Optimal Protein and Energy Nutrition Decreases Mortality in Mechanically Ventilated, Critically Ill Patients: A Prospective Observational Cohort Study
Abstract
Background: Optimal nutrition for patients in the intensive care unit has been proposed to be the provision of energy as determined by indirect calorimetry and the provision of protein of at least 1.2 g/kg. Methods: Prospective observational cohort study in a mixed medical‐surgical intensive care unit in an academic hospital. In total, 886 consecutive mechanically ventilated patients were included. Nutrition was guided by indirect calorimetry and protein provision of at least 1.2 g/kg. Cumulative intakes were calculated for the period of mechanical ventilation. Cox regression was used to analyze the effect of protein + energy target achieved or energy target achieved versus neither target achieved on 28‐day mortality, with adjustments for sex, age, body mass index, Acute Physiology and Chronic Health Evaluation II, diagnosis, and hyperglycemic index. Results: Patients' mean age was 63 ± 16 years; body mass index, 26 ± 6; and Acute Physiology and Chronic Health Evaluation II, 23 ± 8. For neither target, energy target, and protein + energy target, energy intake was 75% ± 15%, 96% ± 5%, and 99% ± 5% of target, and protein intake was 72% ± 20%, 89% ± 10%, and 112% ± 12% of target, respectively. Hazard ratios (95% confidence interval) for energy target and protein + energy target were 0.83 (0.67–1.01) and 0.47 (0.31–0.73) for 28‐day mortality. Conclusions: Optimal nutritional therapy in mechanically ventilated, critically ill patients, defined as protein and energy targets reached, is associated with a decrease in 28‐day mortality by 50%, whereas only reaching energy targets is not associated with a reduction in mortality.
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Leverve et al. showed that only patients receiving a large amino acid load and able to have a positive amino acid flux in their legs survived.
“Leverve et al. showed that only patients receiving a large amino acid load and able to have a positive amino acid flux in their legs survived (161).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [161]
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- Authors
- Weijs, P. J. M., Stapel, S. N., de Groot, S. D. W., Driessen, R. H., de Jong, E., Girbes, A. R. J., Strack van Schijndel, R. J. M., & Beishuizen, A.
- Affiliations
- Amsterdam University of Applied Sciences (NL)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Corresponding author
- Weijs, Peter J. M.
- Venue
- Journal of Parenteral and Enteral Nutrition
- Publisher
- Wiley
- Published
- 2011-12-13
- Volume
- 36
- Issue
- 1
- Pages
- 60-68
- ISSN
- 0148-6071 (ISSN-L)
- 1941-2444
- OpenAlex
- W2071682333
- Cited by
- 408
- References
- 3
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 27 · 2023: 24 · 2022: 20 · 2021: 35 · 2020: 33 · 2019: 30 · 2018: 30 · 2017: 31 · 2016: 27 · 2015: 43 · 2014: 41 · 2013: 22 · 2012: 12
- FWCI
- 22.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Parenteral and Enteral Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- 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 › Nosocomial Infections in ICU
- Keywords
- energy nutrition, critically ill patients, mechanical ventilation, intensive care nutrition, indirect calorimetry, protein intake, energy intake, 28-day mortality
- MeSH terms
- Adult, Aged, Aged, 80 and over, Energy Intake, Calorimetry, Indirect, Dietary Proteins, Enteral Nutrition, Female, Humans, Intensive Care Units, Male, Middle Aged, Nutritional Status, Parenteral Nutrition, Prospective Studies, Respiration, Artificial, Critical Illness, Hospital Mortality, APACHE
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