Starvation as an adaptive response by Harris
Is mum always right ? Roger Harris’ evolutionary approach to feeding in the ICU. Are we fighting mother nature?
In true smaccGOLD style I hope you find this talk both thought provoking and controversial!
Critical Care is the enemy of evolution – “So much for survival of the fittest, we have never let that stop us right!”.
So what does starvation have to do with critical illness? Well a recent large multi-centre RCT in Australasian ICU’s demonstrated the safety of early Parenteral Nutrition (PN) commenced Day 1.
However, this stands in contrast to what our own bodies tell us when we are sick – that is, “we don’t feel hungry”.
In this talk I will look at some evolutionary adaptations to stress and try to reconcile the findings in the Early PN trial with our basic understanding of human physiology and evolution. The characters in this complex tale are a disparate bunch but, perhaps my good old mum was right after all and somehow knew how they were are linked together?
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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