Association Between Energy Delivery and Outcomes in Adult Critically Ill Patients Diagnosed With or At Risk of Malnutrition: A Systematic Review and Meta-analysis With Trial Sequential Analysis

Chong SH 1 , Huang Y 2 , Heng MS 3 , Chong EST 4 , Lim CDQ 5 , Wong KW 6 Show all authors , Chan HN 7 , Heyland DK 8 , Stoppe C 9 , Compher C 10 , Lee ZY 9 , Wong A 2 , Lew CCH 1

Affiliations 

  • 1 Department of Dietetics and Nutrition, Ng Teng Fong General Hospital, Singapore 609606, Singapore
  • 2 Department of Dietetics, Changi General Hospital, Singapore 529889, Singapore
  • 3 Department of Dietetics, Alexandra Hospital, Singapore 159964, Singapore
  • 4 Department of Nutrition and Dietetics, Khoo Teck Puat Hospital, Singapore 768828, Singapore
  • 5 Department of Dietetics, National University Hospital, Singapore 119074, Singapore
  • 6 Department of Nutrition and Dietetics, Tan Tock Seng Hospital, Singapore 308433, Singapore
  • 7 Department of Dietetics, Sengkang General Hospital, Singapore 544835, Singapore
  • 8 Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, Ontario K7L 2V7, Canada
  • 9 Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin 13353, Germany
  • 10 Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, United States
Nutr Rev, 2025 Apr 02.
PMID: 40173413 DOI: 10.1093/nutrit/nuaf042

Abstract

CONTEXT: There is a common belief that adult critically ill patients diagnosed with or at risk of malnutrition would benefit from higher energy delivery.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the association between energy delivery and mortality in adult critically ill patients diagnosed with or at risk of malnutrition.

DATA SOURCES: Databases including Medline, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, and Google Scholar were searched from inception to November 20, 2023.

DATA EXTRACTION: Randomized controlled trials (RCTs) and observational studies that (1) included critically ill patients (aged ≥18 years) diagnosed with or at risk of malnutrition using validated tools following intensive care unit (ICU) admission, (2) had at least 20% energy difference between intervention and comparison groups, and (3) reported mortality outcomes were included. The random-effects model was used to pool the data.

DATA ANALYSIS: Two RCTs (4681 at-risk patients) and 5 observational studies (1587 at-risk patients [including 389 high-risk patients]) were included. The pooled mean energy delivered during the first 7-14 days of ICU admission in higher vs lower energy groups was 25.6 ± 5.9 vs 9.7 ± 5.6 kcal/kg per day (P = .004) in RCTs and 21.0 ± 5.2 vs 13.3 ± 5.3 kcal/kg per day (P 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

Similar publications