Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 28 , ISSUE 11 ( November, 2024 ) > List of Articles

Systematic Review/Meta-Analysis

Clinical Outcomes of Hypocaloric/Hyperproteic vs Normocaloric Enteral Feeding in the Acute Phase of Critical Illness among Patients Admitted in the Intensive Care Unit: A Systematic Review with Meta-analysis

Chito C Permejo, Teresita Joy Ples Evangelista

Keywords : Critically ill, Enteral feeding, High protein, Hyperproteic, Intensive care, Low calorie, Mechanically ventilated, Normocaloric

Citation Information : Permejo CC, Evangelista TJ. Clinical Outcomes of Hypocaloric/Hyperproteic vs Normocaloric Enteral Feeding in the Acute Phase of Critical Illness among Patients Admitted in the Intensive Care Unit: A Systematic Review with Meta-analysis. Indian J Crit Care Med 2024; 28 (11):1069-1083.

DOI: 10.5005/jp-journals-10071-24831

License: CC BY-NC 4.0

Published Online: 30-10-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Objectives: To examine the effect of hypocaloric/hyperproteic enteral feeding vs normocaloric feeding on the survival of critically ill patients in the acute phase in the intensive care unit (ICU). Methodology: Randomized clinical trials utilizing hypocaloric, hyperproteic, and normocaloric enteral feeding in the ICU were searched using the following terms ((((critically ill) OR (intensive care) OR (mechanically ventilated)) AND ((low-calorie enteral feeding) OR (high-protein enteral feeding)))) in MEDLINE, PubMed, Scopus, and Google Scholar by two independent authors. Results: There were no significant differences in hospital mortality [odds ratio (OR), 1.0; 95% confidence interval (CI), 0.77, 1.31; p = 0.99, I2 = 0%], days on mechanical ventilation (MD, −0.05; 95% CI, −0.37, 0.28; p = 0.78, I2 = 0%), the odds of acquiring infectious complications (OR, 0.90; 95% CI, 0.71, 1.14; p = 0.38, I2 = 0%), and the length of ICU stay (MD, 0.60; 95% CI, −2.39, 3.59; p = 0.69, I2 = 96%). The length of hospital stay was significantly lower by 4.18 days in the normocaloric group (MD, 4.18; 95% CI, 2.50, 5.85; p < 0.00001, I2 = 0%). Conclusion: This meta-analysis showed no significant differences in mortality, infectious complications, days of mechanical ventilation, and ICU length of stay between groups. Findings on hospital length of stay were interpreted with caution due to the low quality of evidence and clinical heterogeneity.


