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Simple Summary: Zebrafish have emerged as invaluable model organisms in biological research, offering a cost-effective alternative to rodents. However, the absence of standardized feeding protocols and nutritional requirements poses a significant challenge, potentially compromising the validity of experimental outcomes, particularly in preclinical studies. Our systematic review analyzes a plethora of studies focused on zebrafish feed intake, feeding regimes, and diet compositions. We uncover substantial variability in dietary parameters, notably in crude protein and lipid content. Despite this diversity, energy levels remain quite consistent across zebrafish diets. By using these insights, we propose a novel feeding protocol for zebrafish of different developmental stages, based on a formulated feed optimized for protein and energy content. This protocol might represent the first step towards standardizing zebrafish feeding practices, thereby enhancing experimental reproducibility and data reliability. Zebrafish are one of the most used animal models in biological research and a cost-effective alternative to rodents. Despite this, nutritional requirements and standardized feeding protocols have not yet been established for this species. This is important to avoid nutritional effects on experimental outcomes, and especially when zebrafish models are used in preclinical studies, as many diseases have nutritional confounding factors. A key aspect of zebrafish nutrition is related to feed intake, the amount of feed ingested by each fish daily. With the goal of standardizing feeding protocols among the zebrafish community, this paper systematically reviews the available data from 73 studies on zebrafish feed intake, feeding regimes (levels), and diet composition. Great variability was observed regarding diet composition, especially regarding crude protein (mean 44.98 ± 9.87%) and lipid content (9.91 ± 5.40%). Interestingly, the gross energy levels of the zebrafish diets were similar across the reviewed studies (20.39 ± 2.10 kilojoules/g of feed). In most of the reviewed papers, fish received a predetermined quantity of feed (feed supplied). The authors fed the fish according to the voluntary intake and then calculated feed intake (FI) in only 17 papers. From a quantitative point of view, FI was higher than when a fixed quantity (pre-defined) of feed was supplied. Also, the literature showed that many biotic and abiotic factors may affect zebrafish FI. Finally, based on the FI data gathered from the literature, a new feeding protocol is proposed. In summary, a daily feeding rate of 9–10% of body weight is proposed for larvae, whereas these values are equal to 6–8% for juveniles and 5% for adults when a dry feed with a proper protein and energy content is used. [ABSTRACT FROM AUTHOR]

Zebrafish are one of the most used animal models in biological research and a cost-effective alternative to rodents. Despite this, nutritional requirements and standardized feeding protocols have not yet been established for this species. This is important to avoid nutritional effects on experimental outcomes, and especially when zebrafish models are used in preclinical studies, as many diseases have nutritional confounding factors. A key aspect of zebrafish nutrition is related to feed intake, the amount of feed ingested by each fish daily. With the goal of standardizing feeding protocols among the zebrafish community, this paper systematically reviews the available data from 73 studies on zebrafish feed intake, feeding regimes (levels), and diet composition. Great variability was observed regarding diet composition, especially regarding crude protein (mean 44.98 ± 9.87%) and lipid content (9.91 ± 5.40%). Interestingly, the gross energy levels of the zebrafish diets were similar across the reviewed studies (20.39 ± 2.10 kilojoules/g of feed). In most of the reviewed papers, fish received a predetermined quantity of feed (feed supplied). The authors fed the fish according to the voluntary intake and then calculated feed intake (FI) in only 17 papers. From a quantitative point of view, FI was higher than when a fixed quantity (pre-defined) of feed was supplied. Also, the literature showed that many biotic and abiotic factors may affect zebrafish FI. Finally, based on the FI data gathered from the literature, a new feeding protocol is proposed. In summary, a daily feeding rate of 9–10% of body weight is proposed for larvae, whereas these values are equal to 6–8% for juveniles and 5% for adults when a dry feed with a proper protein and energy content is used.

Introduction:  Gastroschisis feeding practices vary. Standardized neonatal feeding protocols have been demonstrated to improve nutritional outcomes. We report outcomes of infants with gastroschisis that were fed with and without a protocol.Materials and Methods:  A retrospective study of neonates with uncomplicated gastroschisis at 11 children's hospitals from 2013 to 2016 was performed.Outcomes of infants fed via institutional-specific protocols were compared with those fed without a protocol. Subgroup analyses of protocol use with immediate versus delayed closure and with sutured versus sutureless closure were conducted.Results:  Among 315 neonates, protocol-based feeding was utilized in 204 (65%) while no feeding protocol was used in 111 (35%). There were less surgical site infections (SSI) in those fed with a protocol (7 vs. 16%, p = 0.019). There were no differences in TPN duration, time to initial oral intake, time to goal feeds, ventilator use, peripherally inserted central catheter line deep venous thromboses, or length of stay. Of those fed via protocol, less SSIs occurred in those who underwent sutured closure (9 vs. 19%, p = 0.026). Further analyses based on closure timing or closure method did not demonstrate any significant differences.Conclusion:  Across this multi-institutional cohort of infants with uncomplicated gastroschisis, there were more SSIs in those fed without an institutional-based feeding protocol but no differences in other outcomes. [ABSTRACT FROM AUTHOR]

