Early enteral nutrition in acutely ill patients: a systematic review
Abstract
OBJECTIVE: To evaluate the effect of early enteral nutrition on the outcome of critically ill and injured patients. DATA SOURCES: MEDLINE, citation review of relevant primary and review articles, personal files, and contact with expert informants. STUDY SELECTION: Randomized, controlled studies that compared early with delayed enteral nutrition in hospitalized adult postoperative, trauma, head-injured, burn, or medical intensive care unit (ICU) patients. From 161 articles screened, 27 were identified as randomized, controlled trials comparing early with delayed enteral nutrition and were included for data extraction. Of these, 12 were excluded. None of the studies included medical ICU patients. DATA EXTRACTION: Fifteen studies containing 753 subjects were analyzed. Descriptive and outcome data were extracted independently from the articles by the two reviewers. Main outcome measures were infections, noninfectious complications, length of hospital stay, and mortality. The meta-analysis was performed using the random effects model. DATA SYNTHESIS: Early enteral nutrition was associated with a significantly lower incidence of infections (relative risk reduction, 0.45; 95% confidence interval, 0.30-0.66; p =.00006; test for heterogeneity, p =.049) and a reduced length of hospital stay (mean reduction of 2.2 days; 95% confidence interval, 0.81-3.63 days; p =.004; test for heterogeneity, p =.0012). There were no significant differences in mortality or noninfectious complications between the two groups of patients. CONCLUSIONS: The results of this meta-analysis support the experimental data demonstrating the benefit of the early initiation of enteral nutrition. The results of this meta-analysis must, however, be interpreted with some caution because of the significant heterogeneity between studies.
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Enteral nutrition can decrease mortality.
“and can decrease mortality,134,136,137”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [137]
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<i>meta-analysis</i> bias in location and selection of studies
Egger, M., & Smith, G. D. (1998) · BMJ · doi:10.1136/bmj.316.7124.61 · Cited by 1,374 · see citing works
Effects of Enteral and Parenteral Nutrition on Gut Mucosal Permeability in the Critically Ill
Hadfield, R. J., Sinclair, D. G., Houldsworth, P. E., & Evans, T. W. (1995) · American journal of respiratory and critical care medicine · doi:10.1164/ajrccm.152.5.7582291 · Cited by 314 · see citing works
Meta-analysis. Beyond the grand mean?
Smith, G. D., Egger, M., & Phillips, A. N. (1997) · BMJ · doi:10.1136/bmj.315.7122.1610 · Cited by 174 · see citing works
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Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock
Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., Sevransky, J. E., Sprung, C. L., Douglas, I. S., Jaeschke, R., et al. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e31827e83af · Cited by 9,694 · see citing works
Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4683-6 · Cited by 6,621 · see citing works
McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607115621863 · Cited by 3,982 · see citing works
Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002255 · Cited by 3,652 · see citing works
McClave, S. A., Martindale, R. G., Vanek, V. W., McCarthy, M., Roberts, P., Taylor, B., Ochoa, J. B., Napolitano, L., Cresci, G., the A.S.P.E.N. Board of Directors, et al. (2009) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607109335234 · Cited by 1,873 · see citing works
Taylor, B. E., McClave, S. A., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001525 · Cited by 1,476 · see citing works
ESPEN guidelines on enteral nutrition: intensive care
Kreymann, K. G., Berger, M. M., Deutz, N. E. P., Hiesmayr, M., Jolliet, P., Kazandjiev, G., Nitenberg, G., van den Berghe, G., Wernerman, J., Ebner, C., et al. (2006) · Clinical Nutrition · doi:10.1016/j.clnu.2006.01.021 · Cited by 1,366 · see citing works
Reignier, J., Boisramé-Helms, J., Brisard, L., Lascarrou, J.-B., Ait Hssain, A., Anguel, N., Argaud, L., Asehnoune, K., Asfar, P., Bellec, F., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)32146-3 · Cited by 595 · see citing works
Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis
Bakker, O. J., van Brunschot, S., van Santvoort, H. C., Besselink, M. G., Bollen, T. L., Boermeester, M. A., Dejong, C. H., van Goor, H., Bosscha, K., Ali, U. A., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1404393 · Cited by 339 · see citing works
Tian, F., Heighes, P. T., Allingstrup, M. J., & Doig, G. S. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000003152 · Cited by 147 · see citing works
Desachy, A., Clavel, M., Vuagnat, A., Normand, S., Gissot, V., & François, B. (2008) · Intensive Care Medicine · doi:10.1007/s00134-007-0983-6 · Cited by 122 · see citing works
Chourdakis, M., Kraus, M. M., Tzellos, T., Sardeli, C., Peftoulidou, M., Vassilakos, D., & Kouvelas, D. (2012) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607110397878 · Cited by 107 · see citing works
White, H., Sosnowski, K., Tran, K., Reeves, A., & Jones, M. (2009) · Critical Care · doi:10.1186/cc8181 · Cited by 103 · see citing works
Moses, V., Mahendri, N. V., John, G., Peter, J. V., & Ganesh, A. (2009) · Clinical Toxicology · doi:10.1080/15563650902936664 · Cited by 29 · see citing works
Enteral nutrition for patients in septic shock: a retrospective cohort study
Rai, S. S., O’Connor, S. N., Lange, K., Rivett, J., & Chapman, M. J. (2010) · Critical Care and Resuscitation · doi:10.1016/s1441-2772(23)01501-6 · Cited by 27 · see citing works
Aguilera-Martinez, R., Ramis-Ortega, E., Carratalá-Munuera., C., Fernández-Medina, J. M., Saiz-Vinuesa, M. D., & Barrado-Narvión, M. J. (2014) · JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2014-1129 · Cited by 22 · see citing works
Friedman, G., Flávia Couto, C. L., & Becker, M. (2015) · Indian Journal of Critical Care Medicine · doi:10.4103/0972-5229.151013 · Cited by 20 · see citing works
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 · see citing works
Tsai, Y.-C., Yin, C.-H., Chen, J.-S., Chen, Y.-S., Huang, S.-C., & Chen, J.-K. (2024) · Journal of Microbiology, Immunology and Infection · doi:10.1016/j.jmii.2023.12.007 · Cited by 9 · see citing works
- Authors
- Marik, P. E., & Zaloga, G. P.
- Affiliations
- Suburban Hospital (US)
- ORCID
- Marik, Paul E.
- Venue
- Critical Care Medicine
- Published
- 2001-12
- Volume
- 29
- Issue
- 12
- Pages
- 2264-2270
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W2074218333
- Cited by
- 938
- References
- 3
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 18 · 2023: 26 · 2022: 23 · 2021: 21 · 2020: 36 · 2019: 31 · 2018: 40 · 2017: 48 · 2016: 40 · 2015: 50 · 2014: 64 · 2013: 43 · 2012: 41
- FWCI
- 4.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- early enteral nutrition, delayed enteral nutrition, critically ill patients, trauma patients, postoperative patients, traumatic brain injury, burn patients, infection incidence, length of hospital stay, mortality, non-infectious complications, intensive care unit
- MeSH terms
- Enteral Nutrition, Humans, Infections, Intensive Care Units, Length of Stay, Postoperative Care, Postoperative Complications, Risk, Time Factors, Wounds and Injuries, Treatment Outcome
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