PDF Share
  1. Villet S, Chiolero RL, Bollmann MD, Revelly JP, Cayeux RNMC, Delarue J, et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 2005;24(4):502–509. DOI: 10.1016/j.clnu.2005.03.006.
  2. Weijs PJ, Wischmeyer PE. Optimizing energy and protein balance in the ICU. Curr Opin Clin Nutr Metabolic Care 2013;16(2):194–201. DOI: 10.1097/mco.0b013e32835bdf7e.
  3. Wang CY, Fu PK, Chao WC, Wang WN, Chen CH, Huang YC. Full versus trophic feeds in critically ill adults with high and low nutritional risk scores: A randomized controlled trial. Nutrients 2020;12(11):3518. DOI: 10.3390/nu12113518.
  4. Arabi YM, Aldawood AS, Haddad SH, Al-Dorzi HM, Tamim HM, Jones G, et al. Permissive underfeeding or standard enteral feeding in critically ill adults. N Engl J Med 2015;372(25):2398–2408. DOI: 10.1056/NEJMoa1502826.
  5. Al-Dorzi HM, Albarrak A, Ferwana M, Murad MH, Arabi YM. Lower versus higher dose of enteral caloric intake in adult critically ill patients: A systematic review and meta-analysis. Crit Care 2016;20(1):358. DOI: 10.1186/s13054-016-1539-3.
  6. Stapleton RD, Jones NF, Heyland DK. Feeding critically ill patients: What is the optimal amount of energy, Crit Care Med 2007;35(9): S535–S540. DOI: 10.1097/01.ccm.0000279204.24648.44.
  7. Amin P. Does altering protein and energy change outcomes in the ICU. Indian J Crit Care Med 2014;17(6):333–334. DOI: 10.4103/0972-5229.123433.
  8. Allingstrup MJ, Esmailzadeh N, Wilkens Knudsen A, Espersen K, Hartvig Jensen T, Wiis J, et al. Provision of protein and energy in relation to measured requirements in intensive care patients. Clin Nutr 2012;31(4):462–468. DOI: 10.1016/j.clnu.2011.12.006.
  9. Hoffer LJ. High-protein hypocaloric nutrition for non-obese critically ill patients. Nutr Clin Pract 2018;33(3):325–332. DOI: 10.1002/ncp.10091.
  10. Hartl WH, Kopper P, Bender A, Scheipl F, Day AG, Elke G, et al. Protein intake and outcome of critically ill patients: Analysis of a large international database using piece-wise exponential additive mixed models. Crit Care 2022;26(1):7. DOI: 10.1186/s13054-021-03870-5.
  11. Singer P, Bendavid I, BenArie I, Stadlander L, Kagan I. Feasibility of achieving different protein targets using a hypocaloric high-protein enteral formula in critically ill patients. Crit Care 2021;25(1):204. DOI: 10.1186/s13054-021-03625-2.
  12. Marques M, Vander Perre S, Aertgeerts A, Derde S, Guiza F, Casaer M, et al. Critical illness induces nutrient-independent adipogenesis and accumulation of alternatively activated tissue macrophages. Crit Care 2013;17(Suppl 2):P440. DOI: 10.1186/cc12378.
  13. Casaer MP, Van den Berghe G. Editorial on the original article entitled “Permissive underfeeding of standard enteral feeding in critically ill adults”. Ann Transl Med 2015;3(16):226. DOI: 10.3978/j.issn.2305-5839.2015.07.22.
  14. Rugeles SJ, Rueda JD, Díaz CE, Rosselli D. Hyperproteic hypocaloric enteral nutrition in the critically ill patient: A randomized controlled clinical trial. Indian J Crit Care Med 2013;17(6):343–349. DOI: 10.4103/0972-5229.123438.
  15. Rugeles S, Villarraga-Angulo LG, Ariza-Gutiérrez A, Chaverra-Kornerup S, Lasalvia P, Rosselli D. High-protein hypocaloric vs normocaloric enteral nutrition in critically ill patients: A randomized clinical trial. J Crit Care 2016;35:110–114. DOI:10.1016/j.jcrc.2016.05.004.
  16. Charles EJ, Petroze RT, Metzger R, Hranjec T, Rosenberger LH, Riccio LM, et al. Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit: A randomized controlled trial. Am J Clin Nutr 2014;100(5):1337–1343. DOI: 10.3945/ajcn.114.088609.
  17. Rice TW, Mogan S, Hays MA, Bernard GR, Jensen GL, Wheeler AP. A randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure. Crit Care Med 2011;39(5):967. DOI: 10.1097/CCM.0b013e31820a905a.
  18. Mousavian SZ, Pasdar Y, Ranjbar G, Jandari S, Akhlaghi S, Almasi A, et al. Randomized controlled trial of comparative hypocaloric vs full-energy enteral feeding during the first week of hospitalization in neurosurgical patients at the intensive care unit. J Parenter Enteral Nutr 2020;44(8):1475–1483. DOI: 10.1002/jpen.1782.
  19. Choi EY, Park D, Park J. Calorie intake of enteral nutrition and clinical outcomes in acutely critically ill patients. J Parenter Enteral Nutr 2014;39(3):291–300. DOI: 10.1177/0148607114544322.
  20. Zhou X, Fang H, Hu C, Xu J, Wang H, Pan J, et al. Effect of hypocaloric versus standard enteral feeding on clinical outcomes in critically ill adults–A meta-analysis of randomized controlled trials with trial sequential analysis. Med Intensiva (Engl Ed) 2021;45(4):211–225.
  21. Phan KA, Dux CM, Osland EJ, Reade MC. Effect of hypocaloric normoprotein or trophic feeding versus target full feeding on patient outcomes in critically ill adults: A systematic review. Anaesth Intensive Care 2017;45(6):663–675. DOI: 10.1177/0310057X1704500604.
  22. Tian F, Wang X, Gao X, Wan X, Wu C, Zhang L, et al. Effect of initial calorie intake via enteral nutrition in critical illness: A meta-analysis of randomised controlled trials. Crit Care 2015;19(1):180. DOI: 10.1186/s13054-015-0902-0.
  23. Yin J, Jian W, Zhang S, Yao D, Qi M, Kong W, et al. Early versus delayed enteral feeding in patients with abdominal trauma: A retrospective cohort study. Eur J Trauma Emerg Surg 2015;41(1):99–105. Available from: https://scite.ai/reports/10.1007/s00068-014-0425-4.
  24. Nakanishi N, Matsushima S, Tatsuno J, Liu K, Tamura T, Yonekura H, et al. Impact of energy and protein delivery to critically ill patients: A systematic review and meta-Analysis of randomized controlled trials. Nutrients 2022;14(22):4849. DOI: 10.3390/nu14224849.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.