The present study investigates the effects of different feeding regimes with rotifers (Brachionus plicatilis) and Artemia salina on the gene expression and digestive enzymes in pikeperch (Sander lucioperca) larvae at 17 days post-hatch (DPH) over a period of 13 days. Five experimental feeding protocols were performed in four replicates. At 4 DPH, the larvae (total length= 5.62 ± 0.03 mm, body weight = 0.66 ± 0.16 mg) were divided into five experimental groups (2-L tanks) at initial density of 100 larvae per liter. Light intensity on the water surface was 90-100 lux and photoperiod was set at 13L: 11D (07:00 to 20:00 h). Water temperature, pH, and dissolved oxygen (DO) were measured before each feeding and the values were 17.8 ± 0.17°C, 7.3 ± 0.04 and 88.5 ± 2.53%. The fish larvae at 5 days post-hatch (DPH), were initially fed with rotifers (Brachionus plicatilis) for 3 days and from 8 to 17 DPH were fed with rotifers/Artemia for different time periods as follows: (A) only rotifers; (B) 8–13 DPH rotifers/14–17 DPH Artemia; (C) 8–10 DPH rotifers/11–17 DPH Artemia; (D) only Artemia; (E) a combination of rotifers and Artemia. Frozen paste of algae was added to the larval tanks twice a day (2 x 300,000 cells/mL). Rotifers and Artemia were provided as live feed to larvae three times a day with residual counts prior to each feeding. Feeding densities were steadily increased based on residual counts, performed prior to each feeding. The expression of genes related to intestinal development and maturation (aminopeptidase N, anpep; leucine aminopeptidase 3, lap3; intestinal-type alkaline phosphatase, alpi), together with key pancreatic digestive proenzymes (trypsinogen 1, try1; chymotrypsinogen b, ctrb; carboxyl ester lipase precursor, cel; phospholipase a2, pla2g1b; pancreatic alpha amylase, amy2a), were assessed. Additionally, the activity of six enzymes (trypsin, lipase, alkaline phosphatase, amino peptidase, amylase, and chymotrypsin) were determined. The highest expression of two genes related to intestine (lap3; anpep) were observed in the fish fed a combination of rotifers and Artemia from 8 DPH (Group E). The expression of amy2a, ctrb, pla2g1b, try1 was significantly lower in larvae fed rotifers until 14 DPH and replaced by Artemia afterwards (Group B). The specific activity of brush border membrane enzymes (alkaline phosphatase and aminopeptidase N) increased with combination of rotifers and Artemia in larval diet (Group E), indicating a more efficient functionality of digestive structures. The groups fed only with rotifers till 17 DPH (Group A) (38 ± 4.07%) and larvae fed with rotifers till 14 DPH followed by feeding with Artemia till 17 DPH (Group B) (36 ± 5.25%) showed significantly (P

Improved post-operative outcomes following gastroschisis repair are attributed to advancement in perioperative and post-operative care and early enteral feeding. This study evaluates the role of standardized postoperative feeding protocols in gastroschisis. A systematic review and meta-analysis of studies published from January 2000 to April 2019 in MEDLINE, EMBASE, Cochrane Library databases and Google Scholar was conducted. Primary outcomes were duration to full enteral feeding and cessation of parenteral nutrition. Secondary outcomes included days to first enteral feeding, length of stay, compliance, complication and mortality rates. Meta-analysis was done using the RevMan Analysis Statistical Package in Review Manager (Version 5.3) using a random effects model and reported as pooled Risk Ratio and Mean Difference. p- value < 0.05 was considered statistically significant. Eight observational cohort studies were identified and their data analyzed. Significant heterogeneity was noted for some outcomes. Standardized feeding protocols resulted in fewer days to first enteral feeding by 3.19 days (95% CI: -4.73, -1.66, p < 0.0001) than non-protocolized feeding, less complication rates, reduced mortality and better compliance to care. The duration of parenteral nutrition and time to full enteral feeding were not significantly affected. Protocolized feeding post-gastroschisis repair is associated with early initiation of enteral feeding. There is a likelihood of reduced rates of sepsis; shorter duration of parenteral nutrition, length of hospital stay and time to full enteral feeding. However, the latter trends are not statistically significant and will require further studies best accomplished with a prospective randomized trial or more cohort studies. [ABSTRACT FROM AUTHOR]

Understanding the daily digestive function could lead to more efficient feeding practices in the farmed fish species. In this work, the effect of several daily feeding protocols was assessed on the daily expression of the genes related to the circadian system (arntl1, clock, per1, and cry1), appetite (cck), nutrients hydrolysis (try1, ctrb1, pga, atp4a, cel, and amy2a), peptides transport (slc15a1), pH, and activity of key digestive (trypsin, chymotrypsin, amylase, 4C- and 7C-like lipases) and absorptive (alkaline phosphatase) enzymes in the gastrointestinal tract (GIT) of Senegalese sole (Solea senegalensis) juveniles. Some of the tested feeding protocols demonstrated a significant influence on the entrainment of the peripheral oscillator. The synchrony of slc15a1 and some digestive proenzymes with per1 in some of the experimental treatments could underline the role of clock genes in the regulation of these biological functions. Unlike gene expression of the digestive proenzymes wherein feeding protocol occasionally affected the temporal organization, the influence of this factor was determinant on the daily average production and/or circadian pattern of their activities. Daily pH was maintained at approximately neutral levels in all the GIT segments, and no pepsin activity was detected. Fish fed a single diurnal meal showed the lowest activity for all the studied enzymes, except for amylase, suggesting an insufficient utilization of the ingested nutrients. Higher amylase activity in this group, on the other hand, implies the possible activation of alternative compensatory metabolic pathways. Overall, our results pointed to the suitability of higher feeding frequencies, especially during dark hours, for the aquaculture production of this species.

Evaluating effects of different macronutrient diets in randomized trials requires well defined infrastructure and rigorous methods to ensure intervention fidelity and adherence. This controlled feeding study comprised two phases. During a Run-in phase (14–15 weeks), study participants (18–50 years, BMI, ≥27 kg/m2) consumed a very-low-carbohydrate (VLC) diet, with home delivery of prepared meals, at an energy level to promote 15 ± 3% weight loss. During a Residential phase (13 weeks), participants resided at a conference center. They received a eucaloric VLC diet for three weeks and then were randomized to isocaloric test diets for 10 weeks: VLC (5% energy from carbohydrate, 77% from fat), high-carbohydrate (HC)-Starch (57%, 25%; including 20% energy from refined grains), or HC-Sugar (57%, 25%; including 20% sugar). Outcomes included measures of body composition and energy expenditure, chronic disease risk factors, and variables pertaining to physiological mechanisms. Six cores provided infrastructure for implementing standardized protocols: Recruitment, Diet and Meal Production, Participant Support, Assessments, Regulatory Affairs and Data Management, and Statistics. The first participants were enrolled in May 2018. Participants residing at the conference center at the start of the COVID-19 pandemic completed the study, with each core implementing mitigation plans. Before early shutdown, 77 participants were randomized, and 70 completed the trial (65% of planned completion). Process measures indicated integrity to protocols for weighing menu items, within narrow tolerance limits, and participant adherence, assessed by direct observation and continuous glucose monitoring. Available data will inform future research, albeit with less statistical power than originally planned. [ABSTRACT FROM AUTHOR]

