Anhui Provincial Hospital, Anhui, China (People's Republic)
Objectives: Inappropriate nutrition delivery exacerbates the mechanisms of secondary brain injury and results in short- and long-term complications in traumatic brain injury (TBI) . What is the ideal feeding strategy for TBI patients? As is well known, the activated GLP-1/GLP-R system can delay gastric emptying, suppress appetite, and thus reduce energy intake. In our previous study, we have found that disruption of central GLP-1/GLP-1R system could result in central resistance to GLP-1 and elevated endogenous GLP-1 in patients with severe TBI. The aim of this study is to investigate whether central GLP-1 resistance affects the tolerance to enteral nutrition in TBI.
Methods: We conducted a prospective observational study on patients with severe TBI to investigate the first 2-week kinetic of plasma GLP-1 and its relationship with feeding tolerance. Enteral feeding was conducted with the target of 25kcal/kg. d. Metabolic, hematologic profiles and feeding amount were examined in 73 patients with TBI in neurological intensive care unit. The blood samples were collected on four timepoints: post-injury days 1–3 (PID1), PID 4–7 (PID2), PID 8–10 (PID3), and PID 11–14 (PID4).
Results: It was found that those with feeding intolerance (lower than 70% target calorie) showed higher GLP-1 and serum insulin levels than fully fed (achieved 70-100% target calorie) patients, which was more prominent in patients with severe intolerance (lower than 40% target calorie) (p=0.017 and p< 0.001, respectively)m and the differences had already been observed at PID1. In addition, even though the carbohydrates intake in intolerant patients was significantly lower than that of adequately fed patients, there was no statistically significant difference in insulin infusion dose between the two(p=0.495). Moreover, there was no difference in intestinal mucosal barrier indicators between the two groups(p >0.05).
Conclusions: Central GLP-1/GLP-R system malfunction can lead to elevated peripheral GLP-1 levels, inducing gastrointestinal dysfunction, and ultimately result in enteral nutrition intolerance. The GLP-1 based enteral feeding strategy may be a breakthrough for personalized feeding strategy in TBI patients.
Funding Sources: The study was supported by grants from the Chinese National Natural Science Foundation 82241050 to M.Z.
