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The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial
Abstract
Background On the basis of low-quality evidence, international critical care nutrition guidelines recommend a wide range of protein doses. The effect of delivering high-dose protein during critical illness is unknown. We aimed to test the hypothesis that a higher dose of protein provided to critically ill patients would improve their clinical outcomes. Methods This international, investigator-initiated, pragmatic, registry-based, single-blinded, randomised trial was undertaken in 85 intensive care units (ICUs) across 16 countries. We enrolled nutritionally high-risk adults (≥18 years) undergoing mechanical ventilation to compare prescribing high-dose protein (≥2·2 g/kg per day) with usual dose protein (≤1·2 g/kg per day) started within 96 h of ICU admission and continued for up to 28 days or death or transition to oral feeding. Participants were randomly allocated (1:1) to high-dose protein or usual dose protein, stratified by site. As site personnel were involved in both prescribing and delivering protein dose, it was not possible to blind clinicians, but patients were not made aware of the treatment assignment. The primary efficacy outcome was time-to-discharge-alive from hospital up to 60 days after ICU admission and the secondary outcome was 60-day morality. Patients were analysed in the group to which they were randomly assigned regardless of study compliance, although patients who dropped out of the study before receiving the study intervention were excluded. This study is registered with ClinicalTrials.gov, NCT03160547. Findings Between Jan 17, 2018, and Dec 3, 2021, 1329 patients were randomised and 1301 (97·9%) were included in the analysis (645 in the high-dose protein group and 656 in usual dose group). By 60 days after randomisation, the cumulative incidence of alive hospital discharge was 46·1% (95 CI 42·0%-50·1%) in the high-dose compared with 50·2% (46·0%-54·3%) in the usual dose protein group (hazard ratio 0·91, 95% CI 0·77-1·07; p=0·27). The 60-day mortality rate was 34·6% (222 of 642) in the high dose protein group compared with 32·1% (208 of 648) in the usual dose protein group (relative risk 1·08, 95% CI 0·92-1·26). There appeared to be a subgroup effect with higher protein provision being particularly harmful in patients with acute kidney injury and higher organ failure scores at baseline. Interpretation Delivery of higher doses of protein to mechanically ventilated critically ill patients did not improve the time-to-discharge-alive from hospital and might have worsened outcomes for patients with acute kidney injury and high organ failure scores. Funding None.
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“but demonstrated higher mortality in patients with renal failure.145”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [145]
In the citing paper
“The recruited patients' energy intake was very variable, although similar in the groups (around 14 kcal/kg/d) receiving high and low-dose proteins.”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [60]
In the citing paper
“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.”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [60]
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InfluentialESPEN guideline on chronic intestinal failure in adults – Update 2023
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“Subgroup analysis of EFFORT-Protein trial and in REDOX suggests worse outcomes between protein dose and patients with AKI (stage 1–3) not receiving baseline CRRT and high admit SOFA score(≥ 9) [37, 43].”
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“…high versus low protein intake showed no impact on mortality, ventilation duration, or ICU/hospital length of stay but significantly reduced muscle atrophy [144], while the EFFORT trial showed no benefit and a signal of harm in patients with acute kidney injury and high organ failure scores [145].”
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Self-citationNutrition in the intensive care unit: from the acute phase to beyond
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“…on protein supplements, the EFFORT Protein RCT, which randomized 1329 critically ill patients to receive a high ( ≥ 2.2 g/kg/ day) or a usual ( ≤ 1.2 g/kg/day) protein dose, initiated within 96 h after ICU admission and continued for up to 28 days did not show benefit by high protein doses [37].”
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“Secondary analyses of the EFFORT Protein study [65] and the REDOXS trial [42] demonstrated poor outcomes when patients were provided with high protein and glutamine provision, respectively, which was reflected by an elevated UCR trajectory in the high protein/amino acid intervention.”