Limited guidance exists regarding appropriate timing for feed initiation and advancement in gastroschisis. We hypothesized that implementation of a gastroschisis management protocol would allow for standardization of antibiotic and nutritional treatment for these patients. We conducted a retrospective comparison of patients with simple gastroschisis at two pediatric hospitals before and after initiation of our gastroschisis care protocol. Complicated gastroschisis and early mortality were excluded. The control group extended from January 2012 to January 2014 and the protocol group from July 2014 to July 2016. Variables of interest included time to feed initiation, time to goal feeds, length of stay, and National Surgical Quality Improvement Program–defined complications. We performed a subgroup analysis for primary versus delayed gastroschisis closure. Statistical analyses, including F-tests for variance, were conducted in Prism. Forty-seven patients with simple gastroschisis were included (control = 22, protocol = 25). Protocol compliance was 76% with no increase in complication rates. There was no difference in length of stay or time from initiation to full feeds overall between the control and protocol groups. However, neonates who underwent delayed closure reached full feeds significantly earlier, averaging 9 d versus 15 d previously (P = 0.04). For infants undergoing delayed closure, the time to full feeds in this group now appears to match that of patients undergoing primary closure, indicating that delayed closure should not be a reason for slower advancement. Additional studies are needed to assess the impact of earlier full enteral nutrition on rare complications and rates of necrotizing enterocolitis. [ABSTRACT FROM AUTHOR]

The optimal mixed feeding schedule for mono-sex male Nile tilapia (Oreochromis niloticus) was investigated in the current study. The fish (4.01 ± 0.02 g initial weight and 5.84 ± 0.04 cm initial length) were fed up to satiation with high protein (HP, 32.80 % protein on dry basis) and low protein (LP, 28.64 % protein on dry basis) diets in different schedules: alternately every other day (1HP/1 L P), alternately every other week (7HP/7 L P) and alternately every two weeks (14HP/14 L P), in comparison to continuously feeding by HP (positive control) or by LP (negative control) alone. At the end of eight weeks of trial, superior growth performance and feed utilization were observed in fish receiving HP, 1HP/1 L P and 7HP/7 L P relative to the remaining treatments. The specific activity of digestive enzymes (pepsin, trypsin, amylase, lipase, and activity ratio of amylase to trypsin) was modulated, indicating physiological responses for improving nutrient utilization due to the different feeding regimens. All fish mainly utilized carbohydrates rather than lipid and protein, or probably the protein-sparing effect was predominant, as indicated by the positive correlation between amylase specific activity and protein efficiency ratio (r = 0.681, P < 0.01), across five feeding schedules. There were no negative effects of mixed feeding schedules on flesh quality and carcass composition in any experimental group. However, based on economic analysis, fish receiving 1HP/1LP schedule had reduced cost of tilapia production relative to the other treatments. Therefore, the optimal feeding schedule for mono-sex male tilapia is 1HP/1LP, which should be used as a practical feeding guideline for mono-sex male Nile tilapia production.

There has been a lack of information reported on the appropriate period required to replace an original feed formula with a new feed for most fish species. In the current study, a feed containing high protein (HP) was replaced in daily increments of 12.5, 20 and 25% with low protein (LP) feed for mono-sex male Nile tilapia (3.68 ± 0.03 g initial weight) over a nine-week experimental period and the results compared with a control treatment continually fed with the HP feed. At the end of the feeding trial, the body weight, length and specific growth rate did not differ for fish fed with the 20 and 25% replacement levels (P > 0.05), while significantly decreased values were observed for the 12.5% replacement group. The feed conversion ratio was superior for fish receiving the 12.5 and 25% replacement levels, while the protein efficiency ratio showed no differences across all the dietary treatments. Changing the feeding regime had no significant effects on the specific activities of protein- and carbohydrate-digesting enzymes, while significantly lower lipase specific activity was observed for the control group fish. The RNA and RNA/protein ratio were highest in the fish receiving the 25% replacement level, followed by the 12.5 and 20% groups, with the control group lowest, while the protein concentration was lower than the control group at all replacement levels. The amounts of flesh proteins did not differ among all the dietary treatments, nor did the carcass moisture, crude protein or ash, while the crude lipid was higher in all the fish receiving the LP feed. The findings from the current study suggest that the optimal level for replacing the original feed formula with a new feed is 25% per day, which should be used as a practical feeding guideline for mono-sex male Nile tilapia.

Background: We assessed the impact of a standardized nutrition initiative for very low-birth-weight (VLBW) infants on their nutrition and clinical outcomes.Methods: This was a prospective analysis of VLBW infants born before and after the initiation of a nutrition protocol. This protocol included trophic feeds, feeding advancement, fortification guidelines, parameters on the concentration of parenteral nutrition (PN), and the discontinuation of PN and central lines. Gastric residual monitoring was discontinued. Statistical analyses were performed with Fisher's exact and Student's t-tests. Primary outcome measures were days receiving PN, days made nil per os (NPO) after feeding initiation, necrotizing enterocolitis, and growth parameters. Secondary outcome measures were central-line days, sepsis, blood transfusions, cholestasis, osteopenia, chronic lung disease, and retinopathy of prematurity.Results: 136 VLBW infants were analyzed, including 77 in the preprotocol group and 59 in the postprotocol group. Infants postprotocol were found to have reduced PN days (26.1 versus [vs] 18.4, P < .01), fewer days made NPO after feeding initiation (7.2 vs 4.0, P = .02), NEC (7.8% vs 0%, P = 0.038), central-line days (26.5 vs 18.6, P < .01), cholestasis (16% vs 3%, P = .02), and blood transfusions (5.3 vs 3.1, P = .028). Growth, defined by change in z-score from birth to discharge, improved for weight (-1.3 vs -0.8, P < .01), length (-1.5 vs -1.0, P = .033), and head (-1.1 vs -0.6, P = .024).Conclusion: Initiation of a standardized nutrition initiative for VLBW infants significantly improved growth, reduced PN use, and improved patient outcomes. [ABSTRACT FROM AUTHOR]

Abstract Quality Improvement models offer a framework for health care professionals to follow in implementing process improvement changes. Use of these models promotes a systematic approach to problem solving, keeps providers from eliminating important steps, facilitates team work, and provides a clear plan for ongoing communication. This paper describes use of the Plan-Do-Study-Act model to implement a unit-based quality improvement project that focused on improving postoperative nutritional practices for neonates with critical congenital heart disease following complex cardiac surgery. [ABSTRACT FROM AUTHOR]

