ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Large observational series have observed that the optimal calorie load associated with the best survival is around 80% of predicted energy needs, whereas others suggested no relation between intake and outcome or better outcome with lower energy intakes.

“Large observational series including hundreds to thousands of patients have observed that the optimal calorie load associated with the best survival is around 80% of predicted energy needs [53], whereas others suggested no relation between intake and outcome or better outcome with lower energy intakes [54].”

• cites [53] Heyland, 2011, Optimal amount of calories for critically ill patients: depends on how you slice the cake, Crit Care Med sourceNot checked — no full text of the source
• cites [54] Bellomo, 2014, Calorie intake and patient outcomes in severe acute kidney injury: findings from the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial, Crit Care sourceDisputed

  Split into 2 atoms — 1 confirmed, 0 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The ESICM guidelines formulated 17 recommendations favoring initiation of early EN and seven recommendations favoring delaying EN.

“The European Society of Intensive Care Medicine (ESICM) guidelines formulated 17 recommendations favoring initiation of early EN (within 48 h of ICU admission) and seven recommendations favoring delaying EN [13], as summarized in our recommendations No. 8, 11, 12.”

• cites [13] Reintam Blaser, 2017, Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines, Intensive Care Med sourceSupported

May combine two claims.

A cut-off of 48 h for the initiation of early nutrition and contraindications to early EN has been better established since previous recommendations.

“Since previous recommendations [1,2], a cut-off of 48 h for the initiation of early nutrition and contraindications to early EN has been better established [13].”

• cites [13] Reintam Blaser, 2017, Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines, Intensive Care Med sourceSupported

May combine two claims.

In meta-analyses performed for the ESICM guidelines, early EN reduced infectious complications in unselected critically ill patients, in patients with severe acute pancreatitis, and after gastrointestinal surgery, whereas no evidence of superiority for early PN or delayed EN over early EN was detected in any of the sub-questions.

“In meta-analyses performed for the ESICM guidelines, early EN reduced infectious complications in unselected critically ill patients, in patients with severe acute pancreatitis, and after gastrointestinal surgery, whereas no evidence of superiority for early PN or delayed EN over early EN was detected in any of the sub-questions.”

• cites [13] Reintam Blaser, 2017, Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines, Intensive Care Med sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Frailty is well defined and can be diagnosed by clinical observations or by complementary examinations.

“Frailty has been suggested as the burden of comorbid disease, is well defined [15] and can be diagnosed by clinical observations or by complementary examinations [16].”

• cites [15] Fried, 2001, Frailty in older adults: evidence for a phenotype, The Journals of Gerontology Series A: Biological Sciences and Medical Sciences sourceNot checked — no full text of the source
• cites [16] Cederholm, 2015, Diagnostic criteria for malnutrition – an ESPEN consensus statement, Clin Nutr sourceSupported

May combine two claims.

Patients with low muscle mass found at admission by computerized tomography have a higher length of stay and higher mortality.

“Patients with low muscle mass found at admission by computerized tomography have a higher length of stay and higher mortality [25].”

• cites [25] Braunschweig, 2014, Exploitation of diagnostic computed tomography scans to assess the impact of nutrition support on body composition changes in respiratory failure patients, JPEN - J Parenter Enter Nutr sourcePartly supported

  The CT Image Analysis section (page unavailable) confirms that the study quantified skeletal muscle using CT scans. The introductory text says malnourished patients generally have longer hospitalizations and higher mortality, but the Results (page unavailable) report muscle changes between scans, not an association between low muscle mass on an admission CT and either outcome. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

NUTRIC is a novel risk assessment tool merely based on the severity of disease.

“NUTRIC (¼ nutritional risk in critically ill) is a novel risk assessment tool merely based on the severity of disease was proposed [10].”

• cites [10] Heyland, 2011, Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool, Crit Care sourcePartly supported

  The Introduction identifies NUTRIC as a novel risk-assessment tool. But the Results describe a final score with six variables, not one based merely on disease severity; these include age and other factors alongside APACHE II and SOFA scores. The Results also say that weight loss and oral intake were excluded from the final score. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

May combine two claims.

Bolus administration significantly increases gastric volume and superior mesenteric artery blood volume in critically ill patients.

“Despite the fact that bolus administration is significantly different from continuous feeding in healthy individuals, it significantly increases gastric volume and superior mesenteric artery blood volume in critically ill patients [30], although these differences are not always translated into clinical advantages.”

• cites [30] Chowdhury, 2016, Effects of bolus and continuous nasogastric feeding on gastric emptying, small bowel water content, superior mesenteric artery blood flow, and plasma hormone concentrations in healthy adults: a randomized crossover study, Ann Surg sourcePartly supported

  The Results (Gastric Liquid Volume; Superior Mesenteric Artery Blood Velocity and Flow; pages not supplied) report higher gastric liquid volume and superior mesenteric artery blood flow with bolus feeding. The study concerns healthy adults, not critically ill patients, and measures arterial flow rather than superior mesenteric artery blood volume. The Discussion explicitly cautions against drawing conclusions about tube-feeding effects in clinical settings. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Malnutrition assessment requires the association of a phenotype and an etiology (GLIM criteria).

“Meanwhile, following the screening process, the malnutrition assessment requires the association of a phenotype (weight loss %, BMI, decrease in appetite, and/or low muscle mass) and an etiology e.g.critical illness [17] (GLIM (Global Leadership Initiative on Malnutrition) criteria).”

