Table 2 Suggestions for a systematic weekly monitoring of metabolic response to feeding, with interpretation of the changes

Energy balance (daily, accumulated)

X

X

X

X

X

X

X

X

Daily delivery >110% or <80% of prescription: act accordingly to ↓ or ↑ intake

Cumulated energy target over 3 to 6 days: <−4,000 kcal, beware and increase feeding; <−8,000 (−100 kcal/kg), danger

Glucose

4

4

4

4

4

4

4

4

↑: suspect overfeeding or infection; →, continue as is; ↓, improving condition

Insulin/24 hours

X

X

X

X

X

X

X

X

Triglycerides

1

1

1

↑: non-nutritional fat intake? Nutritional fat? Sepsis?

ASAT ALAT

1

1

1

↑: sepsis? Drug toxicity? Overfeeding? Watch for glucose. →, continue

Prealbumin

1

1

↑: decreased inflammation and improved protein accretion; ↓: worsening of inflammation or insufficient protein intakes

Albumin CRP

1

1

Provide information on level of inflammation and severity of disease

Weight (actual)

X

(X)

X

↑: fluid accumulation? ↓: loss of fluid and lean body mass

Se, zn

?

In at-risk patients (CRRT, intestinal fistulae, prolonged feeding)