Background While many people with overweight or obesity can lose weight temporarily, most have difficulty maintaining weight loss over the long term. Studies of dietary composition typically focus on weight loss, rather than weight-loss maintenance, and rely on nutrition education and dietary counseling, rather than controlled feeding protocols. Variation in initial weight loss and insufficient differentiation among treatments confound interpretation of results and compromise conclusions regarding the weight-independent effects of dietary composition. The aim of the present study was to evaluate three test diets differing in carbohydrate-to-fat ratio during weight-loss maintenance. Design and dietary interventions Following weight loss corresponding to 12 ± 2% of baseline body weight on a standard run-in diet, 164 participants aged 18 to 65 years were randomly assigned to one of three test diets for weight-loss maintenance through 20 weeks (test phase). We fed them high-carbohydrate (60% of energy from carbohydrate, 20% fat), moderate-carbohydrate (40% carbohydrate, 40% fat), and low-carbohydrate (20% carbohydrate, 60% fat) diets, controlled for protein content (20% of energy). During a 2-week ad libitum feeding phase following the test phase, we assessed the effect of the test diets on body weight. Outcomes The primary outcome was total energy expenditure, assessed by doubly-labeled water methodology. Secondary outcomes included resting energy expenditure and physical activity, chronic disease risk factors, and variables to inform an understanding of physiological mechanisms by which dietary carbohydrate-to-fat ratio might influence metabolism. Weight change during the ad libitum feeding phase was conceptualized as a proxy measure of hunger. [ABSTRACT FROM AUTHOR]

Objective Necrotizing enterocolitis (NEC) is a catastrophic abdominal complication threatening the life of premature infants, but adoption of prevention and early recognition practices differs as do NEC rates in Neonatal Intensive Care Units (NICUs). The purpose of this research was to validate and weight an evidence-based adherence score (aka NEC-Zero Adherence Score) to prevent and foster timely recognition of NEC. Study design An electronic Delphi (e-Delphi) approach was used to identify consensus. NEC experts were recruited via the NEC Society and surveyed until consensus and stability criteria for the Delphi were met (≥ 70% consensus and mean responses changed < 15% between rounds). Results Expert panelists ( n = 22) were experienced (M = 17.6, SD 11 years) and predominately physicians (68%) or neonatal nurse practitioners (18%). Consensus (> 70% by item) supported a 10 point score. Points were distributed across 1) an exclusive human milk diet (5 points), 2) standardized feeding protocols (3 points), 3) antibiotic stewardship (1 point), and 4) a unit-specified approach to early recognition (1 point). Withholding feeding during transfusion was controversial (M = 0.50, SD 0.73) and met consensus criteria to drop from the score. Conclusions Holding feeding during transfusion was dropped from the score. Relationships between the score and unit NEC rates as well as its utility for use in audit and feedback should be studied in the future. [ABSTRACT FROM AUTHOR]

Background: Patients admitted to pediatric intensive care units (PICUs) often experience prolonged periods without nutrition support, which may result in hospital-induced malnutrition and longer length of stay. Nurse-driven feeding protocols have been developed to prevent unnecessary interruptions or delays to nutrition support. The primary objective of this study was to identify compliance and reasons for noncompliance to a feeding protocol at a tertiary care hospital PICU in Canada. The secondary aim was to determine the mean time (hours) spent without any form of nutrition and to identify reasons for time spent without nutrition.Materials and Methods: This was a prospective cohort audit, consisting of 150 consecutive PICU admissions (January-February 2016). Exclusion criteria consisted of patient mortality within 48 hours (n = 1) and patients who were still admitted at the end of the data collection timeframe (n = 7). The remaining cohort consisted of 142 consecutive admissions. Data collection took place in real time and included patient demographics, diagnostic categories, time spent without nutrition, reasons for interruptions to nutrition support, and reasons for noncompliance to the protocol. Observations were obtained through paper and computer charts and conversing with clinicians.Results: There was a 95% compliance rate to the protocol and an average of 25.6 hours spent without nutrition per patient. The most prevalent reason for noncompliance was an avoidable delay to restart feeds before/after procedures or after surgery.Conclusions: A nurse-driven feeding protocol may reduce time spent without nutrition. Future research is required to examine the relationship between adherence to feeding protocols and clinical outcomes. [ABSTRACT FROM AUTHOR]

In hatcheries, meagre Argyrosomus regius larvae still depend on an adequate supply of rotifers and Artemia, as no artificial diet can totally fulfil their nutritional requirements. However, production of live feed is highly expensive and demands intensive labour and specific facilities. This study investigated the effect of a dietary regime without the use of rotifers, to simplify the meagre larval rearing protocol. Two feeding treatments (T1 & T2) are compared to investigate their effects on survival and growth of meagre larvae. In T1, larvae were fed rotifers from 2 to 5 days post hatch (dph), and Artemia from 4 to 15 dph. In T2, larvae were kept under dark conditions and fed Artemia from 6 to 15 dph. Standard larval length ( SL) was significantly higher in T1 ( p < .01) until 8 dph in comparison with larvae reared initially without rotifers. No significant difference in SL was found among treatments ( p = .187) at 15 dph. Significant difference was found among treatments in survival rate at 15 dph ( p < .003). The survival rate observed at 15 dph in T2 (30 ± 4.2%) represents an important finding, although the highest survival rate was observed in T1 (45.0 ± 3.4%). This study showed that it is possible to conduct larval rearing of meagre without using rotifers. Nevertheless, further research efforts are still needed to improve these results in comparison with the common larval rearing protocol. [ABSTRACT FROM AUTHOR]

Objective Reduce the number of infants requiring home tube feeds by initiating an oral feeding protocol (OFP). Study Design All infants < 30 weeks' gestation were eligible. The OFP involved four steps: encourage non-nutritive suck before 30 weeks, oral motor exercises starting as early as 30 weeks, swallowing exercises as early as 31 weeks, and an infant-driven oral feeding pathway as early as 32 weeks. Results The study included 129 infants before the protocol (January 2010 to December 2011) and 141 infants after the protocol (March 2013 to May 2015). Between the study periods, a multidisciplinary committee took 8 months to create the OFP, followed by a 3-month orientation of the protocol to the nursing and medical staff. The incidence of home tube feeds for 23 to 29 weeks was 26% before and 15% after the protocol (p = 0.03). Oral feeds were started sooner (p < 0.001), and full oral feedings were achieved earlier after the protocol was initiated (p < 0.001). Conclusion After introducing an OFP, oral feedings were started earlier, full oral feedings were achieved sooner, and the incidence of home tube feeds at discharge was reduced. [ABSTRACT FROM AUTHOR]

