Starvation is an adaptive response

Evolution - Adaptation & Critical Illness

‘Starvation is an adaptive response’

Challenge

Should we always feed early?

Through their Eyes

Survival of the fittest

Evolution and critical care?

I’m not hungry – I feel sick

• Stress response & anorexia

Mother knows best

Wear a jumper you’ll

catch cold

Starve a fever feed a cold

Sitting on cold concrete causes piles

• But is anorexia a good thing?

Digestion is Catabolic

Anorexia stimulates Autophagy

Auto-phagy

Macro-Autophagy

43 Days & 1 Mars Bar

EPaNIC v Early PN

EPaNIC

Early PN

Through their Eyes

‘Starvation results in death’

What Do I Do?

We should tailor how we feed

‘Anorexia is an adaptive response’

References1: Signals generating anorexia in acute illness. Langhans W. Proceedings of

Nutrition society 2007;66:321-330

2: Leptin in Anorexia and Cachexia syndrome. Engineer D, Garcia J. International Journal of Peptides 2012;287457:13

3: Autophagy and Adaptive Immunity. Crotzer V, Blum J. Immunology 2010;131:9-17

4: Early versus late Parenteral Nutrition in critically ill Adults. Caesar M et al. N Engl J Med 2011;365:506-17

5: Early Parenteral Nutrition in Critically Ill Patients with short-term relative contraindications to Early Enteral Nutrition. Doig G et al. JAMA 2013;309(20):2130-2138