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The Impact of Nutritional Support on Improving Treatment Outcome for Critically Ill Patients

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (25 March 2025) | Viewed by 8532

Special Issue Editor

Dr. Barbara Adamik

E-Mail Website
Guest Editor
Clinical Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska St. 213, 50-556 Wroclaw, Poland
Interests: nutrition; intensive care; sepsis; biomarkers; endotoxemia
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Nutritional support for critically ill patients is essential, but the results of multiple studies indicate that the nutrition of patients treated in the intensive care unit (ICU) is often not optimal. Factors such as inadequate nutrient intake, impaired gastric emptying, and intestinal dysmotility can lead to malnutrition, which is associated with immunosuppression, poor wound healing, and muscle weakness. In this Special Issue of Nutrients, we will discuss the usefulness of various tools for assessing nutritional status and estimating energy requirements in critically ill patients. Parenteral nutrition versus enteral nutrition and the optimal timing with which to start enteral nutrition will be discussed. Studies examining different approaches to the nutrition of ICU patients are welcome for submission.

Dr. Barbara Adamik
Guest Editor

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Keywords

  • critically ill
  • enteral nutrition
  • biomarkers
  • NUTRIC score
  • calories
  • proteins

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Published Papers (3 papers)

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Research

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11 pages, 432 KiB  
Article
Comparison of CIPA Nutritional Screening with GLIM Criteria for Malnutrition, Prognostic Evolution, and Association with Phase Angle in Hospitalized Patients
by Elena Márquez Mesa, Adán Jesús Guerra Cabrera, Ignacio Llorente Gómez de Segura and José Pablo Suárez Llanos
Nutrients 2024, 16(21), 3652; https://doi.org/10.3390/nu16213652 - 26 Oct 2024
Viewed by 1309
Abstract
Background: Hospital malnutrition has high prevalence and is associated with worse clinical outcomes. The lack of standardized nutritional screening prompted the creation of the CIPA screening tool. Several studies have shown that the phase angle (PA) is associated with increased nutritional risk and [...] Read more.
Background: Hospital malnutrition has high prevalence and is associated with worse clinical outcomes. The lack of standardized nutritional screening prompted the creation of the CIPA screening tool. Several studies have shown that the phase angle (PA) is associated with increased nutritional risk and worse clinical outcomes. The aim of this study was to establish the concordance between the CIPA and GLIM criteria and to assess their correlation with PA values and clinical outcomes. Methods: A cross-sectional single-center study was carried out, with a prospective six-month follow-up for the prognostic variables. On admission, the CIPA and GLIM criteria and bioimpedanciometry were assessed. Results: A total of 510 inpatients were included; 36.5% had positive CIPA outcomes and 46.1% had positive GLIM outcomes. The correlation between the CIPA and GLIM criteria had a kappa index of 0.26, p < 0.01. Those with positive CIPA had a higher mortality risk (OR = 1.81) and longer mean length of stay (MLS) (OR = 1.45). The PA cut-off points were determined by sex and age for CIPA (men > 65 years: 4.75°, men ≤ 65 years: 5.75°, women > 65 years: 4.75°, and women ≤ 65 years: 5.45°) and GLIM (men > 65 years: 4.95°, men ≤ 65 years: 5.85°, women > 65 years: 4.75°, and women ≤ 65 years: 5.55°). These PA cut-off points were associated with worse clinical outcomes with CIPA (mortality OR = 4.2; MLS OR = 1.51; readmissions OR = 2.28) and GLIM (mortality OR = 2.97; MLS OR = 2.61; readmissions OR = 1.79). Conclusions: CIPA screening shows a low correlation with GLIM nutritional assessment. Positive CIPA and GLIM have lower PAs than negative and worse prognostic outcomes. The PA cut-off points associated with worse outcomes have been established. Full article
(This article belongs to the Special Issue The Impact of Nutritional Support on Improving Treatment Outcome for Critically Ill Patients)
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10 pages, 1508 KiB  
Article
Transthyretin and Nutritional Status in Critically Ill Adults on Parenteral Nutrition: A Prospective Cohort Study
by Marcela Almeida Linden, Renata Germano Borges de Oliveira Nascimento Freitas, Lidiane Oliveira de Souza Teles, André Moreno Morcillo, Matthew Thomas Ferreira and Roberto José Negrão Nogueira
Nutrients 2024, 16(15), 2448; https://doi.org/10.3390/nu16152448 - 27 Jul 2024
Cited by 2 | Viewed by 1322
Abstract