Malnutrition is common in intensive care units (ICU), and volume based feeding protocols have been proposed to increase nutrient delivery. However, the volume based approach compared to trophic feeding has not been proven entirely successful in critically ill patients. Our study aimed to compare the clinical outcomes both before and after the implementation of the feeding protocol, and to also evaluate the effects of total energy delivery on outcomes in these patients. We retrospectively collected all patient data, one year before and after the implementation of the volume-based feeding protocol, in the ICU at Taichung Veterans General Hospital. Daily actual energy intake from enteral nutritional support was recorded from the day of ICU admission until either the 7th day of ICU stay, or the day of discharge from the ICU. The energy achievement rate (%) was calculated as: (actual energy intake/estimated energy requirement) x 100%. Two-hundred fourteen patients were enrolled before the implementation of the volume-based feeding protocol (pre-FP group), while 198 patients were enrolled after the implementation of the volume-based feeding protocol (FP group). Although patients in the FP group had significantly higher actual energy intakes and achievement rates when compared with the patients in the pre-FP group, there was no significant difference in mortality rate between the two groups. Comparing survivors and non-survivors from both groups, an energy achievement rate of less than 65% was associated with an increased mortality rate after adjusting for potential confounders (odds ratio, 1.6,95% confidence interval, 1.01-2.47). The implementation of the feeding protocol could improve energy intake for critically ill patients, however it had no beneficial effects on reducing the ICU mortality rate. Receiving at least 65% of their energy requirements is the main key point for improving clinical outcomes in patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Daily caloric and protein intake is crucial for the management of critically ill children. The benefit of feeding protocols in improving daily nutritional intake in children remains controversial. This study aimed to assess whether the introduction of an enteral feeding protocol in a paediatric intensive care unit (PICU) improves daily caloric and protein delivery on day 5 after admission and the accuracy of the medical prescription., Methods: Children admitted to our PICU for a minimum of 5 days who received enteral feeding were included. Daily caloric and protein intake were recorded and retrospectively compared before and after the introduction of the feeding protocol., Results: Caloric and protein intake was similar before and after introduction of the feeding protocol. The prescribed caloric target was significantly lower than the theoretical target. The children who received less than 50% of the caloric and protein targets were significantly heavier and taller than those who received more than 50%; the patients who received more than 100% of the caloric and protein aims on day 5 after admission had a decreased PICU length of stay and decreased duration of invasive ventilation., Conclusion: The introduction of a physician-driven feeding protocol was not associated with an increase in the daily caloric or protein intake in our cohort. Other methods of improving nutritional delivery and patient outcomes need to be explored., Competing Interests: Declaration of competing interest None of the authors declares a conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Objectives: Studies have shown that nutritional strategies instituted early in life will have a lifelong impact on mental and physical outcomes in neonates. The objective of the study is to compare two strategies for the advancement of enteral feeding in very low birth weight infants (VLBWIs). The primary outcome is the assessment of total days required to reach full enteral feeding without necrotizing enterocolitis (NEC). The weight gain at the end of the feeding protocol and the length of the hospital stay were recorded. Settings and Design: A prospective, randomized study of 101 VLBWI born or transferred to our institution for the period 2010–2014. Materials and Methods: One hundred and one infants enrolled, 85 infants (84.2%) completed the study and 16 infants (15.8%) either excluded or withdrawn from the study, 11 infants (10.9%) in frequency advancement (FA), and five infants (4.9%) in volume advancement (VA). FA, n = 38 infants (44.7%) started 8 hourly feeds and increased to every 3 h with increase in volume by only 10 ml/kg/day. Infants of VA n = 47 (55.3%) continued feeds at every 2 h interval; volume increased 20–25 ml/kg/day. Results: The two groups were comparable regarding gestational age, birth weight, and APGAR scores. It was observed that the infants in VA reached full enteral intake without NEC earlier than FA with a difference of 12 days (P < 0.001), and a significant difference at the end of the protocol weight gain between the two groups was (1496 g for FA vs. 1281 g for VA; P = 0.001). There were no statistically significant differences in the length of hospital stay between the two groups (P = 0.221). Conclusions: Among VLBWI, an increase in enteral feeds by 20–25 ml/kg/day as in VA compared to FA protocol is a safe practice. VA of enteral feeding resulted in faster attainment of full enteral feed. However, there was no significant difference in weight gain at the end of feeding protocol and the length of hospital stay. [ABSTRACT FROM AUTHOR]

Neonates with single-ventricle physiology are at increased risk of developing gastrointestinal morbidities. Feeding protocols in this patient population have been shown to decrease feeding complications after the Norwood procedure, but no data exist to determine the effectiveness of a feeding protocol in patients undergoing the hybrid procedure. Goal of this study was to examine the impact of a standardized feeding protocol on the incidence of overall postoperative gastrointestinal morbidity after the hybrid procedure. Retrospective chart review was performed on neonates undergoing the hybrid procedure. Neonates were divided into two groups, pre-feeding protocol (pre-FP), which encompassed the years 2002-2008, and post-feeding protocol (post-FP), which encompassed the years 2011-2014. Preoperative, operative, and postoperative data were collected. T test or Fisher's exact test was used for analysis. p < 0.05 was considered significant. Seventy-three neonates were in the pre-FP and 52 neonates were in the post-FP. There were no significant differences between the pre-FP and the post-FP in cardiac diagnosis (62 HLHS, 11 other vs. 39 HLHS, 13 other, respectively). Pre-FP underwent hybrid procedure later than the post-FP (9.1 ± 5.8 vs. 5.7 ± 3.4 days, respectively, p < 0.01) and achieved full enteral feeds earlier than the post-FP (3.2 + 2.9 vs. 7.8 + 3.9 days, respectively, p < 0.01). The incidence of necrotizing enterocolitis was higher in the pre-FP versus post-FP [11.0 % (8/65) vs. 5.8 % (3/49), respectively, p = 0.36]. Though not significant, the incidence of necrotizing enterocolitis decreased by almost 50 % after initiating a feeding protocol in patients undergoing the hybrid procedure. This is consistent with previous studies showing beneficial results of a feeding protocol in this complex patient population. [ABSTRACT FROM AUTHOR]