Augmented Enteral Protein During Critical Illness
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“In an 85 centre study of 1301 patients, the EFFORT Protein trial randomised patients to 2.2 g/kg/day or more of protein versus 1.2 g/kg/day or less for 28 days [3].”
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The Japanese Critical Care Nutrition Guideline 2024
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“Higher doses (≥ 2.2 g kg-1 day vs ≤ 1.2 g kg-1 day) were tested in 1,329 mechanically ventilated critically ill patients [126] in a pragmatic randomised trial, there was no overall effect on survival or hospital length of stay, although there was a negative signal in the subgroup of patients with…”
InfluentialBlaser, A. R., Rooyackers, O., & Bear, D. E. (2023) · Critical Care · doi:10.1186/s13054-023-04543-1 · Cited by 42
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“…of 1.6 g/kg versus 0.9 g/ kg per day in predominantly medical ICU patients: A major heterogeneity within groups was present, with an important overlap between groups, as well as a likely overfeeding in the intervention group with many patients receiving > 30 kcal/kg/day in the early phase [27].”
BackgroundInfluentialBenefits of Cardiac Rehabilitation: Mechanisms to Restore Function and Clinical Impact
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“Nevertheless, emerging data from recent large trials (Table 2) [10, 11, 15, 35–38] need to be considered for the clinical management and future research on ICUAW.”
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“However, subsequent RCTs confirmed potential harm by early full nutrition support to critically ill patients, leading to more restrictive feeding in the acute phase of critical illness [7, 31, 46].”
Heuts, S., Lee, Z., Lew, C. C. H., Bels, J. L. M., Gabrio, A., Kawczynski, M. J., Heyland, D. K., Summers, M. J., Deane, A. M., Mesotten, D., et al. (2024) · Critical Care Medicine · doi:10.1097/ccm.0000000000006562 · Cited by 27
“The duration of MV was reported by 12 studies ( n = 3042 patients, higher protein: n = 1520 patients, lower protein: n = 1522 patients [6, 20, 23, 25–28, 31, 34–37]) (SDC 12, http://links.lww.com/CCM/H660).”
InfluentialSelf-citationGastrointestinal function in critically ill patients
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Self-citationChallenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies
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“…the administration of high protein doses in critically ill patients on mechanical ventilation, as they do not improve hospital stay and their administration could worsen the outcomes of patients with renal failure as well as be associated with worse outcomes on organ dysfunction scales [93].”
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Metabolism and Nutrition in Sepsis: In Need of a Paradigm Shift
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“The recently published data from the EFFORT randomized controlled trial further suggest that not only does high protein feeding not improve mortality, it may also be harmful in certain subgroups, such as patients with signi fi cant organ dysfunction, including acute kidney injury [12].”
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Vanhorebeek, I., Casaer, M. P., & Gunst, J. (2023) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000001056 · Cited by 25
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Self-citationImpact of early high protein intake in critically ill patients: a randomized controlled trial
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“…EFFORT Protein trial, the high-dose protein group received a protein supplementation of ≥ 2.2 g/kg per day, a dosage considerably higher than the recommended range of 1.2–2.0 g/kg. Subgroup analysis revealed negative impacts of this dosage on patients with kidney injury and organ failure [15, 16].”
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Jameson, T. S. O., Caldow, M. K., Stephens, F. B., Denehy, L., Lynch, G. S., Koopman, R., Krajčová, A., Urban, T., Berney, S. C., Duška, F., et al. (2023) · Critical Care · doi:10.1186/s13054-023-04664-7 · Cited by 19
“…impairment: firstly, that neither physical nor nutritional interventions have been successful at preventing or treating this physical impairment [7, 8] and secondly, that the underpinning biology of altered protein homeostasis described in observational studies increasingly converges on common…”
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“Indeed, despite observational studies associating a higher protein intake with improved outcomes [33], recent large randomized controlled trials have shown potential harm by increased nutritional intake and increased protein doses in the acute phase of critical illness [34–37].”
