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Cited by 74Clinical Nutrition and GastroenterologyHyperglycemia and glycemic control in critically ill and hospitalized patientsNosocomial Infections in ICU

Lower versus higher dose of enteral caloric intake in adult critically ill patients: a systematic review and meta-analysis

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Al-Dorzi, Hasan M., Albarrak, Abdullah, Ferwana, Mazen, Murad, Mohammad Hassan, Arabi, Yaseen M.·2016·Critical Care
DOI 10.1186/s13054-016-1539-3PMC PMC5097427
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Abstract

BACKGROUND: There is conflicting evidence about the relationship between the dose of enteral caloric intake and survival in critically ill patients. The objective of this systematic review and meta-analysis is to compare the effect of lower versus higher dose of enteral caloric intake in adult critically ill patients on outcome. METHODS: We reviewed MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from inception through November 2015. We included randomized and quasi-randomized studies in which there was a significant difference in the caloric intake in adult critically ill patients, including trials in which caloric restriction was the primary intervention (caloric restriction trials) and those with other interventions (non-caloric restriction trials). Two reviewers independently extracted data on study characteristics, caloric intake, and outcomes with hospital mortality being the primary outcome. RESULTS: Twenty-one trials mostly with moderate bias risk were included (2365 patients in the lower caloric intake group and 2352 patients in the higher caloric group). Lower compared with higher caloric intake was not associated with difference in hospital mortality (risk ratio (RR) 0.953; 95 % confidence interval (CI) 0.838-1.083), ICU mortality (RR 0.885; 95 % CI 0.751-1.042), total nosocomial infections (RR 0.982; 95 % CI 0.878-1.077), mechanical ventilation duration, or length of ICU or hospital stay. Blood stream infections (11 trials; RR 0.718; 95 % CI 0.519-0.994) and incident renal replacement therapy (five trials; RR 0.711; 95 % CI 0.545-0.928) were lower with lower caloric intake. The associations between lower compared with higher caloric intake and primary and secondary outcomes, including pneumonia, were not different between caloric restriction and non-caloric restriction trials, except for the hospital stay which was longer with lower caloric intake in the caloric restriction trials. CONCLUSIONS: We found no association between the dose of caloric intake in adult critically ill patients and hospital mortality. Lower caloric intake was associated with lower risk of blood stream infections and incident renal replacement therapy (five trials only). The heterogeneity in the design, feeding route and timing and caloric dose among the included trials could limit our interpretation. Further studies are needed to clarify our findings.

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  • In a RCT, protocoled caloric restriction for 48 hours in patients developing hypophosphatemia upon refeeding improved survival despite similar phosphate supplementation in both groups.

    “In a RCT, Doig et al. showed that protocoled caloric restriction for 48 hours in patients developing hypophosphatemia upon refeeding improved survival despite similar phosphate supplementation in both groups (143).”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [143]

    The Results (Description of included studies; page unavailable) identify Doig et al. as an RCT using protocolized caloric restriction at 20 kcal/h for at least two days, followed by adjustments based on serum phosphate. Our copy does not report that the patients developed hypophosphatemia upon refeeding, that survival improved, or that phosphate supplementation was similar between groups. (LLM, conf=0.86)

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Authors
Al-Dorzi, H. M., Albarrak, A., Ferwana, M., Murad, M. H., & Arabi, Y. M.
Affiliations
  • Riyadh Armed Forces Hospital (SA)
  • King Saud bin Abdulaziz University for Health Sciences (SA)
  • Mayo Clinic (US)
Corresponding author
Arabi, Yaseen M.
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2016-11-04
Volume
20
Issue
1
Pages
358-358
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/s13054-016-1539-3
PMC
PMC5097427
OpenAlex
W2548527972
Cited by
74
References
14
Citations by year
2026: 3 · 2025: 3 · 2024: 7 · 2023: 4 · 2022: 6 · 2021: 9 · 2020: 6 · 2019: 10 · 2018: 14 · 2017: 12
FWCI
1.61
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Critical Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
National Health and Medical Research Council
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
enteral nutrition, energy intake, caloric restriction, critically ill patients, in-hospital mortality, nosocomial infections, bloodstream infection, renal replacement therapy, mechanical ventilation duration, length of hospital stay, pneumonia, ICU mortality, feeding route, timing of enteral feeding
MeSH terms
Adult, Energy Intake, Enteral Nutrition, Humans, Mortality, Respiration, Artificial, Randomized Controlled Trials as Topic, Critical Illness

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