Objective This study aims to elicit physician and nursing perceptions about initiation of minimal enteral feedings (MEF) in very low-birth-weight (VLBW) infants. Study Design A three-phase, mixed methods study including a quantitative chart review of 37 VLBW infants, followed by 26 qualitative observations of morning rounds, 26 interviews of neonatal intensive care unit (NICU) medical team members, tailored interventions based on the identified barriers toMEF, and finally a postintervention chart audit of 50 VLBW infants. Results Themain barriers to initiation ofMEF were failure to appreciate the differences between the goals of MEF versus nutritive feedings, inconsistent definition of "sick" infant, indomethacin for intraventricular hemorrhage prophylaxis, awaiting mother's ownmilk, complicated feeding protocols/algorithms for feeding intolerance, and lack of buy-in from nurses/nurse practitioners. The compliance with early initiation of MEF per the feeding guidelines rose from 25 to 92% after our interventions. Conclusion Understanding the complex interplay of provider, system and patientbased factors that interfere with initiation of MEF may enable NICUs to develop consensus guidelines and targeted interventions and to achieve timely initiation of nonnutritive feedings. [ABSTRACT FROM AUTHOR]

Background: Critically ill children frequently receive inadequate nutritional support. Feeding protocols have been shown to facilitate optimal nutritional care. Purpose: We aim to determine the perceptions of critical care nurses with regard to the implementation of a feeding protocol as well as to their preferred teaching methods before introducing this protocol in our pediatric intensive care unit (PICU). We hypothesize that nursing experience and educational level are factors that predict readiness to adopt this protocol. Methods: All PICU nurses were invited to participate in an online survey to investigate their perceptions on protocol implementation and on preferred teaching methods. Statistical analysis was performed using simple logistic regression and the Fisher exact test. Statistical significance was taken as p G .05. Results: Seventy-four nurses completed the survey. Fifty-four (73%) had nursing degrees. Mean duration of PICU experience was 6.2 years (5th, 95th percentile: 1, 15). Three quarters of participants (74%, n = 55) felt that they did not have sufficient knowledge regarding feeding protocols, and 86% (n = 64) expressed that they were keen to implement a feeding protocol. There was no association between readiness to adopt the feeding protocol with years of ICU experience (OR = 0.99, 95% CI [0.84, 1.18]) and educational level (OR = 1.43, 95% CI [0.31, 6.68]). The preferred teaching methods were bedside teaching (61%), didactic lectures (51%), and the distribution of protocol manuals (50%). PICU nurses felt that the advantages of a feeding protocol included standardization of practice, optimization of patient's nutritional intake, earlier initiation of feeding, increased patient safety, and the extension of nursing roles. Perceived disadvantages included inapplicability of the feeding protocol to all patients, lack of flexibility in feeding management, increased confusion, and doctors placing little value on the feeding protocol. Conclusions: This study found that nursing experience and level of education do not significantly affect the readiness of nurses to adopt a feeding protocol. Medical and nursing teams should not shy away from introducing a new protocol although their nurses have little experience or prior knowledge of that protocol. Future studies to investigate the impact of tailoring of educational needs before introduction of a new protocol are necessary to study the overall effectiveness of this teaching before introducing a new protocol in the ICU. [ABSTRACT FROM AUTHOR]

Optimizing nutrition in neonates with hypo-plastic left heart syndrome is essential, given the high rate of growth failure in this population. Infants with hypoplastic left heart syndrome are predisposed to nutritional deficiency as a result of their increased metabolic demand; however, early enteral feeding also increases the risk of serious gastrointestinal morbidity and mortality caused by poor intestinal perfusion. Consequently, providers have difficulty deciding when and how to safely feed these patients. A review of the literature found that implementation of a structured enteral feeding protocol may decrease the risk of gastrointestinal complications while also minimizing dependence on parenteral nutrition and decreasing length of hospital stay. As these studies were limited, further research is warranted to establish a best practice feeding protocol to decrease risk and optimize nutrition in this fragile population. [ABSTRACT FROM AUTHOR]

Developing nutritional strategies that can reduce production costs for the fish industry without affecting productive performance is paramount to make the activity sustainable. We investigated if short-term cycles of feed deprivation and refeeding elicit compensatory growth in matrinxã ( Brycon amazonicus ) juveniles, using three feeding protocols for 60 days (Phase 1): two levels of deprivation (feed deprivation for two days and refeeding for three — D2R3, or four days — D2R4) and a control level (daily feeding). Following, all fish groups were fed daily at satiation for 15 days (Phase 2). At Phase 1, matrinxã achieved full compensatory growth in both deprivation levels by increasing feed intake and feed efficiency. Overall, deprived fish consumed 40% (D2R3) and 36% (D2R4) less feed than fish fed daily. In Phase 2, growth was similar for all fish. Feed intake increased in both deprived fish, but feed efficiency did not differ among groups and was lower than in Phase 1, indicating a reduced efficiency in feed utilization when food was freely available. We propose that intermittent cycles of feeding represent an effective means to reduce production costs. [ABSTRACT FROM AUTHOR]

Background: While previous studies have reported that feeding protocols improved clinical outcomes in critical care settings, the evidence supporting the application of feeding protocols in older patients has not yet been assessed. Here, we evaluated the effects of a feeding protocol in older patients fed through percutaneous endoscopic gastrostomy (PEG) tubes. Methods: We conducted a retrospective chart review of 109 patients aged ≥ 65 who underwent PEG placement between April 2010 and March 2012 at a single acute care hospital. The protocol group was administered enteral nutrition (EN) according to a feeding protocol, while the non-protocol group was administered EN at the attending physician's discretion. Results: Length of hospital stay (LOS) overall and after EN initiation were significantly shorter in the protocol group than in the non-protocol group. (LOS: p=0.001; LOS after EN initiation: p=0.026). During the second week after EN initiation, significantly fewer patients had percutaneous oxygen saturation (SpO2) <93% and required oxygen therapy in the protocol group (p=0.032 for both comparisons). Nutrition intakes via PEG in the protocol group were significantly greater from Days 6 to 13 for energy and from Days 6 to 11 for protein compared with the non-protocol group. Conclusion: The application of a feeding protocol after PEG placement in older patients was associated with shorter LOS, more efficient EN delivery, and lower incidence of low SpO2 than non-protocol group. Larger prospective studies are required to determine whether a feeding protocol is useful in improving health outcomes in this population. [ABSTRACT FROM AUTHOR]

Background: Clinicians may be reluctant to feed patients on high-flow nasal cannula (HFNC) therapy, despite studies suggesting it is beneficial and safe. We describe the implementation of a feeding protocol for patients with bronchiolitis on HFNC and determine its effect on nutrition goals., Methods: Prospective bedside data on enteral volume, feed interruptions, and aspiration events were collected on patients with bronchiolitis who were <24 months of age, treated with HFNC, and fed per a developed protocol. Exclusion criteria included history of prematurity <32 weeks, congenital heart disease, or positive-pressure ventilation before feeding. Length of intensive care unit and hospital stay was compared with both a concurrent cohort (CC) of patients not fed per the protocol and a retrospective cohort (RC) admitted prior to protocol creation., Results: Seventy-eight patients met the criteria for the prospective study arm: 24 patients were included in the CC, and 74 were included in the RC. Seventy-one percent of prospective patients received enteral nutrition (EN) on HFNC day 1 vs 42% of the CC. In the prospective cohort, feed interruption occurred in 23% of patients and was associated with higher flow rates; however, no aspiration events occurred. Patients fed per protocol were fed 8-10 h sooner and discharged 1 day earlier than those in the RC., Conclusion: The use of a feeding protocol for patients with bronchiolitis on HFNC was safe and associated with shorter time to initiate EN and shorter length of hospital stay., (© 2022 American Society for Parenteral and Enteral Nutrition.)

