Abstract
During the stress response, the energy demand of the body is fulfilled by the interaction between the endogenous and exogenous energy supplies. The stress response physiologically leads to the catabolism and provision of endogenous energy substrates, despite an adequate exogenous energy supply. Therefore, there is a greater likelihood that the sum of the endogenous and exogenous energy substrates is substantially in excess of the total energy expenditure and eventually causes overfeeding with negative impacts on the metabolic response when increasing the exogenous energy supply without regard for the endogenous energy supply. Even during the acute phase of severe stress, conventional nutrition support therapy has adopted the basic concept of exogenously providing all of the so-called “energy requirement” which is equated to predicted or measured resting energy expenditure. As a result, nutrition support therapy might be expected to inevitably promote the risk of overfeeding. In fact, there are astoundingly few studies that have been able to demonstrate clinically relevant benefits with nutritional support, especially in relation to critical illness. Furthermore, recent investigations have demonstrated that even the appropriate quantity of energy and/or protein does not appear to consistently improve patient outcomes, especially in relation to body composition, but when given in excess can exert adverse effects such as hyperglycemia and various sorts of nutritional stress. In the light of these issues, the author recommends a new concept of caloric provision based on energy substrates kinetics under the stress response.