BackgroundMuscle Dysfunction and Physical Recovery After Critical Illness
Mart, M. F., Gordon, J. I., González-Seguel, F., Mayer, K. P., & Brummel, N. E. (2025) · Journal of Intensive Care Medicine · doi:10.1177/08850666251317467 · Cited by 23
“103 The potential adverse effects seen with greater protein intake in recent trials may be due to signi fi - cant anabolic resistance that can ’ t be overcome by delivery of additional protein sources.”
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Combined Effects of Early Mobilization and Nutrition on ICU-Acquired Weakness
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Contemporary Rationale for Delivering Enteral Nutrition in Critically Ill Adults
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“Large-scale studies testing higher protein and calorie strategies during ICU admission (EFFORT Protein, TARGET Protein, PRECISE, TARGET Calories, Nutrirea-3) have not demonstrated improvements in clinical outcomes [116–120].”
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Vest, A. R., DiDomenico, R. J., Lichtenstein, L., Slater, T., Ekpo, E., Damluji, A. A., Bohula, E., Alviar, C. L., on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology, & Council on Cardiovascular and Stroke Nursing (2026) · Circulation · doi:10.1161/cir.0000000000001405 · Cited by 15
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“However, the selection of the appropriate ONS for patients with malnutrition is crucial, as higher or lower protein intakes may be harmful in specific subgroups of patients with DRM [15].”
BackgroundBriassoulis, G. C., Ilia, S., & Briassouli, E. (2024) · Nutrients · doi:10.3390/nu16203523 · Cited by 19
“Administering higher protein doses ( ≥ 2.2 g/kg/day) compared to standard doses ( ≤ 1.2 g/kg/day) in critically ill patients on mechanical ventilation did not improve time-to-discharge-alive and resulted in worse outcomes for those with acute kidney injury and high organ failure scores [85].”
BackgroundInfluentialVeldsman, L., Richards, G. A., Nel, D. G., Kohn, T. A., & Blaauw, R. (2025) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.70041 · Cited by 14
“22,25 Despite no significant differences in structural markers of muscle mass (cross ‐ sectional area), the protein ‐ to ‐ DNA ratio, a proxy for early protein deposition, 2 showed a significant overall increase over time across the cohort.”
InfluentialNutrition considerations for patients with persistent critical illness: A narrative review
Smith, E. V., Lambell, K., Tatucu-Babet, O. A., Ridley, E. J., & Chapple, L. S. (2024) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.2623 · Cited by 17
Nine Myths about Enteral Feeding in Critically Ill Adults: An Expert Perspective
Ramaswamy, T., DeWane, M. P., Dashti, H. S., Lau, M., Wischmeyer, P. E., Nagrebetsky, A., & Sparling, J. L. (2024) · Advances in Nutrition · doi:10.1016/j.advnut.2024.100345 · Cited by 16
Low‐protein diet for chronic kidney disease: Evidence, controversies, and practical guidelines
Mafra, D., Brum, I. D. S. D. C., Borges, N. A., Leal, V. D. O., & Fouque, D. P. (2025) · Journal of Internal Medicine · doi:10.1111/joim.20117 · Cited by 13
“High protein intakes did not improve time-to-discharge-alive from hospital (TTDA) or 60-day mortality, and patients with high-dose protein had a higher urea concentration [86].”
Pouncey, A. L., Sweeting, M. J., Bicknell, C. D., Powell, J. T., Lübcke, J., Gunnarsson, K., Wanhainen, A., & Mani, K. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae675 · Cited by 13
“20,21 In this study, we used two national data sets, from Sweden and the UK, to investigate whether sex-specific differences in the rate of alive hospital discharge following AAA repair vary between healthcare environments and to identify drivers of the rate of hospital discharge.”