• cites [17] Cederholm, 2019, GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community, Journal of cachexia, sarcopenia and muscle sourcePartly supported

  The Results section (‘Approach to using combined phenotypic and etiologic criteria’) says GLIM diagnosis requires at least one phenotypic and one etiologic criterion. It lists weight loss, reduced BMI, and reduced muscle mass as phenotypic, but places reduced food intake or assimilation under etiologic criteria; the citing sentence incorrectly lists decreased appetite as phenotypic. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Casaer et al. observed that early (supplemental or exclusive) PN is associated with increased morbidity including prolonged ICU dependency and mechanical ventilation, and increased infection rate and need for renal replacement therapy.

“Casaer et al. [14] observed that early (supplemental or exclusive) PN is associated with increased morbidity including prolonged ICU dependency and mechanical ventilation, and increased infection rate and need for renal replacement therapy.”

• cites [14] Casaer, 2011, Early versus late parenteral nutrition in critically ill adults, N Engl J Med sourcePartly supported

  The Discussion reports that late PN was associated with fewer ICU infections and shorter ICU stays, mechanical ventilation, and renal-replacement therapy than early PN. However, Table 2 (Study Intervention) shows no meaningful difference in the proportion requiring renal-replacement therapy (8.9% early vs. 8.6% late; P=0.77). The claim is supported for longer therapy, not increased need for it. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All issued recommendations in the ESICM guidelines were weak due to low quality of evidence, with most based on expert opinion.

“However, all issued recommendations were weak due to the low quality of evidence, with most of them finally based on expert opinion [13].”

• cites [13] Reintam Blaser, 2017, Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines, Intensive Care Med sourceSupported

May combine two claims.

Meta-analysis found a significant reduction in diarrhea with continuous versus bolus administration (RR 0.42, 95%CI 0.19-0.91, p=0.03), whereas no difference was identified in other outcomes.

“Five studies were identified and meta-analysis found a significant reduction in diarrhea with continuous versus bolus administration (RR 0.42, 95%CI 0.19e0.91,p ¼ 0.03), whereas no difference was identified in other outcomes [4].”

• cites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr sourceSupported

May combine two claims.

When comparing early EN with early PN, a reduction of infectious complications with EN (RR 0.50, 95%CI 0.37-0.67, p=0.005), shorter ICU stay (RR -0.73, 95%CI -1.30 to -0.16, p=0.01) and shorter hospital stay (RR -1.23, 95%CI -2.02 to -0.45, p=0.002) were observed, while mortality was not different.

“When comparing early EN with early PN (six studies in ICU patients and seven studies with non-ICU patients included) a reduction of infectious complications with EN (RR 0.50, 95%CI 0.37e0.67,p ¼ 0.005), as well as shorter ICU (RR -0.73, 95%CI -1.30 to À0.16, p ¼ 0.01) and hospital stay (RR -1.23, 95%CI -2.02 to À0.45, p ¼ 0.002) was observed, while mortality was not different [4].”

• cites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Muscle mass can be evaluated by ultrasound, computerized tomography scan, or bioelectric impedance analysis (BIA).

“Muscle mass can be evaluated by ultrasound [18], computerized tomography scan [19], or bioelectric impedance analysis (BIA) [20].”

• cites [18] Wischmeyer, 2015, Winning the war against ICU-acquired weakness: new innovations in nutrition and exercise physiology, Crit Care sourceSupported
• cites [19] Looijaard, 2016, Skeletal muscle quality as assessed by CT-derived skeletal muscle density is associated with 6-month mortality in mechanically ventilated critically ill patients, Crit Care sourceSupported
• cites [20] Thibault, 2016, Fat-free mass at admission predicts 28-day mortality in intensive care unit patients: the international prospective observational study Phase Angle Project, Intensive Care Med sourceNot checked — no full text of the source

May combine two claims.

A better survival was observed in patients in whom EFI was resolved within 72 h, more likely in patients receiving prokinetics.

“A better survival was observed in patients in whom EFI was resolved within 72 h, more likely in patients receiving prokinetics [38].”

• cites [38] Vijayaraghavan, 2022, Reversal of feed intolerance by prokinetics improves survival in critically ill cirrhosis patients, Dig Dis Sci sourceSupported

May combine two claims.

A larger database analysis suggested that energy intake is associated with significantly improved survival when it is close to measured EE or between 70 and 100% of the repeatedly measured resting EE.

“A larger database analysis suggested that energy intake is associated with significantly improved survival when it is close to measured EE [55] or between 70 and 100% of the repeatedly measured resting EE [56].”

• cites [55] Weijs, 2014, Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients, Crit Care sourcePartly supported

  The Results (Possible underfeeding effect; page unavailable) report lower mortality odds at 90–100% of measured EE, but that comparison is between protein-intake groups, not a finding that energy intake near EE independently improves survival. The Discussion (Overfeeding; page unavailable) explicitly says improved energy intake with insufficient protein was not associated with lower mortality. The separate 70–100% claim is attached to citation [56], not this source. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [56] Zusman, 2016, Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study, Crit Care sourcePartly supported

  The Results report the lowest 60-day mortality at 70% of administered calories to measured resting energy expenditure (REE). They also report increasing mortality as intake rises above 70%, so the cited paper does not support improved survival across the full 70–100% range. The Discussion says many patients had repeated measurements, not that REE was repeatedly measured for every patient. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Postpyloric EN has been associated with a decrease in ventilator acquired pneumonia in several earlier meta-analyses, but this benefit did not translate into decreases in length of ventilation, ICU or hospital stay, or mortality.

“Postpyloric EN has been associated with a decrease in ventilator acquired pneumonia in several earlier meta-analyses, but this benefit did not translate into decreases in length of ventilation, ICU or hospital stay, or mortality [4].”

• cites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr sourceSupported

May combine two claims.

