PURPOSE: The objectives of this review are to summarize the current practices and major recent advances in critical care nutrition and metabolism, review common beliefs that have been contradicted by recent trials, highlight key remaining areas of uncertainty, and suggest recommendations for the top 10 studies/trials to be done in the next 10 years.METHODS: Recent literature was reviewed and developments and knowledge gaps were summarized. The panel identified candidate topics for future trials in critical care nutrition and metabolism. Then, members of the panel rated each one of the topics using a grading system (0-4). Potential studies were ranked on the basis of average score.RESULTS: Recent randomized controlled trials (RCTs) have challenged several concepts, including the notion that energy expenditure must be met universally in all critically ill patients during the acute phase of critical illness, the routine monitoring of gastric residual volume, and the value of immune-modulating nutrition. The optimal protein dose combined with standardized active and passive mobilization during the acute phase and post-acute phase of critical illness were the top ranked studies for the next 10 years. Nutritional assessment, nutritional strategies in critically obese patients, and the effects of continuous versus intermittent enteral nutrition were also among the highest-ranking studies.CONCLUSIONS: Priorities for clinical research in the field of nutritional management of critically ill patients were suggested, with the prospect that different nutritional interventions targeted to the appropriate patient population will be examined for their effect on facilitating recovery and improving survival in adequately powered and properly designed studies, probably in conjunction with physical activity.
Eating rate is a basic determinant of appetite regulation, as people who eat more slowly feel sated earlier and eat less. Without assistance, eating rate is difficult to modify due to its automatic nature. In the current study, participants used an augmented fork that aimed to decelerate their rate of eating. A total of 114 participants were randomly assigned to the Feedback Condition (FC), in which they received vibrotactile feedback from their fork when eating too fast (i.e., taking more than one bite per 10 s), or a Non-Feedback Condition (NFC). Participants in the FC took fewer bites per minute than did those in the NFC. Participants in the FC also had a higher success ratio, indicating that they had significantly more bites outside the designated time interval of 10 s than did participants in the NFC. A slower eating rate, however, did not lead to a significant reduction in the amount of food consumed or level of satiation.These findings indicate that real-time vibrotactile feedback delivered through an augmented fork is capable of reducing eating rate, but there is no evidence from this study that this reduction in eating rate is translated into an increase in satiation or reduction in food consumption. Overall, this study shows that real-time vibrotactile feedback may be a viable tool in interventions that aim to reduce eating rate. The long-term effectiveness of this form of feedback on satiation and food consumption, however, awaits further investigation.