Haines, R. W., Granholm, A., Puthucheary, Z., Day, A. G., Bear, D. E., Prowle, J. R., & Heyland, D. K. (2024) · British Journal of Anaesthesia · doi:10.1016/j.bja.2024.08.033 · Cited by 14
Self-citationOn how to feed critically ill children in intensive care: A slowly shifting paradigm
Gunst, J., Vanhorebeek, I., Verbruggen, S. C. A. T., Dulfer, K., Joosten, K. F. M., & den Berghe, G. V. (2025) · Clinical Nutrition · doi:10.1016/j.clnu.2025.02.003 · Cited by 13
Strategies to Maximize the Benefits of Evidence-Based Enteral Nutrition: A Narrative Review
Kano, K.-I., Yamamoto, R., Yoshida, M., Sato, T., Nishita, Y., Ito, J., Nagatomo, K., Ohbe, H., Takahashi, K., Kaku, M., et al. (2025) · Nutrients · doi:10.3390/nu17050845 · Cited by 14
“In cases of AKI or severe illness, high protein intake should be avoided during the acute phase [121].”
O’Keefe, G. E., Brown, S. P., Shelton, M., Qiu, Q., Bisgaard, E., Wilson, I. M., Robinson, J. L., Roubik, D. J., Malloy, A., & May, S. J. (2025) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0000000000004745 · Cited by 12
Summers, M. J., Kouw, I. W. K., Asser, I., Louis, R., Devanand, N. A., Murthy, T. A., Plummer, M. P., Deane, A. M., Raith, E. P., Lange, K. M., et al. (2026) · American Journal of Respiratory and Critical Care Medicine · doi:10.1093/ajrccm/aamag086 · Cited by 12
Pu, H., Doig, G. S., Lv, Y., Wu, X., Fu, Y., Zhang, S., Liang, Z., Zhou, Y., & Kang, Y. M. (2023) · BMC Pulmonary Medicine · doi:10.1186/s12890-023-02633-y · Cited by 14
Eligibility Criteria of Randomized Clinical Trials in Critical Care Medicine
Heirali, A., Heybati, K., Sereeyotin, J., Khan, F. A., Yarnell, C. J., Krewulak, K. D., Murthy, S., Burns, K. E. A., Fowler, R., Fiest, K. M., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.54944 · Cited by 12
Rethinking energy and protein provision for critically ill patients
Stoppe, C., Ridley, E. J., & Lee, Z. (2024) · Intensive Care Medicine · doi:10.1007/s00134-024-07726-8 · Cited by 15
Self-citationMalnutrition and perioperative nutritional rehabilitation in major operations
Lasithiotakis, K. G., Andreou, A., Migdadi, H., & Kritsotakis, E. I. (2025) · European surgery. Supplement/European surgery · doi:10.1007/s10353-025-00863-4 · Cited by 16
Im, K. M., & Kim, E. Y. (2023) · Nutrients · doi:10.3390/nu15214684 · Cited by 12
“…controlled trials reported Nutrients 2023 , 15 , 4684 2 of 13 conflicting results with current guidelines, with some suggesting that lower calorie or higher protein administration did not significantly impact clinical outcomes and may even worsen the outcomes for certain group of patients [16,19].”
BackgroundDudzik, J. M., Balk, E. K., & Deierlein, A. L. (2025) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2025.03.171 · Cited by 12
van Gassel, R. J. J., Bels, J. L. M., Tartaglia, K., van Bussel, B. C. T., van Kuijk, S. M. J., Deane, A. M., Puthucheary, Z., Weijs, P. J. M., Vloet, L. C. M., Beishuizen, B., et al. (2023) · Trials · doi:10.1186/s13063-023-07380-3 · Cited by 11
“9 g/ kg/day in the control group and found no difference in mortality or ICU length of stay, yet no functional outcomes were assessed [18].”
