Bioenergetic and metabolic response to continuous v intermittent nasoenteric feeding

Resting thermal energy losses and metabolic balances of N, K, P, Ca, Na, and Mg were compared during continuous and intermittent nasoenteric formula infusion in four healthy men. Each feeding protocol lasted 1 week in a 4-week double crossover experiment. The initial feeding schedule was established randomly. Continuous nasoenteric formula infusion produced no increase in thermal energy losses above the fasting level; energy expenditure fell with sleep to the same extent as with intermittent feeding. Thermal losses were similar during intermittent feeding with the exception of the thermic effect of food that produced an additional average energy loss of 115.7 kcal/d. The total resting and sleeping 24-hour energy expenditure was significantly lower (P less than .01) during continuous formula infusion (means +/- SD for n = 8 balance periods, 1344 +/- 119 kcal) compared to intermittent feeding (1457 +/- 179 kcal). No significant differences in nutrient absorption or balances of N, Na, Ca, and Mg were detected between the two feeding protocols. In contrast, continuous infusion of formula was accompanied by negative balances of K and the cytosolic portion of P; weight balance was slightly negative. Weight, K, and cytosolic P balances were all positive during intermittent feeding (P = NS, less than 0.01, and P less than .05 compared to respective continuous infusion periods). Hence, 1 week of continuous nasogastric formula infusion is associated with similar nutrient absorption, a significant reduction in thermal energy losses, and equivalent protein (N) balance relative to intermittent feeding. Differences in weight balance between the two feeding protocols can be ascribed largely to fluid and mineral shifts. These results suggest that energy requirements are lower during continuous formula infusion by about 100 kcal/d compared to regular meal ingestion.