Gastrointestinal Hormone Profiles Associated With Enteral Nutrition Tolerance and Gastric Emptying in Pediatric Critical Illness: A Pilot Study

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 44; no. 3; pp. 472 - 480
• Main Authors: Martinez, Enid E., Panciotti, Courtney, Pereira, Luis M., Kellogg, Mark D., Stylopoulos, Nicholas, Mehta, Nilesh M.
• Format: Journal Article
• Language: English
• Published: United States 01-03-2020
• Subjects: Child; critical care; Critical Illness; Enteral Nutrition; enteral nutrition tolerance; enterohormones; Female; Gastric Emptying; Gastrointestinal Hormones; glucagon‐like peptide 1; Humans; Male; pediatric; Pilot Projects; enteral nutrition; enteral nutrition tolerance; gastrointestinal hormones; enterohormones; critical care; glucagon-like peptide 1; gastric emptying; pediatric
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1002/jpen.1678

Background
Enteral nutrition (EN) intolerance and delayed gastric emptying are prevalent in pediatric critical illness and limit EN delivery. Gastrointestinal (GI) hormones may be associated with EN intolerance and delayed gastric emptying in this cohort.
Methods
We determined GI hormone levels, time to achieve 50% of EN goal, and gastric emptying in critically ill children. Total amylin, active ghrelin, total glucagon‐like peptide‐1 (GLP‐1), total gastric inhibitory polypeptide, glucagon, and total peptide‐YY (PYY) were measured by multiplex assay and cholecystokinin by ELISA. Lower concentrations of acetaminophen at 1 hour (C1h, µg/mL) using the acetaminophen absorption test defined delayed gastric emptying. Correlation, regression analyses, and a principal component analysis were used to examine the association between GI hormones and time to 50% EN goal and C1h.
Results
GI hormones were measured in 14 of 21 patients with gastric emptying testing; median age of 11.2 years (6.74–16.3) and 50% male. Increasing hormone levels from GI hormone profile 1 (GLP‐1, glucagon, and amylin) correlated with greater time to reach 50% EN goal (R2 = 0.296, P = 0.04). Decreasing hormone levels from GI hormone profile 2 (PYY and ghrelin) correlated with lower C1h and slower gastric emptying (R2 = 0.342, P = 0.02).
Conclusion
GI hormone profiles are associated with time to achieve 50% of EN goal and gastric emptying in critically ill children. We have described a feasible model to study the role of GI hormones in this cohort, including the potential clinical applicability of GI hormone measurement in the management of delayed gastric emptying.