Cited by 293Clinical Nutrition and GastroenterologyHyperglycemia and glycemic control in critically ill and hospitalized patientsSepsis Diagnosis and Treatment

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Optimal amount of calories for critically ill patients: Depends on how you slice the cake!*

Heyland, Daren K., Cahill, Naomi, Day, Andrew G.·2011·Critical Care Medicine

DOI 10.1097/ccm.0b013e318226641d

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Abstract

OBJECTIVE: The optimal amount of calories required by critically ill patients continues to be controversial. The objective of this study is to examine the relationship between the amount of calories administered and mortality. DESIGN: Prospective, multi-institutional audit. SETTING: Three hundred fifty-two intensive care units from 33 countries. PATIENTS: A total of 7,872 mechanically ventilated, critically ill patients who remained in the intensive care unit for at least 96 hrs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We evaluated the association between the amount of calories received and 60-day hospital mortality using various sample restriction and statistical adjustment techniques and demonstrate the influence of the analytic approach on the results. In the initial unadjusted analysis, we observe a significant association between increased caloric intake and increased mortality (odds ratio 1.28; 95% confidence interval 1.12-1.48 for patients receiving more than two-thirds of their caloric prescription vs. those receiving less than one-third of their prescription). Excluding days after permanent progression to oral intake attenuated the estimates of harm (unadjusted analysis: odds ratio 1.04; 95% confidence interval 0.90-1.20). Restricting the analysis to patients with at least 4 days in the intensive care unit before progression to oral intake and excluding days of observation after progression to oral intake resulted in a significant benefit to increased caloric intake (unadjusted odds ratio 0.73; 95% confidence interval 0.63-0.85). When further adjusting for both evaluable days and other important covariates, patients who received more than two-thirds of their caloric prescription are much less likely to die than those receiving less than one-third of their prescription (odds ratio 0.67; 95% confidence interval 0.56-0.79; p < .0001). When treated as a continuous variable, the overall association between the percent of the caloric prescription received and mortality is highly statistically significant with increasing calories associated with decreasing mortality (p < .0001). CONCLUSIONS: The estimated association between the amount of calories and mortality is significantly influenced by the statistical methodology used. The most appropriate available analyses suggest that attempting to meet caloric targets may be associated with improved clinical outcomes in critically ill patients.

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Additional file 4 of Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis
Duan, J.-Y., Zheng, W.-H., Zhou, H., Xu, Y., & Huang, H.-B. (2021) · Figshare · doi:10.6084/m9.figshare.14130851
Additional file 1 of Association between the modified Nutrition Risk in Critically Ill (mNUTRIC) score and clinical outcomes in the intensive care unit: a secondary analysis of a large prospective observational study
Wang, N., Wang, M.-P., Jiang, L., Du, B., Zhu, B., & Xi, X.-M. (2021) · Figshare · doi:10.6084/m9.figshare.16590420
Additional file 1 of Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis
Duan, J.-Y., Zheng, W.-H., Zhou, H., Xu, Y., & Huang, H.-B. (2021) · Figshare · doi:10.6084/m9.figshare.14130842
Additional file 1 of Early versus delayed enteral nutrition in mechanically ventilated patients with circulatory shock: a nested cohort analysis of an international multicenter, pragmatic clinical trial
Ortiz‐Reyes, L., Patel, J. J., Jiang, X., Yataco, A. C., Day, A. G., Shah, F., Zelten, J., Kakazu, M. T., Rice, T., & Heyland, D. K. (2022) · Figshare · doi:10.6084/m9.figshare.20047239
Self-citation
Additional file 3 of Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis
Duan, J.-Y., Zheng, W.-H., Zhou, H., Xu, Y., & Huang, H.-B. (2021) · Figshare · doi:10.6084/m9.figshare.14130848
Additional file 2 of Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis
Duan, J.-Y., Zheng, W.-H., Zhou, H., Xu, Y., & Huang, H.-B. (2021) · Figshare · doi:10.6084/m9.figshare.14130845
Additional file 2 of Early versus delayed enteral nutrition in mechanically ventilated patients with circulatory shock: a nested cohort analysis of an international multicenter, pragmatic clinical trial
Ortiz‐Reyes, L., Patel, J. J., Jiang, X., Yataco, A. C., Day, A. G., Shah, F., Zelten, J., Kakazu, M. T., Rice, T., & Heyland, D. K. (2022) · Figshare · doi:10.6084/m9.figshare.20047242
Self-citation
Additional file 5 of Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis
Duan, J.-Y., Zheng, W.-H., Zhou, H., Xu, Y., & Huang, H.-B. (2021) · Figshare · doi:10.6084/m9.figshare.14130854
Real-world implementation of a standardized ICU protocol for daytime-restricted enteral nutrition in critically ill adults: A retrospective quality improvement study
Russell-Murray, K., & Dashti, H. S. (2025) · Clinical Nutrition Open Science · doi:10.1016/j.nutos.2025.100622
An observational study on the efficacy and safety of Enzotein plus in post-surgical recovery in critically ill patients by improving nutritional indices
Rodrigues, F. C. S., Rodrigues, J., Sahakari, U., Sharma, S., Rodrigues, F. C. S., Nimbulkar, G. C., & Colaco, D. (2026) · International Journal of Basic & Clinical Pharmacology · doi:10.18203/2319-2003.ijbcp20261947
ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit
González, J. C. M., Singer, P., Blaser, A. R., Berger, M. M., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Pichard, C., Preiser, J., et al. (2026) · Nutrición Hospitalaria · doi:10.20960/nh.06943 · Cited by 1
Is normoglycemia a reachable state in safe, effective glycemic control in critical care? A review and steady-state analysis showing the need for dual insulin and nutrition control
Chase, J. G., Seret, M., Uyttendaele, V., Knopp, D. J., Shannon, H., & Desaive, T. (2026) · Annual Reviews in Control · doi:10.1016/j.arcontrol.2026.101072
Resting energy expenditure-guided nutritional support in acute ischaemic stroke patients: a single-centre quasi-randomised controlled trial
Yang, X., Zuo, T., Jiang, W., Li, H., Chen, X., Shen, W., & Zhang, X. (2026) · British Journal Of Nutrition · doi:10.1017/s0007114526108423

Authors: Heyland, D. K., Cahill, N., & Day, A. G.
Affiliations: Kingston General Hospital (CA)
Queen's University (CA)
ORCID: Heyland, Daren K.
Day, Andrew G.
Venue: Critical Care Medicine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2011-12
Volume: 39
Issue: 12
Pages: 2619-2626
ISSN: 0090-3493 (ISSN-L)
DOI: 10.1097/ccm.0b013e318226641d
OpenAlex: W2019218952
Cited by: 293
References: 24
Citations by year: 2026: 7 · 2025: 14 · 2024: 14 · 2023: 14 · 2022: 19 · 2021: 30 · 2020: 20 · 2019: 24 · 2018: 32 · 2017: 27 · 2016: 22 · 2015: 24 · 2014: 23 · 2013: 14 · 2012: 6
FWCI: 13.01
Type: journal article
Language: en
Open access: closed
Locations: Critical Care Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Health Research Board
Canadian Institutes of Health Research
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
Keywords: energy intake, critically ill patients, mechanical ventilation, 60-day mortality, nutritional support, sample selection bias, statistical adjustment, oral intake, intensive care unit
MeSH terms: Energy Intake, Critical Care, Female, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Prospective Studies, Regression Analysis, Odds Ratio, Hospital Mortality, Nutritional Support

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Optimal amount of calories for critically ill patients: Depends on how you slice the cake!*

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