Location: Children's Nutrition Research CenterTitle: Intermittent bolus feeding promotes greater lean growth than continuous feeding in a neonatal piglet model
|EL-KADI, SAMER - Virginia Tech|
|BOUTRY, CLAIRE - Baylor College Of Medicine|
|SURYAWAN, AGUS - Children'S Nutrition Research Center (CNRC)|
|GAZZANEO, MARIA - Children'S Nutrition Research Center (CNRC)|
|ORELLANA, RENAN - Children'S Nutrition Research Center (CNRC)|
|SRIVASTAVA, NEERAJ - Children'S Nutrition Research Center (CNRC)|
|NGUYEN, HANH - Children'S Nutrition Research Center (CNRC)|
|KIMBALL, SCOT - Baylor College Of Medicine|
|FIOROTTO, MARTA - Children'S Nutrition Research Center (CNRC)|
|DAVIS, TERESA - Children'S Nutrition Research Center (CNRC)|
Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/1/2018
Publication Date: 10/1/2018
Citation: El-Kadi, S.W., Boutry, C., Suryawan, A., Gazzaneo, M.C., Orellana, R.A., Srivastava, N., Nguyen, H.V., Kimball, S.R., Fiorotto, M.L., Davis, T.A. 2018. Intermittent bolus feeding promotes greater lean growth than continuous feeding in a neonatal piglet model. American Journal of Clinical Nutrition. 108(4):830-841. https://doi.org/10.1093/ajcn/nqy133.
Interpretive Summary: Orogastric tube feeding is necessary for babies who are unable to suck, swallow, or breathe normally. Human milk or formula can be provided by orogastric tube either continuously or on an intermittent bolus schedule that is similar to meal feeding. The clinical benefits of these different feeding modalities have been debated for some time. Using piglets as a model for human babies, we conducted a 21 day feeding study to elucidate the effect of these two methods of orogastric feeding on growth and body composition. We found that intermittent bolus feeding increased body weight more than continuous feeding even though both groups were fed the same amount of formula. This increase in body weight was due to an increase in linear growth as well as an increase in skeletal muscle growth. The increase in muscle growth was due to a higher activation of intracellular signaling components that regulate the synthesis of protein in skeletal muscle. Our results provide new and important information that may be applied in the hospital to help babies to achieve normal growth and development.
Technical Abstract: Orogastric tube feeding is indicated in neonates with an impaired ability to ingest food normally and can be administered with an intermittent bolus or continuous feeding schedule. The objectives were to 1) compare the long-term effect of continuous with intermittent feeding on growth using the newborn pig as a model, 2) determine whether feeding frequency alters lean tissue and fat mass gain, and 3) identify the signaling mechanisms by which protein deposition is controlled in skeletal muscle in response to feeding frequency. Neonatal pigs were fed the same amount of a balanced formula by orogastric tube either as an intermittent bolus meal every 4 h (INT) or as a continuous infusion (CON). Body composition was assessed at the start and end of the study by dual-energy X-ray absorptiometry, and hormone and substrate profiles, muscle mass, protein synthesis, and indexes of nutrient and insulin signaling were measured after 21 d. Body weight, lean mass, spine length, and skeletal muscle mass were greater in the INT group than in the CON group. Skeletal muscle fractional protein synthesis rates were greater in the INT group after a meal than in the CON group and were associated with higher circulating branched-chain amino acid and insulin concentrations. Skeletal muscle protein kinase B (PKB) and ribosomal protein S6 kinase phosphorylation and eukaryotic initiation factor (eIF) 4E-eIF4G complex formation were higher, whereas eIF2a phosphorylation was lower in the INT group than in the CON group, indicating enhanced activation of insulin and amino acid signaling to translation initiation. These results suggest that when neonates are fed the same amounts of nutrients as intermittent meals rather than continuously there is greater lean growth. This response can be ascribed, in part, to the pulsatile pattern of amino acids, insulin, or both induced by INT, which enables the responsiveness of anabolic pathways to feeding to be sustained chronically in skeletal muscle.