A large proportion of patients in intensive care receive specialised nutrition formula through a tube. These formulae are designed to meet all their nutritional needs. Patients in the ICU are complex and have a wide variety of clinical conditions which poses a challenge with a “one size fits all” approach. Nutrition formula may need to be tailored in certain conditions to improve patient outcomes and post treatment health
With patient health front of mind, a pioneering study by PA Hospital dietitian Dr Ra’eesa Doola, made possible by the supporters of the PA Research Foundation, is exploring that very possibility.
Dr Doola’s project entitled The effect of modifying nutritional support on glucose metabolism and clinical outcomes during critical illness, focuses on the content of nutrition given to intensive care unit (ICU) patients. This nutrition which is given to patients through a tube contains what is known as advanced glycation end products (AGEs) which can affect blood sugar control as well as inflammatory response which subsequently can impact clinical outcomes as a result.
The initial focus of the study is to examine associations between the AGE content of the of the nutrition formula that’s given to ICU patients, in particular those with acute kidney injuries, and patient outcomes including blood sugar control, inflammatory response and other important clinical outcomes.
“The human body produces these AGEs, with external AGE provision from nutrition formula, adding to the amount circulating in the patient’s blood stream. If these AGEs accumulate, they can have an influence on a range of factors that potentially influence their clinical outcomes,” Dr Doola explained.
“Patients with adequate renal function are able to tightly control circulating AGE’s by excreting any excess through their urine. ICU patients that have acute kidney injuries are often not able to produce enough urine and subsequently do not excrete high amounts of AGEs which can potentially lead to an accumulation of AGEs in the plasma.
“This can potentially contribute to a hyper-inflammatory response for them, which is in turn could be triggering a series of events leading to multi-organ failure.
“A senior member of this research team has pioneered work in this area. A previous study she’s led showed that participants on a high AGE intake had lower insulin sensitivity when compared to the period they were on a low AGE diet. .”
The study which is part of a larger body of work by the PA Hospital’s Nutrition and Dietetics Department, will review plasma and urine markers to measure AGE excretion, accumulation and specific inflammatory measures . The results of this study will ideally provide us with data to support our request to nutrition companies to review their formula with the aim of reducing the amount of AGEs within it, which we can then test further in a clinical trial setting.
Dr Doola expressed her gratitude to the PA Research Foundation for its support of not only intensive care research but nutrition research, as she is confident the results of her work will lead to better outcomes for patients in the future, and ultimately change the way nutrition in the ICU is considered.
“What we're really hoping to achieve at the end of the day is getting people home sooner, so a shorter ICU length of stay, which we know in itself is associated with negative outcomes, also hopefully less people going on dialysis and a reduction in patients who experience multi-organ failure,” she said.
“I feel very strongly that this will help lead to better outcomes for patients, not just at the PA but across the country,” she said.
“This project will allow us to collect the data we need so that we can apply for larger funding and engage industry partners as we will have more pieces of the puzzle to make our case.
“I’m very grateful, I can’t thank the Foundation and its donors enough for supporting this project.”
You can support patients in the ICU to have better outcomes by making the PA Research Foundation your place to give here.
