Normocaloric versus hypocaloric feeding on the outcomes of ICU patients: a systematic review and meta-analysis

  title={Normocaloric versus hypocaloric feeding on the outcomes of ICU patients: a systematic review and meta-analysis},
  author={Paul Ellis Marik and Michael H. Hooper},
  journal={Intensive Care Medicine},
IntroductionCurrent clinical practice guidelines recommend providing ICU patients a daily caloric intake estimated to match 80–100 % of energy expenditure (normocaloric goals). However, recent clinical trials of intentional hypocaloric feeding question this approach.MethodsWe performed a systematic review and meta-analysis to compare the outcomes of ICU patients randomized to intentional hypocaloric or normocaloric goals. We included randomized controlled trials that enrolled ICU patients and… 
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Permissive or Trophic Enteral Nutrition and Full Enteral Nutrition Had Similar Effects on Clinical Outcomes in Intensive Care: A Systematic Review of Randomized Clinical Trials
In conclusion, hypocaloric enteral nutrition had no significantly different effects on morbidity and mortality in critically ill patients when compared with full-energy nutrition.
Lower versus higher dose of enteral caloric intake in adult critically ill patients: a systematic review and meta-analysis
There is no association between the dose of caloric intake in adult critically ill patients and hospital mortality and 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.
Prescribed hypocaloric nutrition support for critically-ill adults.
The quality of the evidence for the effects of prescribed hypocaloric nutrition support in comparison with standard nutrition support for critically-ill adults was very low due to unclear or high risk of bias, inconsistency and imprecision.
Implementation of an Aggressive Enteral Nutrition Protocol and the Effect on Clinical Outcomes
  • D. Yeh, C. Cropano, G. Velmahos
  • Medicine
    Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
  • 2017
In surgical ICU patients, implementation of an aggressive EN protocol resulted in greater macronutrient delivery and fewer late infections.
Is Energy Delivery Guided by Indirect Calorimetry Associated With Improved Clinical Outcomes in Critically Ill Patients? A Systematic Review and Meta-analysis
Limited data exist to assess the impact of using IC to inform energy delivery in comparison to predictive equations on hospital mortality, and the association of IC use with other important outcomes, including duration of MV, needs to be further explored before definitive conclusions can be made.
Normocaloric versus hypocaloric feeding in ICU patients: response to comments by Bitzani
It is important to emphasize that there is no high-quality evidence in critically ill or injured patients that one particular nutritional strategy is associated with better patient outcomes than another and it is inappropriate to make strong recommendations regarding the provision of calories and protein in this heterogenous group of patients.


Hypocaloric vs Normocaloric Nutrition in Critically Ill Patients: A Prospective Randomized Pilot Trial.
Hypocaloric feeding in the first 7 days in critically ill patients was associated with more nosocomial infections but less insulin demand and less gastrointestinal intolerance compared with normocaloric Feeding.
Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit: a randomized controlled trial.
Among critically ill surgical patients, caloric provision across a wide acceptable range does not appear to be associated with major outcomes, including infectious complications, and the optimum target for caloric provision remains elusive.
The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study
Increased intakes of energy and protein appear to be associated with improved clinical outcomes in critically ill patients, particularly when BMI is <25 or ≥35, particularly in patients with a BMI <25 and ≥35.
Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database
In critically ill septic patients, a calorie and protein delivery closer to recommended amounts by EN in the early phase of ICU stay was associated with a more favorable outcome.
Considering energy deficit in the intensive care unit
The differences in the recent guidelines issued by the American Society of Parenteral and Enteral Nutrition (ASPEN) and the European Society of Clinical Nutrition and Metabolism (ESPen) regarding these aspects are described.
Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol in Critically Ill Patients: Results of a Cluster Randomized Trial*
In ICUs with low baseline nutritional adequacy, use of the enhanced protein-energy provision via the enteral route feeding protocol is safe and results in modest but statistically significant increases in protein and calorie intake.
Intensive nutrition in acute lung injury: a clinical trial (INTACT).
BACKGROUND Despite extensive use of enteral (EN) and parenteral nutrition (PN) in intensive care unit (ICU) populations for 4 decades, evidence to support their efficacy is extremely limited.
Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial.
In patients with acute lung injury, a strategy of initial trophic enteral feeding for up to 6 days did not improve ventilator-free days, 60-day mortality, or infectious complications but was associated with less gastrointestinal intolerance.
Permissive underfeeding and intensive insulin therapy in critically ill patients: a randomized controlled trial.
In critically ill patients, permissive underfeeding may be associated with lower mortality rates than target feeding, and no significant differences in outcomes were observed between the IIT and CIT groups.
Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure
Initial trophic enteral nutrition resulted in clinical outcomes in mechanically ventilated patients with acute respiratory failure similar to those of early full-energyEnteral nutrition but with fewer episodes of gastrointestinal intolerance.