Our meta-analysis focused only on studies using indirect calorimetry found a trend (RR 1.28, 95%CI 0.98-1.67, p=0.07) to improved short-term mortality when using indirect calorimetry to identify the energy target, compared to hypocaloric regimens, but there were no significant differences in long term mortality, infection or length of stay.

“Our meta-analysis focused only on studies using indirect calorimetry found a trend (RR 1.28, 95%CI 0.98e1.67,p ¼ 0.07) to improved short-term mortality when using indirect calorimetry to identify the energy target, compared to hypocaloric regimens but there were no significant differences in long term mortality, infection or length of stay [4].”

• cites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr sourceSupported

May combine two claims.

We observed a trend for less pneumonia (RR 0.75, 95%CI 0.55-1.03, p=0.07) in patients treated with postpyloric feeding with no differences in mortality, diarrhea or ICU length of stay.

“We observed a trend for less pneumonia (eleven studies) (RR 0.75, 95%CI 0.55e1.03,p ¼ 0.07) in patients treated with postpyloric feeding with no differences in mortality (twelve studies), diarrhea (seven studies) or ICU length of stay.”

• cites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr sourceSupported

May combine two claims.

RCTs did not confirm the expected benefit of higher protein intakes alone, or combined with physical activity or energy.

“However, RCTs did not confirm the expected benefit of higher protein intakes alone, or combined with physical activity or energy [37,54,58].”

• cites [37] Murthy, 2022, Higher versus lower enteral calorie delivery and gastrointestinal dysfunction in critical illness: a systematic review and meta-analysis, Clin Nutr sourceNot checked — no full text of the source
• cites [54] Bellomo, 2014, Calorie intake and patient outcomes in severe acute kidney injury: findings from the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial, Crit Care sourcePartly supported

  The Abstract Conclusions report that greater daily calorie intake was not associated with improved outcomes in patients with severe acute kidney injury. But the Methods (Daily calorie intake) say nutrition was not assigned by protocol and calories excluded protein nitrogen; the Discussion (Study strengths and limitations) calls these observational findings from a trial of kidney-replacement therapy. This paper therefore does not establish that an RCT found no benefit from higher protein intake, alone or in combination with activity or energy. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [58] Dvir, 2006, Computerized energy balance and complications in critically ill patients: an observational study, Clin Nutr sourceNot checked — no full text of the source

May combine two claims.

Calculation of REE from VCO2 only obtained from ventilators (REE = VCO2 x 8.19) has been demonstrated to be more accurate than equations but less accurate than indirect calorimetry.

“If indirect calorimetry is not available, calculation of REE from VCO 2 only obtained from ventilators (REE ¼ VCO 2 x 8.19) has been demonstrated to be more accurate than equations [50] but less accurate than indirect calorimetry [51].”

• cites [50] Stapel, 2015, Ventilator-derived carbon dioxide production to assess energy expenditure in critically ill patients: proof of concept, Crit Care sourceSupported
• cites [51] Oshima, 2017, Can calculation of energy expenditure based on CO(2) measurements replace indirect calorimetry?, Crit Care sourcePartly supported

  The Discussion reports that VCO₂-based estimates met the 5% accuracy standard in only 46% of cases and concludes that they should not replace energy expenditure measured by indirect calorimetry. However, the Methods and Strengths and weaknesses sections specify that this study obtained VCO₂ from an indirect calorimeter, not a ventilator. It therefore supports the accuracy comparison, but not as a direct demonstration for ventilator-derived VCO₂. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The ESICM guidelines performed an extensive review of the literature, multiple meta-analyses, six web-seminars and utilized the GRADE methodology, evidence to decision framework and Delphi methodology.

“The latter performed an extensive review of the literature, multiple metaanalyses, six web-seminars and utilized the GRADE methodology, evidence to decision framework and Delphi methodology.”

• cites [13] Reintam Blaser, 2017, Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines, Intensive Care Med sourcePartly supported

  The Methods section (page unavailable) describes systematic reviews, and the Results section documents multiple meta-analyses; the Question 1 section also refers to two Delphi rounds and grades the certainty of evidence. Our copy does not substantiate the claim of six web-seminars or identify an evidence-to-decision framework. The explicit statement that the authors used the GRADE approach appears only in the abstract, which is not evidence for this verdict. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

May combine two claims.

The analysis of a large data base including 1171 patients with indirect calorimetry data confirmed that under- and overfeeding were both deleterious, and that the optimal amount appeared to be between 70 and 100% of measured EE.

“Recently the analysis of a large data base including 1171 patients with indirect calorimetry data [56] confirmed that under-and overfeeding were both deleterious, and that the optimal amount appeared to be between 70 and 100% of measured EE.”

• cites [56] Zusman, 2016, Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study, Crit Care sourcePartly supported

  The Abstract Results report 1,171 patients, and the Results describe a U-shaped association between calorie intake and 60-day mortality. But the lowest observed mortality was at 70% of measured resting energy expenditure, not throughout a 70–100% range. The Discussion also cautions that this observational study cannot establish that under- or overfeeding caused harm, so 'confirmed' is too strong. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

A higher GLN requirement in burn patients is explained by exudative losses: analysis of burn exudates shows that GLN is lost in larger amounts than any other amino acid.

“A higher GLN requirement in burn patients is explained by exudative losses: analysis of burn exudates shows that GLN is lost in larger amounts than any other amino acid [80].”

• cites [80] Gonzalez, 2016, Effect of human burn wound exudate on Pseudomonas aeruginosa virulence, mSphere sourcePartly supported

  The Results (Physicochemical characterization of burn wound exudate; page not provided) say glutamine was the only amino acid at a reduced concentration in both exudate and patient serum relative to clinical reference values. The Discussion links low glutamine in exudate to depletion in burn patients. Neither passage establishes that more glutamine is lost through exudate than any other amino acid or measures the resulting increase in glutamine requirement. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Propofol lipid solution contains 1.1 kcal/mL and can provide a large energy load exceeding nutritional support.