The article discusses a study of the impact of a two-step interdisciplinary quality nutrition program which includes the implementation of an intensive care unit (ICU) nutrition protocol and presence of an ICU dietitian. The study involved ICU patients at the University Hospital of Lausanne (CHUV) in France from 2005 to 2007. Results showed an improvement in nutritional management due to the protocol. The importance of the integration of a protocol into the daily local practice is emphasized.

Abstract: The aim of this study was to determine suitable Artemia enrichment and feeding protocols for the rearing of juvenile long snout seahorse, Hippocampus guttulatus from birth. The first phase of the project, examined the effect of two different Artemia enrichments treatments (DHA-Selco®, and Chlorella sp.) on the growth performance and survival of early-stage juvenile H. guttulatus. DHA-Selco® enrichment of Artemia resulted in a null survival at 10days post parturition (DPP) whereas the use of Artemia enriched with Chlorella sp. resulted in 20% survival at the end of 60DPP. The second phase of the study (60 to 120DPP) reported the progressive feed transition of juvenile seahorse from Artemia to live shrimp (Palaemonetes varians) and from live to frozen shrimp and its effect on growth performance and survival of the juveniles. Overall, the mean standard length of juvenile H. guttulatus increased from 1.4±0.05cm at release from male''s pouch to 12.4±1.2cm at 120DPP. Mean juvenile wet weight increased from 4.2±0.2mg to 4133±1230mg in that same period. Length, wet weight, daily weight gain and thermal-unit growth coefficient were used to characterise juvenile H. guttulatus growth performance, which was found to be similar to that of published accounts for other juvenile seahorse species at the same life stage. This study is the first record of successful rearing of H. guttulatus juveniles in captivity, and offers a promising starting point to improve the rearing techniques to successfully breed this candidate aquaculture species. [Copyright &y& Elsevier]

Abstract: Development of optimal nutrition feeding protocols is considered a major challenge in intensive marine fish larval rearing. There is a general lack of knowledge on the molecular basis underlying larval digestive capability and endocrine function, and relatively few studies have employed molecular biological techniques to study the ontogeny of digestive capability and effects of nutrients on growth and appetite of marine fish larvae. In this study, Atlantic cod larvae were fed either Acartia tonsa nauplii, rotifers grown on Rhodomonas baltica or a control rotifer diet, before weaning to formulated diet. Larvae were sampled at 5, 8, 16, 29 and 38days post hatch. Larval dry weight and specific growth rate were measured, and gene expression patterns of trypsin, amylase, bile salt-activated lipase, phospholipase A2, Acyl CoA dehydrogenase, neuropeptide Y, cholecystokinin, growth hormone and thyroid hormone receptors α and β determined by quantitative PCR. We show that transcripts involved in appetite regulation and digestion were differentially expressed after different feeding protocols. Interestingly, several similar transcript profiles for genes coding for digestive enzymes and neural controlling factors were demonstrated. In addition, these relationships were partially reflected in larval specific growth rates, demonstrating for the first time in cod, that the ontogeny of digestive capability and its hormonal components may be tied directly to the type and quality of initial and early dietary constituents. [Copyright &y& Elsevier]

Mixed feeding schedule (MFS) switching between high (HP) and low (LP) protein diets has been used to improve growth and feed utilization in various fish species. In the current study, the optimal MFS was investigated in Asian seabass (Lates calcarifer) over the duration of an 8-week feeding trial. The fish (18.7 ± 0.1 g initial weight) were fed alternating between one day of HP and one day of LP diet (1 H/1 L), two days of HP and one day of LP (2 H/1 L), three days of HP and one day of LP (3 H/1 L), two days of HP and two days of LP (2 H/2 L), or three days of HP and two days of LP (3 H/2 L), and these treatments were compared to continuous feeding with HP (positive control, 403 g/kg protein and 86.1 g/kg lipid of feed basis) or with LP only (negative control, 333 g/kg protein and 55.7 g/kg lipid of feed basis). Twenty-one experimental units comprising fifteen fish each were set under a completely randomized design. At the end of experiment, growth performance and feed utilization parameters were similar between fish fed HP, 2 H/1 L and 3 H/1 L, followed by 3 H/2 L treatment, and all the fish in the alternating feed groups ingested a higher amount of HP than LP (P < 0.05). Economic analysis suggests that the most profitable schedule was 2 H/1 L among the tested feeding regimens. Specific activities of chymotrypsin, amylase, cellulase, lipase; and the amylase to trypsin ratio, indicated significant improvement in nutrient utilization and protein-sparing effect in the alternating treatments. There were no negative effects on muscle quality or carcass composition by the preferred alternating treatments (2 H/1 L and 3 H/1 L). Findings from the current study can be used to decide a practical feeding schedule for the commercial production of Asian seabass. • Improved growth and feed utilization were observed in some alternative treatments. • Alternate feeding between high (HP) and low (LP) protein diets enhanced sparing effects. • No negative effects on muscle quality and carcass composition in suitable alternate treatments. • Based on economic analysis, the most profitable schedule is two days HP and one day LP. [ABSTRACT FROM AUTHOR]

Aspiration pneumonia is a serious complication of mechanical ventilation and enteral tube feedings. It results in increased patient mortality, increased length of hospital stay, and increased health-care costs. This article describes an evidence-based practice approach to the creation of an enteral feeding protocol and an aspiration risk reduction algorithm. These tools were piloted in a Medical Intensive (Care Unit at a Midwest tertiary care center. Chart audits show an increase in the percentage of patients who reach their goal rate for enteral feedings from 78% to 85%, Reported aspiration pneumonias decreased from an average count of" 4,8 patients per month to 4,3 per month and ventilator-associated pneumonia rates decreased from 6.8 to 3.2 per 1000 patient days. [ABSTRACT FROM AUTHOR]

