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Nutrients
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Nutritional Support and Metabolic Strategies in Critical Illness: From Intensive...
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Nutritional Support and Metabolic Strategies in Critical Illness: From Intensive Care to Recovery

A Special Issue of Nutrients (ISSN 2072-6643) belonging to the section "Clinical Nutrition".

Deadline for manuscript submissions: 20 January 2027 | Viewed by 4612

Editor

Dr. Chi-Min Park

E-Mail Website
Guest Editor
Department of Critical Care Medicine and Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Interests: critical care medicine; emergency surgery; nutrition; metabolism; postoperative care

Special Issue Information

Dear Colleagues,

Nutritional therapy is a cornerstone of care for critically ill patients and plays a decisive role in a patient’s recovery and long-term outcomes. However, it is also accompanied by substantial challenges due to the unique characteristics of critical illnesses, including hemodynamic instability, organ dysfunction, and metabolic derangement. Despite the growing body of research and the emergence of new evidence leading to changes in clinical practice, nutrition in critical care remains a complex and evolving field in which increasing evidence often raises further questions. In particular, the profound metabolic alterations observed in critically ill patients require phase-specific nutritional strategies tailored to each satge of illness. Nutritional therapy should therefore be adapted across the entire continuum of critical care, from the acute phase to the recovery phase and further into the post-ICU period.

Based on this perspective, we are pleased to launch this Special Issue, ‘Nutritional Support and Metabolic Strategies in Critical Illness: From Intensive Care to Recovery’. Through original articles and literature reviews, this Special Issue aims to comprehensively examine metabolic changes and nutritional interventions throughout the course of critical illnesses, as well as provide insights into the emerging evidence and future directions in this field.

Dr. Chi-Min Park
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • basic nutritional practices in the ICU
  • screening and assessment of nutritional status in the ICU
  • metabolic changes in critically ill patients
  • phase-specific nutrition in critical illness
  • macro- and micronutrients in critically ill patients
  • high-protein supplementation in critically ill patients
  • nutrition and rehabilitation in critically ill patients
  • post-ICU nutritional therapy

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Published Papers (3 papers)

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Research

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16 pages, 5931 KB  
Article
Serum Zinc and Selenium Are Independently Associated with Acute-Phase Inflammatory Markers in Critically Ill Patients: A Retrospective Observational Study
by Hyoseok Oh, Seung Min Baik and Jae-Myeong Lee
Nutrients 2026, 18(15), 2508; https://doi.org/10.3390/nu18152508 - 3 Aug 2026
Viewed by 463
Abstract
Background/Objectives: Zinc, selenium, copper, and manganese are essential cofactors for immune defense and redox homeostasis, yet their independent associations with routinely measured inflammatory markers in critically ill patients remain incompletely characterized. We aimed to examine these associations in intensive care unit (ICU) patients. [...] Read more.
Background/Objectives: Zinc, selenium, copper, and manganese are essential cofactors for immune defense and redox homeostasis, yet their independent associations with routinely measured inflammatory markers in critically ill patients remain incompletely characterized. We aimed to examine these associations in intensive care unit (ICU) patients. Methods: This retrospective observational study enrolled 267 adult ICU patients at a single tertiary center. Serum trace element levels were measured at ICU admission and serially in a subset. Inflammatory markers—white blood cell count, neutrophil percentage, C-reactive protein (CRP), and procalcitonin—were measured concurrently. Hierarchical regression was performed at three adjustment levels, with Model 2 further adjusted for all remaining trace elements. A supplementary serial-level analysis used per-patient median concentrations. Results: In the fully adjusted model, zinc was independently and negatively associated with CRP (β = −0.68; 95% CI, −1.11 to −0.25; p = 0.002) and procalcitonin (exp[β] = 0.973; 95% CI, 0.961–0.986; p < 0.001), and selenium with CRP (β = −0.87; 95% CI, −1.48 to −0.25; p = 0.006). Copper showed a positive association with CRP exclusively in the fully adjusted model (β = 0.60; p = 0.006), consistent with ceruloplasmin’s role as a positive acute-phase reactant. Serial-level analyses corroborated these findings. No trace element was associated with neutrophil percentage. Conclusions: Lower serum zinc and selenium were independently associated with higher acute-phase inflammatory markers in critically ill ICU patients. These findings highlight the potential clinical relevance of trace element assessment in critically ill patients. Prospective studies are needed to determine whether targeted repletion can modify inflammation or improve clinical outcomes. Full article
(This article belongs to the Special Issue Nutritional Support and Metabolic Strategies in Critical Illness: From Intensive Care to Recovery)
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17 pages, 650 KB  
Article
Feeding Recovery in Post-PICU Patients: A Case Series in an Intensive Feeding Program
by Tariq Almanaseer, Ellen Hayhurst, Jessica B. Doorn, Ashley Bonebrake, Brooke Dudick, Elizabeth A. Rosner, Nancy F. Bandstra and Mara L. Leimanis-Laurens
Nutrients 2026, 18(8), 1291; https://doi.org/10.3390/nu18081291 - 20 Apr 2026
Viewed by 915
Abstract
Background/Objectives: Survival after pediatric intensive care unit (PICU) admission has improved, yet many children experience post-intensive care syndrome in pediatrics (PICS-p), including persistent feeding difficulties that impair growth and quality of life. An intensive feeding program (IFP), also known as intensive interdisciplinary behavioral [...] Read more.
Background/Objectives: Survival after pediatric intensive care unit (PICU) admission has improved, yet many children experience post-intensive care syndrome in pediatrics (PICS-p), including persistent feeding difficulties that impair growth and quality of life. An intensive feeding program (IFP), also known as intensive interdisciplinary behavioral treatment (IIBT), reduces tube dependence and improves oral intake; however, outcomes in PICU survivors remain understudied. This study aimed to evaluate feeding outcomes in children with prior PICU admission who completed IIBT. Methods: This study was a retrospective case series of children (0–18 years) admitted to the HDVCH, Corewell Health, Grand Rapids, Michigan, who subsequently completed IIBT (from 2007 to 2024). Variables included demographics, PICU course (admission indication, complications, length of stay, ventilation, and nutrition status) and IIBT outcomes (feeding modality, oral skills, and malnutrition status). Feeding outcomes were compared pre- and post-IIBT. Results: Sixteen patients were included (62.5% female; mean age 1.44 ± 1.21 years). Primary PICU admission causes were post-operative recovery (68.8%) and acute respiratory failure (25%). PICU complications included acute respiratory failure (43.8%) and the need for respiratory support beyond baseline (62.5%). At PICU discharge, 75% remained tube-fed and 18.8% were malnourished. The mean time from PICU discharge to IIBT initiation was 641 ± 385 days. At IIBT baseline, 75% were tube-fed and all were non-self-feeders. Following IIBT completion (mean length of stay 4.8 ± 0.9 weeks), 58% of tube-fed patients achieved tube removal eligibility; 44% transitioned to partial or full self-feeding; problematic mealtime behaviors decreased (45.7% → 9.9%); oral acceptance improved (62% → 95%); and mouth clearance improved (59% → 96%). Malnutrition prevalence decreased (20% → 12%). Conclusions: Children with prior PICU admission demonstrated substantial feeding and behavioral improvement during IIBT participation, with over half achieving tube-weaning eligibility. The time from referral to program start reflects barriers that delay intervention. Full article
(This article belongs to the Special Issue Nutritional Support and Metabolic Strategies in Critical Illness: From Intensive Care to Recovery)
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Review