“This lipid solution contains 1.1 kcal/mL and can provide a large energy load exceeding nutritional support [75].”

• cites [75] Bousie, 2016, Relevance of non-nutritional calories in mechanically ventilated critically ill patients, Eur J Clin Nutr sourcePartly supported

  The Introduction states that propofol contains 1.1 kcal/mL and calculates that an infusion of 20 mL/h provides 528 kcal over 24 hours. The Conclusions say non-nutritional calories can be substantial in individual patients, but the paper does not establish that propofol’s energy contribution exceeds nutritional support. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

• AssumptionRests on an assumption: Propofol is a source of fatty acids.

May combine two claims.

Recent stable isotope studies demonstrate that amino acid conversion is improved with time, allowing an increase in whole body protein production only after the early period of the acute phase, even increasing further in the post-acute phase.

“Recent stable isotope studies [63,64] demonstrate that amino acid conversion is improved with time, allowing an increase in whole body protein production only after the early period of the acute phase, even increasing further in the post-acute phase.”

• cites [63] Gamrin-Gripenberg, 2018, An attenuated rate of leg muscle protein depletion and leg free amino acid efflux over time is seen in ICU long-stayers, Crit Care sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites [64] Deutz, 2021, Comprehensive metabolic amino acid flux analysis in critically ill patients, Clin Nutr sourcePartly supported

  The Discussion (page unavailable) reports increased whole-body protein synthesis in ICU patients, measured using stable isotope tracers. The Methods (page unavailable) say patients were studied 4 or 14 days after admission, but the paper does not show that amino acid conversion improves over time or that protein synthesis rises only after the early acute phase and further in the post-acute phase. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

In critically ill ICU patients, fish oil was associated with reductions in infections (RR 0.65, 95% CI 0.46e0.94), ICU LOS (-2.14 days, 95% CI -3.89 to -0.40), and hospital length of stay (-3.98 days, 95% CI -6.90 to -1.06), but with a non-significant reduction in 30-day mortality in all ICU patients (RR 0.90, 95% CI 0.69e1.16).

“In critically ill ICU patients, fish oil was associated with reductions in infections (RR 0.65, 95% CI 0.46e0.94),ICU LOS (À2.14 days, 95% CI -3.89 to À0.40), and hospital length of stay (À3.98 days, 95% CI -6.90 to À1.06), but with a non-significant reduction in 30-day mortality in all ICU patients (RR 0.90, 95% CI 0.69e1.16).”

• cites [96] Pradelli, 2020, Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis, Crit Care sourceSupported

May combine two claims.

In major burns, existing randomized trials have repeatedly demonstrated that GLN (and its precursor ornithine a-ketoglutarate) has beneficial effects in major burn injuries, reducing infectious complications (mainly gram negative infections) and also mortality.

“In major burns, studies include a limited number of patients: nevertheless, the existing randomized trials have repeatedly demonstrated that GLN (and its precursor ornithine a-ketoglutarate) has beneficial effects in major burn injuries, reducing infectious complications (mainly gram negative infections) and also mortality [4].”

• cites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr sourceSupported

May combine two claims.

Our meta-analysis including three studies showed a decrease in length of stay (RR -0.47, 95%CI -7.57 to -1.71, p = 0.002), and a trend for decrease in mortality (RR 0.69, 95%CI 0.39e1.23,p = 0.21), but no difference in incidence of pneumonia when early EN was administered rather than early PN.

“Our meta-analysis including three studies showed a decrease in length of stay (RR -0.47, 95%CI -7.57 to À1.71, p ¼ 0.002), and a trend for decrease in mortality (RR 0.69, 95%CI 0.39e1.23,p ¼ 0.21), but no difference in incidence of pneumonia when early EN was administered rather than early PN [4].”

• cites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr sourceSupported

May combine two claims.

High-quality RCTs evaluating high doses of selenium, vitamin D, vitamin C, and combinations of vitamin C and thiamine revealed no hard clinical benefit of such interventions.

“High-quality RCTs evaluating high doses of selenium [99], vitamin D [100,101], vitamin C [102e108], and combinations of vitamin C and thiamine [109], revealed no hard clinical benefit of such interventions.”

• cites [99] Manzanares, 2016, High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis, Crit Care sourceSupported
• cites [100] Han, 2021, Effect of early high-dose vitamin D3 repletion on cognitive outcomes in critically ill adults, Chest sourceNot checked — no full text of the source
• cites [101] Ginde, 2019, Blood Institute, Petal Clinical Trials Network. Early high-dose vitamin D(3) for critically ill, vitamin D-deficient patients, N Engl J Med sourceSupported
• cites [102e108]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

In a sub-group analysis of the EPaNIC study, reduced infection rates in late vs early PN were observed (29.9% vs. 40.2%,p = 0.01) with no difference in any mortality outcomes, whereas all these patients received virtually no EN during the seven study days.

“Reduced infection rates in late vs early PN were observed (29.9% vs. 40.2%,p ¼ 0.01) with no difference in any mortality outcomes, whereas all these patients received virtually no EN during the seven study days [14].”

• cites [14] Casaer, 2011, Early versus late parenteral nutrition in critically ill adults, N Engl J Med sourcePartly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

Oral intake is frequently prescribed in the intensive care setting varying from 25 to 45% of the patients in the first four days, but does not reach the energy or protein requirements according to the Nutrition Day ICU survey.

“Oral intake is frequently prescribed in the intensive care setting varying from 25 to 45% of the patients in the first four days, but does not reach the energy or protein requirements according to the Nutrition Day ICU survey [6].”

