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Title: Bolus vs. continuous feeding to optimize anabolism in neonates

item DAVIS, TERESA - Children'S Nutrition Research Center (CNRC)
item FIOROTTO, MARTA - Children'S Nutrition Research Center (CNRC)
item SURYAWAN, AGUS - Children'S Nutrition Research Center (CNRC)

Submitted to: Current Opinion in Clinical Nutrition and Metabolic Care
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/1/2014
Publication Date: 1/1/2015
Citation: Davis, T.A., Fiorotto, M.L., Suryawan, A. 2015. Bolus vs. continuous feeding to optimize anabolism in neonates. Current Opinion in Clinical Nutrition and Metabolic Care. 18(1):102-108.

Interpretive Summary: Hospitalized babies who have feeding difficulties are frequently fed by stomach tube. The milk or formula can be delivered either continuously at a constant flow rate or by an intermittent bolus pattern of feeding similar to meal feeding. It has not been known which type of feeding is better due to the difficulties in conducting human studies and the many confounding factors that influence outcomes. Our studies using the neonatal piglet model of the human infant showed that intermittent bolus feeding increases the synthesis of protein in skeletal muscle. This increase in protein synthesis is due to the pulsatile rise in amino acids and insulin that, in turn, stimulates the intracellular signaling pathways that increase protein synthesis. This increase in protein synthesis in muscle leads to an increase in the protein deposition in muscle. These studies have provided critical information to support the use of intermittent bolus feeding, rather than continuous feeding,to promote protein deposition and growth of infants.

Technical Abstract: Neonates with feeding difficulties can be fed by orogastric tube, using either continuous or bolus delivery. This review reports on recent findings that bolus is advantageous compared to continuous feeding in supporting optimal protein anabolism. Whether bolus or continuous feeding is more beneficial has been controversial, largely due to limitations inherent in clinical studies, such as the presence of confounding variables and the inability to use invasive approaches. Recent studies using the piglet as a model of the human neonate showed that, compared to continuous feeding, bolus feeding enhances protein synthesis and promotes greater protein deposition. The increase in protein synthesis occurs in muscles of varying fiber type and in visceral tissues whereas muscle protein degradation is largely insensitive to feeding pattern. This higher protein synthesis rate is enabled by the rapid and profound increases in circulating amino acids and insulin that occur following a bolus feed, which activate the intracellular signaling pathways leading to mRNA translation.Recent findings indicate that bolus feeding enhances protein synthesis more than continuous feeding and promotes greater protein anabolism. The difference in response is attributable to the pulsatile pattern of amino acid-induced and insulin-induced translation initiation induced only by bolus feeding.