Background and Aims: Correctly characterizing malnutrition is a challenge. Transthyretin (TTR) rapidly responds to adequate protein intake/infusion, which could be used as a marker to identify malnutrition. Nutritional therapy is used to prevent malnutrition. Parenteral nutrition (PN) requires daily monitoring to determine whether [...] Read more.
Background and Aims: Correctly characterizing malnutrition is a challenge. Transthyretin (TTR) rapidly responds to adequate protein intake/infusion, which could be used as a marker to identify malnutrition. Nutritional therapy is used to prevent malnutrition. Parenteral nutrition (PN) requires daily monitoring to determine whether what is being offered is adequate. This article aims to investigate whether the practice of measuring TTR is justified. Methods: Data from patients admitted to the ward or intensive care unit (ICU) were collected at three different times: within the first 72 h (T1) of PN use, on the 7th day (T2), and the 14th day (T3) after the initial assessment. Results: 302 patients were included; the average age was 48.3 years old; the prevalence of death was 22.2%, and 61.6% of the sample were male. TTR values and the effectiveness of nutritional support in these patients were not associated with the outcome; however, meeting caloric needs was related to the outcome (p = 0.047). No association was found when TTR values were compared to the nutritional status. Thus, TTR was not a good indicator of nutritional risk or nutritional status in hospitalized patients. Conclusions: Undoubtedly, the TTR measurement was inversely proportional to CRP measurements. It was possible to conclude in this follow-up cohort of hospitalized patients that TTR values were not useful for determining whether the patient was malnourished, predicting death or effectiveness of nutritional support, yet based upon our analyses, a decrease in TTR greater than 0.024 units for every 1 unit increase in CRP might be due to ineffective nutritional supply. Full article
(This article belongs to the Special Issue The Impact of Nutritional Support on Improving Treatment Outcome for Critically Ill Patients)
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11 pages, 2571 KiB  
Systematic Review
Early Enteral Nutrition (within 48 h) for Patients with Sepsis or Septic Shock: A Systematic Review and Meta-Analysis
by Carlos F. Grillo-Ardila, Diego Tibavizco-Palacios, Luis C. Triana, Saúl J. Rugeles, María T. Vallejo-Ortega, Carlos H. Calderón-Franco and Juan J. Ramírez-Mosquera
Nutrients 2024, 16(11), 1560; https://doi.org/10.3390/nu16111560 - 22 May 2024
Cited by 10 | Viewed by 5574
Abstract
OBJECTIVE: Medical nutrition therapy provides the opportunity to compensate for muscle wasting and immune response activation during stress and trauma. The objective of this systematic review is to assess the safety and effectiveness of early enteral nutrition (EEN) in adults with sepsis or [...] Read more.
OBJECTIVE: Medical nutrition therapy provides the opportunity to compensate for muscle wasting and immune response activation during stress and trauma. The objective of this systematic review is to assess the safety and effectiveness of early enteral nutrition (EEN) in adults with sepsis or septic shock. METHODS: The MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and ICTRP tools were searched from inception until July 2023. Conference proceedings, the reference lists of included studies, and expert content were queried to identify additional publications. Two review authors completed the study selection, data extraction, and risk of bias assessment; disagreements were resolved through discussion. Inclusion criteria were randomized controlled trials (RCTs) and non-randomized studies (NRSs) comparing the administration of EEN with no or delayed enteral nutrition (DEE) in adult populations with sepsis or septic shock. RESULTS: Five RCTs (n = 442 participants) and ten NRSs (n = 3724 participants) were included. Low-certainty evidence from RCTs and NRSs suggests that patients receiving EEN could require fewer days of mechanical ventilation (MD −2.65; 95% CI, −4.44–0.86; and MD −2.94; 95% CI, −3.64–−2.23, respectively) and may show lower SOFA scores during follow-up (MD −1.64 points; 95% CI, −2.60–−0.68; and MD −1.08 points; 95% CI, −1.90–−0.26, respectively), albeit with an increased frequency of diarrhea episodes (OR 2.23, 95% CI 1.115–4.34). Even though the patients with EEN show a lower in-hospital mortality rate both in RCTs (OR 0.69; 95% CI, 0.39–1.23) and NRSs (OR 0.89; 95% CI, 0.69–1.13), this difference does not achieve statistical significance. There were no apparent differences for other outcomes. CONCLUSIONS: Low-quality evidence suggests that EEN may be a safe and effective intervention for the management of critically ill patients with sepsis or septic shock. Full article
(This article belongs to the Special Issue The Impact of Nutritional Support on Improving Treatment Outcome for Critically Ill Patients)
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