• cites [6] Wischmeyer, 2017, Tailoring nutrition therapy to illness and recovery, Crit Care sourcePartly supported

  The Background section on ICU nutrition delivery (page unavailable) reports that patients receive substantially less energy and protein than recommended, supporting the general point about unmet requirements. It does not report oral intake being prescribed for 25–45% of patients in the first four days or attribute those figures to a Nutrition Day ICU survey; its figures concern overall delivery over the first 12 days from the International Nutrition Survey. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

We performed a meta-analysis of EN vs no nutrition within the first 48 h, which did not reveal clear benefit of EN in this subgroup of patients, but a trend towards fewer infectious complications was observed (RR 0.47, 95%CI 0.20e1.07,p = 0.07).

“We performed a meta-analysis of EN vs no nutrition within the first 48 h, which did not reveal clear benefit of EN in this subgroup of patients, but a trend towards fewer infectious complications was observed (RR 0.47, 95%CI 0.20e1.07,p ¼ 0.07) [4].”

• cites [4] Singer, 2019, ESPEN guideline on clinical nutrition in the intensive care unit, Clin Nutr sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Recent evidence tends to show that persistently low zinc concentrations might become an important biomarker of adverse outcomes in sepsis.

“Recent evidence tends to show that persistently low zinc concentrations might become an important biomarker of adverse outcomes in sepsis [97].”

• cites [97] Hoeger, 2017, Persistent low serum zinc is associated with recurrent sepsis in critically ill patients - a pilot study, PLoS One sourceSupported

May combine two claims.

Oral intake is impaired after extubation and a high incidence of swallowing dysfunction has been described (between 10 and 67.5%, with a mean around 50%, despite different timing and methods used for assessing the dysphagia).

“Oral intake is impaired after extubation and a high incidence of swallowing dysfunction has been described (between 10 and 67.5%, with a mean around 50%, despite different timing and methods used for assessing the dysphagia) [112].”

• cites [112] Tsai, 2016, Swallowing dysfunction following endotracheal intubation: age matters, Medicine (Baltim) sourceSupported

May combine two claims.

Among all screening tools, NRS 2002 and MUST have the strongest predictive value for mortality and are the easiest and quickest to calculate.

“It appears that among all the screening tools, NRS 2002 and MUST have the strongest predictive value for mortality, and they are the easiest and quickest to calculate [12].”

• cites [12] Lew, 2016, Association between malnutrition and clinical outcomes in the intensive care unit: a systematic review, J Parenter Enteral Nutr sourceNot checked — no full text of the source

May combine two claims.

Loss of muscle is associated with prolonged hospital stay and decreased quality of life and functional capacity.

“This loss of muscle may be considered as frailty and is associated with a prolonged hospital stay, and a decrease in quality of life and functional capacity [22].”

• cites [22] Detsky, 1984, Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons, J Parenter Enteral Nutr sourceNot checked — no full text of the source

May combine two claims.

A too low intake, below 50%, was associated in retrospective studies with a worse clinical outcome, may lead to severe calorie debt and empty the energy reserves, reduce lean body mass and may increase infectious complications.

“On the other hand, a too low intake, below 50%, was associated in retrospective studies with a worse clinical outcome.may lead to severe calorie debt and empty the energy reserves, reduce lean body mass and may increase infectious complications [58,59].”

• cites [58] Dvir, 2006, Computerized energy balance and complications in critically ill patients: an observational study, Clin Nutr sourceNot checked — no full text of the source
• cites [59] Villet, 2005, Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients, Clin Nutr sourceNot checked — no full text of the source

May combine two claims.

Numerous meta-analyses have demonstrated the poor value of predictive equations, and variability is increased because body weight remains difficult to accurately assess.

“Numerous metaanalyses have demonstrated the poor value of predictive equations [43,44], variability that is increased because body weight remains difficult to accurately assess [45].”

• cites [43] Frankenfield, 2008, Analysis of estimation methods for resting metabolic rate in critically ill adults, J Parenter Enteral Nutr sourceNot checked — no full text of the source
• cites [44] Tatucu-Babet, 2015, Prevalence of underprescription or overprescription of energy needs in critically ill mechanically ventilated adults as determined by indirect calorimetry, J Parenter Enteral Nutr sourceNot checked — no full text of the source
• cites [45] Graf, 2017, Energy expenditure in mechanically ventilated patients: the weight of body weight, Clin Nutr sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Berger & Pichard observe an increase in mortality in the group of patients receiving energy close to the prescribed recommended energy intake.

“Berger & Pichard observe an increase in mortality in the group of patients receiving energy close to the prescribed recommended energy intake [52].”

• cites [52] Berger, 2015, Understanding the Causes of Death in INTACT by Braunschweig et al, J Parenter Enteral Nutr sourceNot checked — no full text of the source

May combine two claims.

Early full feeding causes overfeeding as it adds to the endogenous energy production which amounts to 500-1400 kcal/d and can lead to deleterious effects such as increased length of stay, ventilation duration and infection rates.

“Early full feeding causes overfeeding as it adds to the endogenous energy production which amounts to 500e1400 kcal/d and can lead to.deleterious effects such as increased length of stay, ventilation duration and infection rates [57].”

• cites [57] Iapichino, 2006, Metabolic treatment of critically ill patients: energy balance and substrate disposal, Minerva AnestesiolNot checked — no full text of the source

May combine two claims.

The pilot TICACOS study showed that a strategy using indirect calorimetry was associated with an improvement in 60 day survival in the per protocol study, but also to an increase in length of ventilation, infections and length of stay related to calorie overload and positive energy balance due to non-nutritional energy intakes.

