Preservation of autophagy should not direct nutritional therapy

Recent reports in the literature have proposed that forced mandatory feeding should be avoided in the first week of critical illness to preserve autophagy, in order to maximize responses to oxidative stress, preserve organ function, and improve outcomes.

Autophagy is a well recognized physiologic process that serves a housekeeping role for the cell to eliminate large protein aggregates and as a survival mechanism in starvation for generating energy (ATP) and promoting protein synthesis to maintain cell structure. In the critical care setting, autophagy may have important roles in modulating immune function, fighting infection, and preventing organ failure. The effect of feeding on autophagy is complex, poorly understood, and difficult to predict.

The argument to withhold feeding to preserve autophagy is poorly substantiated and should not interfere with the delivery of early enteral nutrition to the critically ill patient in that first week following admission to the ICU.