016/j.cub.2018.10.005] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/05/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022]
Abstract
There is emerging evidence that circadian misalignment may alter energy expenditure, leading to obesity risk among those with irregular schedules [1-5]. It has been reported that energy expenditure is affected by the timing of sleep, exercise, and meals [6]. However, it is unclear whether the circadian system also modulates energy expenditure, independent of behavioral state and food intake. Here, we used a forced desynchrony protocol to examine whether fasted resting energy expenditure (REE) varies with circadian phase in seven participants. This protocol allowed us to uncouple sleep-wake and activity-related effects from the endogenous circadian rhythm, demonstrating that REE varies by circadian phase. REE is lowest at circadian phase ∼0°, corresponding to the endogenous core body temperature (CBT) nadir in the late biological night, and highest at circadian phase ∼180° in the biological afternoon and evening. Furthermore, we found that respiratory quotient (RQ), reflecting macronutrient utilization, also varies by circadian phase. RQ is lowest at circadian phase ∼240° and highest at circadian phase ∼60°, which corresponds to biological morning. This is the first characterization of a circadian profile in fasted resting energy expenditure and fasted respiratory quotient (with rhythmic profiles in both carbohydrate and lipid oxidation), decoupled from effects of activity, sleep-wake cycle, and diet in humans. The rhythm in energy expenditure and macronutrient metabolism may contribute to greater weight gain in shift workers and others with irregular schedules.
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Affiliation(s)
- Kirsi-Marja Zitting
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Nina Vujovic
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Robin K Yuan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Cheryl M Isherwood
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Jacob E Medina
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Wei Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Orfeu M Buxton
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA; Division of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA; Department of Biobehavioral Health, Pennsylvania State University, University Park, PA 16802, USA
| | - Jonathan S Williams
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Jeanne F Duffy
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
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