“The pilot TICACOS study [46] showed that such a strategy was associated with an improvement in 60 day survival in the per protocol study, but also to an increase in length of ventilation, infections and length of stay related to the calorie overload and positive energy balance due to non-nutritional energy intakes.”

• cites [46] Singer, 2011, The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients, Intensive Care Med sourceNot checked — no full text of the source

May combine two claims.

The predictive equations are associated with significant inaccuracy (up to 60%), leading to over or under evaluation of the needs and inducing over or underfeeding.

“The predictive equations are associated with significant inaccuracy (up to 60%), leading to over or under evaluation of the needs and inducing over or underfeeding [42].”

• cites [42] Zusman, 2019, Predictive equations versus measured energy expenditure by indirect calorimetry: a retrospective validation, Clin Nutr sourceNot checked — no full text of the source

May combine two claims.

Energy-dense feed delivery is associated with increased prokinetic use, but does not affect other outcomes.

“Energy-dense feed delivery is associated with increased prokinetic use, but does not affect other outcomes [37].”

• cites [37] Murthy, 2022, Higher versus lower enteral calorie delivery and gastrointestinal dysfunction in critical illness: a systematic review and meta-analysis, Clin Nutr sourceNot checked — no full text of the source

May combine two claims.

Heidegger et al. measured EE at day 3 and adapted the energy intake accordingly, comparing supplemental PN from day four to an EN only group; the intervention group had a lower late nosocomial infection rate after day 9.

“Heidegger et al. [48] measured EE at day 3 and adapted the energy intake accordingly, comparing supplemental PN from day four to an EN only group.The intervention group had a lower late nosocomial infection rate after day 9.”

• cites [48] Heidegger, 2013, Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial, Lancet sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The recruited patients' energy intake was very variable, although similar in the groups (around 14 kcal/kg/d) receiving high and low-dose proteins.

“The recruited patients' energy intake was very variable, although similar in the groups (around 14 kcal/kg/d) receiving high and low-dose proteins.”

• cites [60] Heyland, 2023, The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial, Lancet (London, England) sourceNot checked — no full text of the source

May combine two claims.

A comparison between 1.6 ± 0.5 g/kg/d compared with 0.9 ± 0.3 g/kg/d administered protein did not find any significant difference in outcomes, but an increased mortality in patients with acute kidney injury randomized to high protein intakes.

“Recently [60], a comparison between 1.6 ± 0.5 g/kg/d compared with 0.9 ± 0.3 g/kg/d administered protein did not find any significant difference in outcomes, but an increased mortality in patients with acute kidney injury randomized to high protein intakes.”

• cites [60] Heyland, 2023, The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial, Lancet (London, England) sourceNot checked — no full text of the source

May combine two claims.

A meta-analysis did not reveal any benefit of omega-3 FA, but there was a trend towards increase in PO2/FiO2 with intervention (RR 22.59, 95%CI -0.88 -46.05, p = 0.06).

“A meta-analysis did not reveal any benefit of omega-3 FA, but there was a trend towards increase in PO 2 /FiO 2 with intervention (RR 22.59, 95%CI -0.88 -46.05, p ¼ 0.06).”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

There are no PN studies with or without micronutrients.

“There are no PN studies with or without micronutrients.”

May combine two claims.

BIA can assess body composition in a stable patient not suffering from fluid compartment shifts, and phase angle is useful in evaluating prognosis of critically ill patients.

“BIA can assess body composition in a stable patient not suffering from fluid compartment shifts and phase angle [24] is useful in the evaluation of the prognosis of critically ill patients.”

• cites [24] Reis de Lima e Silva, 2014, Phase angle as an indicator of nutritional status and prognosis in critically ill patients, Nutr HospNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

A definition of acute critical illness-associated malnutrition still needs to be developed.

“A definition of acute critical illnessassociated malnutrition still needs to be developed [8].”

• cites [8] Kondrup, 2003, Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials, Clin Nutr sourceNot checked — no full text of the source

May combine two claims.

Bolus and continuous enteral feeding can achieve the same target without an increase in side effects.

“This limited amount of data suggests that bolus and continuous enteral feeding can achieve the same target without an increase in side effects in any of these routes.”

Classified as probably not a substantial claim.

Patients at increased risk for aspiration may be identified by factors including inability to protect the airways, mechanical ventilation, age >70 years, reduced level of consciousness, poor oral care, inadequate nurse:patient ratio, supine positioning, neurologic deficits, gastroesophageal reflux, transport out of the ICU, and use of bolus intermittent EN.

“According to the American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations [27], patients at increased risk for aspiration may be identified by a number of factors, including inability to protect the airways, support with mechanical ventilation, age >70 years, reduced level of consciousness, poor oral care, inadequate nurse:patient ratio, supine positioning, neurologic deficits”

• cites [27] Taylor, 2016, Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient, Crit Care Med sourceNot checked — no full text of the source
• cites [28] Mahadeva, 2008, Transnasal endoscopic placement of nasoenteric feeding tubes: outcomes and limitations in non–critically ill patients, Nutr Clin Pract sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The observed benefit of EN in earlier studies may be due to the higher energy and amino acid/protein content provided by PN compared to EN.

“However, recent randomized controlled trials (RCTs) do not demonstrate a clear advantage of EN over PN, and the observed benefit of EN in earlier studies may be due to the higher energy and amino acid/protein content provided by PN compared to EN.”

• AssumptionRests on an assumption: Recent randomized controlled trials do not demonstrate a clear advantage of EN over PN.

Probably not a substantial claim: may not pass S3 (load-bearing).

These findings may be related to the specific study protocol, the patients' characteristics and the large amounts of energy administered under guidance of predictive equations instead of indirect calorimetry.

