The Impact of Lipid-Rich Nutrition on Ketogenesis and Muscle Weakness in Sepsis

Authors: Caroline Lauwers, Jan Gunst, Soraya El Dawy, Sarah Derde, Lies Pauwels, Inge Derese, Sarah Vander Perre, Greet Van den Berghe, Michael P. Casaer, Lies Langouche

Sepsis-induced muscle weakness is a frequent complication in critical illness. Because ketone bodies have shown protective effects in preclinical models, this study explored whether lipid-rich parenteral nutrition could stimulate endogenous ketogenesis and improve muscle function during sepsis.

In a murine model of prolonged sepsis, different lipid formulations were tested. Pure long-chain triglycerides increased ketone production but unexpectedly worsened muscle weakness. When glucose was added, ketone production was markedly suppressed, and muscle strength was similar to standard parenteral nutrition. In a second experiment, neither glucose-supplemented long-chain triglycerides nor mixed medium- and long-chain triglycerides were able to induce meaningful ketosis or improve muscle function.

Overall, lipid-rich parenteral nutrition did not protect against sepsis-induced muscle weakness, highlighting the complex relationship between nutritional metabolism and muscle function in critical illness