BackgroundNutritional support in the cardiac intensive care unit
Frederiks, P., Peetermans, M., & Wilmer, A. (2024) · European Heart Journal: Acute Cardiovascular Care · doi:10.1093/ehjacc/zuae018 · Cited by 14
Badpeyma, M., Sedaghat, A., Moghaddam, A. B., Khadem‐Rezaiyan, M., Sistanian, F., Bagherniya, M., Ranjbar, G., Fazeli, F., & Norouzy, A. (2025) · Nutrition & Metabolism · doi:10.1186/s12986-025-01003-1 · Cited by 13
“Recent large-scale randomized controlled trials—includ-ing PRECISE [25], EFFORT [44], and NUTRIREA-3 [26] —have challenged the assumption that higher protein provision leads to linear improvements in outcomes for critically ill patients.”
Deutz, N. E. P., & ENGELEN, M. P. K. J. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1388969 · Cited by 10
Applying the 2022 ASPEN adult nutrition support guidelines in a 2024 ICU
Cogle, S. V., Hallum, M., & Mulherin, D. W. (2024) · Nutrition in Clinical Practice · doi:10.1002/ncp.11188 · Cited by 12
Lee, S. H., Lee, J. G., Kwon, M. K., Kim, M., Kim, M., Park, J. Y., Lee, J. Y., Sung, Y. W., Kim, B., Kim, S. E., et al. (2024) · 한국정맥경장영양학회지 · doi:10.15747/acnm.2024.16.3.89 · Cited by 11
Wunderle, C., Urbach, K.-H., Buchmueller, L., Randegger, S., Kaegi-Braun, N., Laviano, A., van Zanten, A. R. H., Seres, D. S., & Schüetz, P. (2025) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2025.07.009 · Cited by 13
Pan, S., Huang, T. T.-M., Jiang, Z.-H., Lin, L.-C., Tsai, I., Wu, T.-L., Hsu, C.-Y., Wang, T., Chen, H.-C., Lin, Y., et al. (2024) · Kidney Research and Clinical Practice · doi:10.23876/j.krcp.23.289 · Cited by 9
“In a recent trial conducted in the intensive care unit (EFFORT Protein trial), a high-protein diet (≥2.2 g/kg per day) resulted in a higher 60-day mortality rate compared with a normal-protein diet (≤1.2 g/kg per day) in patients with AKI [50].”
BackgroundInfluentialTime course of plasma urea and urinary urea excretion in patients with a prolonged ICU stay
Zijlstra, H. W., Westland, G. J., Volbeda, M., van Meurs, M., Pillay, J., Franssen, C. F. M., Stegeman, C. A., & Nijsten, M. W. (2024) · Scientific Reports · doi:10.1038/s41598-024-74579-y · Cited by 9
“Moreover, they demonstrated that plasma urea is higher in patients with higher protein intake, with potential harmful effects 12 .”
InfluentialRisk Factors for Patient-Important Upper Gastrointestinal Bleeding
Deane, A. M., Lauzier, F., Adhikari, N. K. J., Lamontagne, F., Heels‐Ansdell, D., Thabane, L., Williamson, D. R., Kanji, S., Barletta, J. F., Finfer, S. R., et al. (2025) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202411-2245oc · Cited by 14
“By contrast, gastrointestinal bleeding is rarely an outcome in large nutrition trials (31 – 34).”
Mohamed, M. A., Doleman, B., Phillips, B. E., & Williams, J. P. (2025) · Nutrients · doi:10.3390/nu17162613 · Cited by 10
“…illness [17], the recent international multi-centre EFFORT trial reported that high (>2.2 g/kg/d) compared to low ( 1.2 g/kg/d) protein provision did not improve time to discharge, and may have resulted in worse clinical outcomes for those with acute kidney injury or high organ failure scores [18].”