“These findings may be related to the specific study protocol, the patients' characteristics and the large amounts of energy administered under guidance of predictive equations instead of indirect calorimetry.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Bolus feeding could provide a greater stimulus for protein synthesis.

“Finally, bolus feeding could provide a greater stimulus for protein synthesis [31].”

• cites [31] Patel, 2018, Intermittent versus continuous feeding in critically ill adults, Curr Opin Clin Nutr Metab Care sourceNot checked — no full text of the source

May combine two claims.

In all these studies, calorie delivery was lower than recommended/prescribed or the studies were not targeted to this parameter.

“However, in all these studies, calorie delivery was lower than recommended/prescribed or the studies were not targeted to this parameter.”

Classified as probably not a substantial claim. May combine two claims.

The routine use of the postpyloric route is currently not justified because postpyloric tube placement requires expertise, is commonly associated with some time delay, and is considered less physiological compared to gastric EN.

“As postpyloric tube placement requires expertise, is commonly associated with some time delay, and is considered less physiological compared to gastric EN, the routine use of the postpyloric route is currently not justified.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Postpyloric tube placement requires expertise, is probably less physiologic compared to gastric EN, and could possibly be harmful in cases of GI motility problems distal to the stomach.

“It should be considered that postpyloric tube placement requires expertise, is probably less physiologic compared to gastric EN, and could possibly be harmful in cases of GI motility problems distal to the stomach.”

Classified as probably not a substantial claim. May combine two claims.

Many authors of the current guidelines are also co-authors of the ESICM guidelines, and a decision was made to endorse the respective recommendations related to early enteral feeding.

“Since many of the authors of the current guidelines are also co-authors of the ESICM guidelines, a decision was made to endorse the respective recommendations related to early enteral feeding.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Postpyloric feeding could possibly be harmful in cases of gastrointestinal motility problems distal to the stomach.

“Moreover, postpyloric feeding could possibly be harmful in cases of gastrointestinal motility problems distal to the stomach.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The original guideline was developed according to the standard operating procedure (SOP) for ESPEN guidelines and consensus papers.

“The original guideline was developed according to the standard operating procedure (SOP) for ESPEN guidelines and consensus papers [3].”

• cites [3] Bischoff, 2015, Standard operating procedures for ESPEN guidelines and consensus papers, Clin Nutr sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All recommendations were agreed in a multistage consensus process, which resulted in a percentage of agreement.

“All recommendations were agreed in a multistage consensus process, which resulted in a percentage of agreement (%).”

May combine two claims.

Low plasma triglyceride levels and high-density lipoprotein (HDL) cholesterol levels are associated with improved survival.

“Lipid metabolism is modified in critical illness and low plasma triglyceride levels and high-density lipoprotein (HDL) cholesterol levels are associated with improved survival [72].”

• cites [72] Green, 2016, Lipid metabolism in critical illness, Curr Opin Clin Nutr Metab Care sourceNot checked — no full text of the source

May combine two claims.

Endogenous glucose production is increased and does not decrease when nutrients and insulin are administered as compared with healthy conditions.

“Endogenous glucose production is increased and does not decrease when nutrients and insulin are administered as compared with healthy conditions [68].”

• cites [68] Thorell, 2004, Intensive insulin treatment in critically ill trauma patients normalizes glucose by reducing endogenous glucose production, J Clin Endocrinol Metabol sourceNot checked — no full text of the source

May combine two claims.

Mechanistic understandings of the action of omega-3 FA from fish oil have advanced, and positive effects of fish oil on organ function (kidney, liver, muscle) have been reported.

“Mechanistic understandings of the action of omega-3 FA from fish oil have advanced [91], and positive effects of fish oil on organ function (kidney, liver, muscle) have been reported [92].”

• cites [91] Calder, 2020, Lipids in parenteral nutrition: biological aspects, JPEN - J Parenter Enter Nutr sourceNot checked — no full text of the source
• cites [92] Singer, 2023, The role of omega-3 polyunsaturated fatty acids in the intensive care unit, Curr Opin Clin Nutr Metab Care sourceNot checked — no full text of the source

May combine two claims.

Excessive glucose based energy provision is associated with hyperglycemia, enhanced CO2 production, enhanced lipogenesis, increased insulin requirements and no advantage in protein sparing in comparison with lipid based energy provision.

“Excessive glucose based energy provision is associated with hyperglycemia, enhanced CO 2 production, enhanced lipogenesis, increased insulin requirements and no advantage in protein sparing in comparison with lipid based energy provision [69].”

• cites [69] Tappy, 1998, Effects of isoenergetic glucose-based or lipid-based parenteral nutrition on glucose metabolism, de novo lipogenesis, and respiratory gas exchanges in critically ill patients, Crit Care Med sourceNot checked — no full text of the source

May combine two claims.

Since the 1990s, many studies have shown benefits in terms of infectious complication reduction, lower mortality and reduction of hospital costs recently confirmed in an analysis including RCTs performed after 2000, using GLN as part of nutrition support.

“Since the 1990s, many studies have shown benefits in terms of infectious complication reduction, lower mortality and reduction of hospital costs recently confirmed in an analysis including RCTs performed after 2000, using GLN as part of nutrition support [84].”

• cites [84] Pasin, 2013, Glutamine and antioxidants in critically ill patients, N Engl J Med sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The guideline process summary and dissemination were funded exclusively by ESPEN.

“The guideline process summary and dissemination were funded exclusively by ESPEN.”

May combine two claims.

Administration of marked amounts of carbohydrates and lipids can lead to hyperglycemia and liver function test abnormalities.

“Administration of marked amounts of carbohydrates and lipids can lead to hyperglycemia and liver function test abnormalities while high fat administration can lead to lipid overload, and especially unsaturated fat to impaired lung function and immune suppression [73].”