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18 pages, 1315 KB  
Review
Intensive Care Unit Acquired Weakness as a Modifiable Organ Dysfunction? A Narrative Review of Evolving Diagnostic and Therapeutic Concepts
by Moritz L. Schmidbauer and Konstantinos Dimitriadis
Nutrients 2026, 18(5), 820; https://doi.org/10.3390/nu18050820 - 3 Mar 2026
Cited by 3 | Viewed by 2396
Abstract
Intensive Care Unit Acquired Weakness (ICUAW) is a highly prevalent neuromuscular complication affecting around 40% of critically ill patients, rising to over 80% in high-risk cohorts. It is independently associated with prolonged mechanical ventilation, increased intensive care unit (ICU) and hospital length of [...] Read more.
Intensive Care Unit Acquired Weakness (ICUAW) is a highly prevalent neuromuscular complication affecting around 40% of critically ill patients, rising to over 80% in high-risk cohorts. It is independently associated with prolonged mechanical ventilation, increased intensive care unit (ICU) and hospital length of stay, elevated mortality (in-hospital, 1-year, and 5-year), higher healthcare costs, and long-term functional impairment. ICUAW is clinically defined by symmetric flaccid tetraparesis, frequently involving respiratory muscles, and exhibits significant pathobiological heterogeneity. Further subclassification is based on neurotopographic patterns: Critical Illness Polyneuropathy (CIP), Myopathy (CIM), and Polyneuromyopathy (CIPNM). Diagnosis typically relies on the Medical Research Council (MRC) Sum Score, with a threshold of <48 indicating clinically relevant weakness. While adjunct modalities such as electromyography/nerve conduction studies support assessment, their utility may be limited by patient cooperation and availability. Preventive strategies center on modifiable metabolic factors. Caloric and protein deficits exacerbate catabolism, while overfeeding—linked to anabolic resistance and stress hyperglycemia—also impairs recovery. To date, pharmacologic interventions remain inconclusive. However, early mobilization and neuromuscular electrical stimulation are promising non-pharmacologic strategies. The multifactorial and heterogeneous pathophysiology of ICUAW highlights the need for a biologically refined definition that can guide future targeted therapeutic interventions. Comprehensive multimodal strategies, together with structured long-term follow-up in Post-Intensive Care Syndrome (PICS) clinics, are essential for improving outcomes in this prevalent complication of critical care. Full article
(This article belongs to the Special Issue Nutritional Support and Metabolic Strategies in Critical Illness: From Intensive Care to Recovery)
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