The influence of diurnal and nocturnal feeding on daily rhythms of gut levels of cholecystokinin (CCK) and the activity of two key pancreatic proteases, trypsin and chymotrypsin, were examined in juveniles of Senegalese sole (Solea senegalensis), a species with nocturnal habits. Four feeding protocols were performed: P1) One morning meal; P2) Six meals during the light period; P3) Six meals during the dark period; and P4) 12 meals during 24 h. Daily activity patterns of both proteases were remarkably similar and showed a high correlation in all the experimental protocols. In P1, daily patterns of CCK and digestive enzymes showed a single maximum. In P2, CCK levels exhibited two peaks. Digestive enzymes activities showed slightly delayed peaks compared to CCK, although their daily fluctuations were not significant. In P3, intestinal CCK concentration exhibited two peaks at the end of light and dark periods, but only the second one was significant. The first maximum level of chymotrypsin activity occurred 4 h after the first CCK peak, while the second one coincided with the second CCK peak. Fluctuations of trypsin activity were not significant. In P4, CCK concentration showed three small peaks. Digestive enzymes daily fluctuations were not significant, although they showed an inverted trend with respect to CCK. The daily pattern of the gut CCK content in our study is in agreement with the anorexigenic function of this hormone. Our results support the existence of a negative feedback regulatory loop between CCK and pancreatic proteolytic enzymes in Senegalese sole juveniles. Unlabelled Image • CCK-8 was detected in all the gastrointestinal tract segments. • Senegalese sole nocturnal feeding habit at juvenile stage clearly affected the daily CCK pattern. • The regulatory loop between CCK and proteases was more evident in protocols with nocturnal feeding. [ABSTRACT FROM AUTHOR]

A better knowledge of daily digestive function may help to improve the feeding efficiency in farmed fish species. In this study, daily expression profiles of key genes related to the circadian system (arntl1, clock, per3 and cry1), nutrients hydrolysis (pga , atp4a , try , ctrb , cel1b , pla2 , and amy2a), appetite control and food intake (ghrl and cck), and nutrient transport (slc15a1) were assessed in the gastrointestinal tract (GIT) of gilthead seabream (Sparus aurata) juveniles, under four different daily feeding frequencies (one, three, five diurnal meals and continuous diurnal feeding). Additionally, the activity of two key proteolytic enzymes (pepsin and trypsin) and variations in luminal pH within the different GIT segments were determined. Clock genes showed significant circadian patterns, being highly synchronized to the light-dark cycle and first daily meal in all the groups. In contrast, most of the genes codifying digestive enzyme precursors did not exhibit relevant changes in expression along the daily cycle. A correlation was detected between the expression of slc15a1 and per3 and, to a lesser extent between arntl1 / clock and ghrl , supporting the role of clock genes in daily organization of some digestive functions. Feeding frequency had a poor influence on the expression of all the analysed genes. In contrast to the results obtained for the expression of genes encoding digestive enzymes, the proteolytic activities exhibited circadian rhythms, and their temporal distribution were significantly affected by some of the experimental feeding protocols, being mostly synchronized with the presence of food in the corresponding GIT segment. Fish fed three times a day did not exhibit a significant daily rhythm for trypsin activity, but the daily average of activated trypsin was similar in all feeding frequencies. Gastric pH was maintained neutral, and acidification occurred only after food ingestion although showing different daily pattern for each feeding protocol. Overall, these results indicate that in gilthead seabream the majority of modulations for the hourly profile of digestive functionality occur post-transcriptionally to adapt to different feeding frequencies. • GIT clock genes in gilthead seabream showed strong synchronization with the light/dark cycle and first daily meal time. • Duration of feeding period and meal frequency have a poor influence in the clock genes • The molecular expression of ghrelin and peptide transporter 1 was in phase with some clock genes. • Proteolytic enzymes activity depended on the food availability within the gut. • Seabream modulates post-transcriptionally the hourly profile of digestive function to adapt to changes of feeding frequency [ABSTRACT FROM AUTHOR]

Abstract: Malnutrition in critically ill patients is associated with increased morbidity and mortality. The stress response to severe illness results in altered substrate availability and utilisation. Nutritional support is a vital part of patient management in critical care units and can be administered enterally, parenterally or in combination. Feeding regimens aim to provide essential nutrients with minimum risk. The enteral route has benefits over and above the supply of nutrition, playing a role in maintenance of gut integrity and protecting against bacterial translocation across the gut wall. Successful enteral feeding may require the use of feeding protocols incorporating the use of prokinetics to achieve adequate nutrient delivery. Parenteral nutrition is associated with significant problems and complications and its use should be reserved for those patients in whom enteral feeding is unlikely to be established for at least 7 days or the patient who is intolerant to enteral feed. The role of immunomodulatory dietary supplementation is inconclusive and randomised clinical trials of immune-enhanced feeds have failed to show a clear benefit in critically ill patients. [Copyright &y& Elsevier]

Background: The development of the endoscopic technique has resulted in an increasing number of patients undergoing percutaneous endoscopic gastrostomy (PEG) insertion; however, the protocols for increasing the volume of feeding formula after PEG insertion have not been established. Therefore, we compared the clinical outcomes of patients receiving low- and high-volume increase in enteral feeding formula., Methods: A total of 215 patients who underwent PEG insertion between January 2016 and March 2019 were included. They were divided into 2 groups according to the increase in volume of feeding formula: the low-volume group (n = 135) received ≤150 mL/d, and the high-volume group (n = 80) received ≥300 mL/d. Patient characteristics, procedure, and feeding-related clinical outcomes were retrospectively reviewed using medical records., Results: The adverse events of the feeding protocol did not significantly differ between the 2 groups. The number of days needed to attain the calorie targets was significantly lower in the high-volume group than in the low-volume group (5.4 ± 3.0 vs 2.4 ± 1.5; P < .001). The duration of supplemental parenteral nutrition and the length of hospitalization were also significantly lower in the high-volume group (3.9 ± 3.3 vs 1.2 ± 2.2; P < .001 and 5.8 ± 2.7 vs 4.6 ± 2.6; P = .007, respectively)., Conclusion: To rapidly attain the calorie targets in appropriately selected patients with PEG insertion, a high-volume increase in daily feeding can safely be recommended given the favorable outcomes., (© 2020 American Society for Parenteral and Enteral Nutrition.)