Permissive Underfeeding or Standard Enteral Feeding in High– and Low–Nutritional-Risk Critically Ill Adults. Post Hoc Analysis of the PermiT Trial

Arabi, Yaseen M.; Aldawood, Abdulaziz S.; Al-Dorzi, Hasan M.; Tamim, Hani M.; Haddad, Samir H.; Jones, Gwynne; McIntyre, Lauralyn; Solaiman, Othman; Sakkijha, Maram H.; Sadat, Musharaf; Mundekkadan, Shihab; Kumar, Anand; Bagshaw, Sean M.; Mehta, Sangeeta

doi:10.1164/rccm.201605-1012oc

Cited by 154Clinical Nutrition and GastroenterologySepsis Diagnosis and TreatmentEnhanced Recovery After Surgery

Permissive Underfeeding or Standard Enteral Feeding in High– and Low–Nutritional-Risk Critically Ill Adults. Post Hoc Analysis of the PermiT Trial

Arabi, Yaseen M., Aldawood, Abdulaziz S., Al-Dorzi, Hasan M., Tamim, Hani M., Haddad, Samir H., Jones, Gwynne, McIntyre, Lauralyn, Solaiman, Othman +6 more·2017·American Journal of Respiratory and Critical Care Medicine

DOI 10.1164/rccm.201605-1012oc

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Abstract

RATIONALE: The optimal nutritional strategy for critically ill adults at high nutritional risk is unclear. OBJECTIVES: To examine the effect of permissive underfeeding with full protein intake compared with standard feeding on 90-day mortality in patients with different baseline nutritional risk. METHODS: This is a post hoc analysis of the PermiT (Permissive Underfeeding versus Target Enteral Feeding in Adult Critically Ill Patients) trial. MEASUREMENTS AND MAIN RESULTS: Nutritional risk was categorized by the modified Nutrition Risk in Critically Ill score, with high nutritional risk defined as a score of 5-9 and low nutritional risk as a score of 0-4. Additional analyses were performed by categorizing patients by body mass index, prealbumin, transferrin, phosphate, urinary urea nitrogen, and nitrogen balance. Based on the Nutrition Risk in Critically Ill score, 378 of 894 (42.3%) patients were categorized as high nutritional risk and 516 of 894 (57.7%) as low nutritional risk. There was no association between feeding strategy and mortality in the two categories; adjusted odds ratio (aOR) of 0.84 (95% confidence interval [CI], 0.56-1.27) for high nutritional risk and 1.01 (95% CI, 0.64-1.61) for low nutritional risk (interaction P = 0.53). Findings were similar in analyses using other definitions, with the exception of prealbumin. The association of permissive underfeeding versus standard feeding and 90-day mortality differed when patients were categorized by baseline prealbumin level (≤0.10 g/L: aOR, 0.57 [95% CI, 0.31-1.05]; >0.10 and ≤0.15 g/L: aOR, 0.79 [95% CI, 0.42-1.48]; >0.15 g/L: aOR, 1.55 [95% CI, 0.80, 3.01]; interaction P = 0.009). CONCLUSIONS: Among patients with high and low nutritional risk, permissive underfeeding with full protein intake was associated with similar outcomes as standard feeding.

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A limitation to the NUTRIC score is that no nutritional parameters are included.
“A limitation to this score is that no nutritional parameters are included.”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [45]
The final composite NUTRIC score was correlated with mortality.
“The final composite NUTRIC score was correlated with mortality and the expected advantage of the score was to be able to show interaction between the score and nutritional intervention regarding outcome, hypothesizing that nutritional support might decrease mortality in patients with a high NUTRIC score (>5).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [45]
When the NUTRIC score was compared to traditional screening tools, a large variability was observed.
“When the score was compared to traditional screening tools, a large variability was observed.”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [45]

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Permissive underfeeding or standard enteral feeding in critically ill adults
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Authors: Arabi, Y. M., Aldawood, A. S., Al-Dorzi, H. M., Tamim, H. M., Haddad, S. H., Jones, G., McIntyre, L., Solaiman, O., Sakkijha, M. H., Sadat, M., Mundekkadan, S., Kumar, A., Bagshaw, S. M., & Mehta, S.
Affiliations: King Saud bin Abdulaziz University for Health Sciences (SA)
King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
University of Ottawa (CA)
King Faisal Specialist Hospital & Research Centre (SA)
Health Sciences Centre (CA)
University of Alberta (CA)
Mount Sinai Hospital (CA)
Corresponding author: Arabi, Yaseen M.
ORCID: Arabi, Yaseen M.
Tamim, Hani M.
Haddad, Samir H.
McIntyre, Lauralyn
Sadat, Musharaf
Kumar, Anand
Bagshaw, Sean M.
Mehta, Sangeeta
Venue: American Journal of Respiratory and Critical Care Medicine
Publisher: Oxford University Press (OUP)
Published: 2017-03-01
Volume: 195
Issue: 5
Pages: 652-662
ISSN: 1073-449X (ISSN-L)
1535-4970
DOI: 10.1164/rccm.201605-1012oc
OpenAlex: W2517641494
Cited by: 153
References: 25
Citations by year: 2026: 5 · 2025: 15 · 2024: 9 · 2023: 10 · 2022: 10 · 2021: 13 · 2020: 30 · 2019: 19 · 2018: 26 · 2017: 15
FWCI: 20.88
Type: journal article
Language: en
Open access: closed
Licence: academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations: American Journal of Respiratory and Critical Care Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Canada Research Chairs
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
Keywords: permissive underfeeding, enteral nutrition, critically ill adults, nutritional risk, 90-day mortality, prealbumin, protein intake, nitrogen balance
MeSH terms: Adult, Energy Intake, Canada, Critical Care, Enteral Nutrition, Female, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Nutritional Status, Risk, Saudi Arabia, Odds Ratio, Critical Illness, Hospital Mortality, Caloric Restriction

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Permissive Underfeeding or Standard Enteral Feeding in High– and Low–Nutritional-Risk Critically Ill Adults. Post Hoc Analysis of the PermiT Trial

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