InfluentialAcute respiratory distress syndrome (adult patients). Clinical guidelines (2025 revision)
Yaroshetskiy, A. I., Gritsan, A. I., Avdeev, S. N., Vlasenko, A. V., Eremenko, A. A., Кirov, М. Y., Лебединский, К. М., Leyderman, I. N., Mazurok, V. A., Solodov, A. A., et al. (2025) · Annals of critical care · doi:10.21320/1818-474x-2025-4-7-68 · Cited by 9
Landoni, G., Oriani, A., Ti, L. K., Losiggio, R., Bradić, N., Pruna, A., Burrell, A., Pieri, M., Hodgson, C. L., D’Amico, F., et al. (2026) · British Journal of Anaesthesia · doi:10.1016/j.bja.2025.12.054 · Cited by 9
Spicer, A. B., Cavalcanti, A. B., & Zampieri, F. G. (2024) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000001186 · Cited by 9
Nutrition and metabolic control for ICU patients
Gunst, J., Egi, M., & den Berghe, G. V. (2025) · Intensive Care Medicine · doi:10.1007/s00134-025-07937-7 · Cited by 9
Nutrition therapy in critically ill patients with severe acute pancreatitis
Sun, J.-K., Lv, C., Gao, L., Mao, W., Li, W., & Ke, L. (2024) · Nutrition in Clinical Practice · doi:10.1002/ncp.11135 · Cited by 10
“For protein delivery, a recent large ‐ scale trial showed that high ‐ protein intake (~1.6 g/kg/day) compared with the usual dose (~0.9 g/kg/day) may be harmful in critically ill patients with acute kidney injury (AKI), 9 which is a common complication of SAP occurring in 7.9% – 18.4% of patients.”
InfluentialWittholz, K., Bidgood, E., Fetterplace, K., McLean, A., Rooyackers, O., Deane, A. M., & Karahalios, A. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.09.025 · Cited by 8
Protein Delivery in Critical Care- What Have Recent Trials Shown Us?
Paulus, M. C., & van Zanten, A. R. H. (2024) · Critical Care Clinics · doi:10.1016/j.ccc.2024.09.003 · Cited by 9
Mario, F. D., Sabatino, A., & Fiaccadori, E. (2024) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2024.12.015 · Cited by 10
Amino acid kinetics in the critically ill
Deutz, N. E. P., Haines, K., Wischmeier, P. E., & ENGELEN, M. P. K. J. (2023) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000995 · Cited by 8
Hartl, W. H., Kopper, P., Xu, L., Heller, L., Mironov, M., Wang, R., Day, A. G., Elke, G., Küchenhoff, H., & Bender, A. (2023) · Critical Care Medicine · doi:10.1097/ccm.0000000000006155 · Cited by 9
“Our findings confirm those of a recent meta-analysis (36) and of the EFFORT Protein trial, which compared a daily protein intake of 0.9 g/kg with 1.3 or 1.6 g/kg, respectively, and found no effect on the duration of MV (20).”
BackgroundResultInfluentialSelf-citationFrailty in the cardiac intensive care unit: assessment and impact
Moumneh, M. B., Jamil, Y., Kalra, K., Ijaz, N., Campbell, G., Kochar, A., Nanna, M. G., van Diepen, S., & Damluji, A. A. (2024) · European Heart Journal Acute Cardiovascular Care · doi:10.1093/ehjacc/zuae039 · Cited by 8
Advancing Nutritional Care Through Bioelectrical Impedance Analysis in Critical Patients
Dumitriu, A. S., Cobilinschi, C., Dumitriu, B., Vâlcea, S., Ungureanu, R., Popa, A., Ene, R., Ţincu, R. C., Grințescu, I. M., & Mirea, L. E. (2025) · Nutrients · doi:10.3390/nu17030380 · Cited by 10
“Recent studies have failed to demonstrate significant benefits from adjusting protein intake beyond these recommendations [63,64].”
van Zanten, A. R. H. (2023) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000001060 · Cited by 9
“com in the subgroup of patients with acute kidney injury and high SOFA scores, increased mortality was observed [28].”
