Evidence map›Paper›PMID 41197596›Full record

Trial reportClinical nutrition (Edinburgh, Scotland)2025

Does Intermittent Nutrition Enterally Normalise hormonal and metabolic responses to feeding in critically ill adults? The DINE-normal proof-of-concept study.

Clodagh E Beattie, Borislavova Borislava, Harry A Smith, Michael T Ambler, Paul White, Danielle Milne, Aravind V Ramesh, Alexander Ferriman, Thomas Fisher, Charlotte Horsley and 8 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Clinical nutrition (Edinburgh, Scotland), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06115044 (Does Intermittent Nutrition Enterally Normalise Hormonal and Metabolic Responses to Feeding in Critically Ill Adults), which is not on this map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06115044 nacompletednot on this map

Does Intermittent Nutrition Enterally Normalise Hormonal and Metabolic Responses to Feeding in Critically Ill Adults: The DINE-Normal Proof-of-concept Study

TypeinterventionalSponsorNorth Bristol NHS TrustRan2023 to 2024Enrolled30ConditionsCritical Illness, Enteral Nutrition, Time Restricted FeedingArmsIntermittent diurnal nutrition, Continuous
3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Clodagh E BeattieIntensive Care Unit, North Bristol NHS Trust, Bristol, UK; Anaesthesia, Pain and Critical Care Research, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
Borislavova BorislavaIntensive Care Unit, North Bristol NHS Trust, Bristol, UK.
Harry A SmithCentre for Nutrition, Exercise and Metabolism, University of Bath, Bath, UK.
Michael T AmblerAnaesthesia, Pain and Critical Care Research, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
Paul WhiteMathematics and Statistics Research Group, University of the West of England, Bristol, UK.
Danielle MilneIntensive Care Unit, North Bristol NHS Trust, Bristol, UK.
Aravind V RameshAnaesthesia, Pain and Critical Care Research, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
Alexander FerrimanIntensive Care Unit, North Bristol NHS Trust, Bristol, UK.
Thomas FisherIntensive Care Unit, North Bristol NHS Trust, Bristol, UK.
Charlotte HorsleyIntensive Care Unit, North Bristol NHS Trust, Bristol, UK.
Sherena JacksonIntensive Care Unit, North Bristol NHS Trust, Bristol, UK.
Chloe JubainvilleIntensive Care Unit, North Bristol NHS Trust, Bristol, UK.
Kate LoboIntensive Care Unit, North Bristol NHS Trust, Bristol, UK.
Hannah MaxfieldIntensive Care Unit, North Bristol NHS Trust, Bristol, UK.
Javier T GonzalezCentre for Nutrition, Exercise and Metabolism, University of Bath, Bath, UK.
James A BettsCentre for Nutrition, Exercise and Metabolism, University of Bath, Bath, UK.
Anthony E PickeringAnaesthesia, Pain and Critical Care Research, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK. Electronic address: tony.pickering@bristol.ac.uk.
Matt ThomasIntensive Care Unit, North Bristol NHS Trust, Bristol, UK; Anaesthesia, Pain and Critical Care Research, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimsFor intensive care unit (ICU) patients fed via a nasogastric (NG) tube, current guidelines recommend continuous feeding through the day and night. Emerging evidence in healthy individuals shows that NG feeding in an intermittent diurnal pattern promotes phasic hormonal, digestive and metabolic responses vital for effective nutrition, though this has not been studied in the critically ill population. This proof-of-concept study aimed to compare the effect of diurnal intermittent versus continuous enteral feeding on hormonal and metabolic outcomes in ICU patients.

methodsWe conducted a single-centre, randomised, open-label trial in the ICU. Adult ICU patients that were anticipated to require NG feeding for >48 h were randomised to an intermittent diurnal regimen (feeds at 8:00, 13:00 and 18:00), or continuous feeding with equivalent nutritional value, for 48 h. The primary outcome was peak plasma insulin within 3 h of delivering the first intermittent feed on the second study day, compared to the same time period in the continuous group. Secondary outcomes included feasibility, tolerability and metabolic profiles.

resultsThirty patients were randomised to intermittent (n = 13) or continuous (n = 17) feeding. Two patients in the intermittent group were excluded from analysis. Both groups achieved their feed targets. Peak plasma insulin concentrations (mean ± SD) were significantly higher in the intermittent group versus continuous (295.1 ± 167.8 vs. 128.1 ± 57.2 pmol/L, p < 0.001). Plasma glucose concentrations were not significantly different between groups. There were no between-group differences in other plasma metabolites and there were no adverse events such as hyper-/hypo-glycaemia. There was evidence of increased bowel motility in the intermittent group.

conclusionIntermittent diurnal feeding, compared to continuous feeding, preserves the physiological insulin response in critically ill adults. Both regimens were well tolerated, supporting the need for a larger trial to assess other clinically important patient-centred outcomes.

trial registrationThis trial was registered prospectively at clinicaltrials.gov (study ID NCT06115044).

Indexed as

Critical IllnessEnteral NutritionInsulinAdultAgedBlood GlucoseCircadian RhythmCritical CareFemaleHumansIntensive Care UnitsMaleMiddle AgedProof of Concept StudyBlood GlucoseInsulinCircadian rhythmCritical careEnteral nutritionGlucoseInsulinIntermittent fasting

Identifiers

PMID41197596
PMCPMC7618939

What Socratic holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.