• cites [73] Elwyn, 1993, Protein and energy requirements: effect of clinical state, Clin Nutr sourceNot checked — no full text of the source

May combine two claims.

Glenn and Wischmeyer found that continuous administration of omega-3 FAs improved length of stay and length of ventilation; in contrast, bolus administration had no advantage.

“Glenn and Wischmeyer [88] analyzed separately the studies administering omega-3 FAs as a bolus or in a continuous manner and found that continuous administration improved length of stay and length of ventilation; in contrast, bolus administration had no advantage.”

• cites [88] Glenn, 2014, Enteral fish oil in critical illness, Curr Opin Clin Nutr Metab Care sourceNot checked — no full text of the source

May combine two claims.

High fat administration can lead to lipid overload, and especially unsaturated fat to impaired lung function and immune suppression.

“Administration of marked amounts of carbohydrates and lipids can lead to hyperglycemia and liver function test abnormalities while high fat administration can lead to lipid overload, and especially unsaturated fat to impaired lung function and immune suppression [73].”

• cites [73] Elwyn, 1993, Protein and energy requirements: effect of clinical state, Clin Nutr sourceNot checked — no full text of the source

May combine two claims.

Continuous renal replacement therapy for more than two weeks is a new cause of acute micronutrient deficiencies and particularly of severe copper deficiency that may explain life-threatening complications in patients requiring this therapy.

“Continuous renal replacement therapy for more than two weeks is a new cause of acute micronutrient deficiencies and particularly of severe copper deficiency that may explain life-threatening complications in patients requiring this therapy [98].”

• cites [98] Ben-Hamouda, 2017, Massive copper and selenium losses cause life-threatening deficiencies during prolonged continuous renal replacement, Nutrition sourceNot checked — no full text of the source

May combine two claims.

One larger retrospective study comparing early EN via surgical jejunostomy with early PN resulted in less life-threatening complications and a shorter postoperative hospital stay.

“One larger retrospective study comparing early EN via surgical jejunostomy with early PN resulted in less life-threatening complications and a shorter postoperative hospital stay [116].”

• cites [116] Fujita, 2012, Early enteral nutrition reduces the rate of life-threatening complications after thoracic esophagectomy in patients with esophageal cancer, Eur Surg Res sourceNot checked — no full text of the source

May combine two claims.

Electrolyte alterations are less likely to occur with a cautious introduction of feeding, as shown by a recent early calorie restriction study and confirmed by a retrospective study.

“A recent early calorie restriction study showed that electrolyte alterations were less likely to occur with a cautious introduction of feeding and this was confirmed by a retrospective study [149].”

• cites [149] Olthof, 2018, Impact of caloric intake in critically ill patients with, and without, refeeding syndrome: a retrospective study, Clin Nutr sourceNot checked — no full text of the source

May combine two claims.

Recently, 29% of 446 ICU patients had prolonged post-extubation swallowing disorder at discharge and some post-extubation swallowing disorder has been shown four months after discharge.

“Recently, 29% of 446 ICU patients had prolonged post-extubation swallowing disorder at discharge and some post-extubation swallowing disorder has been shown four months after discharge [114].”

• cites [114] Macht, 2014, Swallowing dysfunction after critical illness, Chest sourceNot checked — no full text of the source

May combine two claims.

Commercially available PN solutions contain no micronutrients for stability reasons: this requires their separate prescription.

“Parenteral and enteral feeding preparations differ in that commercially available PN solutions contain no micronutrients for stability reasons: this requires their separate prescription [2].”

• cites [2] Singer, 2009, ESPEN guidelines on parenteral nutrition: intensive care, Clin Nutr sourceNot checked — no full text of the source

May combine two claims.

Fan et al. compared three groups: early EN, early PN and EN followed by supplemental PN. Complications and mortality were significantly decreased and nutritional status and clinical outcomes were improved in the early EN + supplemental PN group.

“Fan et al. [125] compared three groups: early EN, early PN and EN followed by supplemental PN.Complications and mortality were significantly decreased and nutritional status and clinical outcomes were improved in the early EN þ supplemental PN group.”

• cites [125] Fan, 2016, Early enteral combined with parenteral nutrition treatment for severe traumatic brain injury: effects on immune function, nutritional status and outcomes, Chin Med Sci J sourceNot checked — no full text of the source

May combine two claims.

Kompan et al. compared early EN to early PN followed by EN in multiple trauma patients and found a significant decrease in pneumonia and length of stay, but not in hospital stay and mortality.

“Kompan et al. [124] compared early EN to early PN followed by EN in multiple trauma patients and found a significant decrease in pneumonia and length of stay, but not in hospital stay and mortality.”

• cites [124] Kompan, 2004, Is early enteral nutrition a risk factor for gastric intolerance and pneumonia?, Clin Nutr sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Providing micronutrients to include the full range of trace elements and vitamins is an integral part of nutritional support as stated in the 2009 guidelines.

“Providing micronutrients to include the full range of trace elements and vitamins is an integral part of nutritional support as stated in the 2009 guidelines [2].”

• cites [2] Singer, 2009, ESPEN guidelines on parenteral nutrition: intensive care, Clin Nutr sourceNot checked — no full text of the source

May combine two claims.

Most trauma patients are not malnourished on admission (6% SGA C), but may become malnourished during ICU stay (increase in SGA B).

“Most trauma patients are not malnourished on admission (6% SGA C), but may become malnourished during ICU stay (increase in SGA B) [123].”

• cites [123] Goiburu, 2006, The impact of malnutrition on morbidity, mortality and length of hospital stay in trauma patients, Nutr HospNot checked — no full text of the source