BackgroundNutritional Support in Critically Ill Trauma Patients
Williams, R. D., & Yeh, D. D. (2023) · Surgical Clinics of North America · doi:10.1016/j.suc.2023.10.002 · Cited by 8
Coruja, M. K., Antunes, L. D. C., Leotti, V. B., & Steemburgo, T. (2024) · Nutrition in Clinical Practice · doi:10.1002/ncp.11155 · Cited by 6
“17 In addition, the NUTRIREA ‐ 3 trial showed that neither early energy and protein restriction nor standard energy and protein targets during the first 7 ICU days were able to decrease 90 ‐ day mortality in patients receiving MV and vasopressor support for shock.”
InfluentialThe kidney: the critical organ system for guiding nutrition therapy in the ICU-patient?
Druml, W., Staudinger, T., & Joannidis, M. (2024) · Critical Care · doi:10.1186/s13054-024-05052-5 · Cited by 8
“In a recent large RCT, the EFFORT protein study a very high, again hardly physiologic protein intake of 2.2 g/kg/ day given independent from energy intake was compared with a protein dose currently recommended by European Guidelines (1.2 g/kg/day) [17, 33].”
MethodInfluentialWaele, E. D., Leduc, S., Jonckheer, J., Demol, J., Geers, J., Verhelst, C., Meers, G., Rosseel, Z., Leemans, L., & Pen, J. J. (2025) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2025.06.053 · Cited by 8
Gargi, Y., Levran, N., Vine, J., Cohen, A., Weiner, D., Stein, D., Levi, O., Cohen, D., Klein, J., Taube, H., et al. (2026) · Critical Care · doi:10.1186/s13054-026-05874-5 · Cited by 8
“…and interventional studies highlight substantial inter-patient variability in the duration of catabolism and the optimal window for full nutritional support [7, 9, 14–19, 22, 27, 32–35], suggesting that the benefit of nutritional escalation may depend on when and in whom it is delivered.”
Nutrition support for patients with renal dysfunction in the intensive care unit: A narrative review
Otis, J. L., Parker, N. M., & Busch, R. A. (2024) · Nutrition in Clinical Practice · doi:10.1002/ncp.11231 · Cited by 6
Metadata
- Authors
- Heyland, D. K., Patel, J., Compher, C., Rice, T. W., Bear, D. E., Lee, Z.-Y., González, V. C., O'Reilly, K., Regala, R., Wedemire, C., Ibarra-Estrada, M., Stoppe, C., Ortiz-Reyes, L., Jiang, X., & Day, A. G.
- Affiliations
- Queen's University (CA)
- Medical College of Wisconsin (US)
- Hospital of the University of Pennsylvania (US)
- Vanderbilt University Medical Center (US)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- University of Malaya (MY)
- Fundacion Allende (AR)
- King's College Hospital NHS Foundation Trust (GB)
- Legacy Salmon Creek Medical Center (US)
- Universidad de Guadalajara (MX)
- Universitätsklinikum Würzburg (DE)
- Corresponding author
- Heyland, Daren K
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2023-02
- Volume
- 401
- Issue
- 10376
- Pages
- 568-576
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W4318022770
- Cited by
- 401
- References
- 35
- Citations by year
- 2026: 118 · 2025: 114 · 2024: 113 · 2023: 56
- FWCI
- 70.39
- Type
- journal article
- Language
- en
- Update notices
- erratum (2023-03-25)
- Open access
- closed
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Society for Parenteral and Enteral Nutrition
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- critically ill patients, intensive care nutrition, protein supplementation, nutritional risk, mechanical ventilation, 60-day mortality, hospital discharge, ICU length of stay, mechanical circulatory support, sepsis, acute kidney injury, acute respiratory failure, acute coronary syndrome, acute stroke, acute heart failure, acute liver failure, acute neurological injury, acute pancreatitis
- MeSH terms
- Adult, Critical Care, Hospitalization, Humans, Intensive Care Units, Registries, Respiration, Artificial, Critical Illness
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