Submit to Special Issue Submit Abstract to Special Issue Review for Nutrients Propose a Special Issue

Journal Menu

Journal Browser

► Journal Browser

Nutritional Management in Intensive Care

Special Issue Editors
Special Issue Information
Keywords
Benefits of Publishing in a Special Issue
Published Papers

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

Deadline for manuscript submissions: 25 February 2026 | Viewed by 15891

Share This Special Issue

Special Issue Editor

Prof. Dr. Jae Gil Lee

E-Mail Website
Guest Editor

Department of Surgery, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul 07985, Republic of Korea
Interests: perioperative nutrition; ICU nutrition; enteral nutrition; fluid balance; short bowel syndrome; immunonutrition
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Nutrition plays a critical role in the management of critically ill patients, where adequate nutritional support is essential for optimizing outcomes and reducing complications. To meet nutritional adequacy, more effort is required. Nutritional goals in the ICU include providing sufficient calories and protein to meet increased metabolic demands, preventing malnutrition, enhancing recovery, and supporting immune response. Monitoring and adjusting nutritional support based on patient tolerance and clinical response are key to achieving these goals, ensuring personalized care and enhancing patient outcomes.

The theme of this Special Issue encompasses a broad range of topics related to ICU nutrition, including but not limited to the following:

Early enteral nutrition initiation and strategies for overcoming challenges.
Nutritional requirements and feeding protocols in specific patient populations.
Innovations in monitoring and assessment of nutritional status in the ICU.
Pharmacological and non-pharmacological approaches to optimizing nutritional support.
Multidisciplinary approaches and team-based strategies for enhancing patient outcomes.

We encourage submissions of original research articles, reviews, and comments that address these themes or other relevant aspects of ICU nutrition. Manuscripts should adhere to the journal's guidelines and will undergo rigorous peer review to ensure scientific rigor and relevance.

Prof. Dr. Jae Gil Lee
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 100 words) can be sent to the Editorial Office for announcement on this website.

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-blind 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

early enteral nutrition
nutritional requirements
intensive care nutrition
energy expenditure
immunonutrition
parenteral nutrition
protein supply

Benefits of Publishing in a Special Issue

Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (7 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

Jump to: Review, Other

16 pages, 1529 KiB

Open AccessArticle

Impact of Protein and Nutritional Support on the Muscular Status of Critically Ill Patients: A Pilot, Perspective, and Exploratory Study

by Marialaura Scarcella, Emidio Scarpellini, Silvia De Rosa, Michele Umbrello, Gian Marco Petroni, Riccardo Monti, Pierfrancesco Fusco, Edoardo De Robertis, Rita Commissari, Ludovico Abenavoli and Jan Tack

Nutrients 2025, 17(3), 497; https://doi.org/10.3390/nu17030497 - 29 Jan 2025

Viewed by 2043

Abstract

Background: Malnutrition and muscle weakness are highly prevalent in critically admitted patients. To overcome sarcopenia and muscle weakness, physical activity and neuromuscular electric stimulation have been introduced with limited efficacy. Thus, several anabolic remedies have been introduced. An adequate increase in protein support according to indirect calorimetry and body composition and methyl hydroxybutyrate (HMB) is emerging. Therefore, we wanted to investigate the impact of HMB-enriched whey formula on the nutritional status, muscle weakness, and clinical course of critically ill patients undergoing nutritional status multimodal assessment and physical rehabilitation. Methods: We consecutively enrolled critically ill adult patients admitted to the intensive care unit (ICU) of “Santa Maria Hospital”, Terni, Italy. All patients underwent preliminary anthropometric, laboratory tests, nutritional (bioimpedance vector analysis and indirect calorimetry), and ultrasound muscle assessment at admission (T0). Laboratory tests monitoring continued throughout the ICU stay. Nutritional and muscle strength assessment was taken weekly throughout the patient’s ICU stay. All patients were enterally administered with a whey protein-enriched formula. Ten days after admission (during the physical rehabilitation period), patients were randomly administered a mixture of essential amino acids and methyl hydroxybutyrate (HMB). Results: We consecutively enrolled 54 ICU patients. At the baseline, survivors (n = 46) were significantly younger than non-survivors. The latter had a worse SAPS II score, nutritional status, and risk, with no significant difference in basal metabolism. Prealbumin values significantly correlated with improved nutritional status and metabolism. Starting from 10 days upon ICU admission, the pennation angle (used as a measure of muscle strength) significantly correlated with the improvement in nutritional status. Whey proteins were well tolerated. Its administration showed a tendency to improve the pennation angle. No specific effect of the mixture containing essential amino acids and methyl hydroxybutyrate was observed. Nutritional status improvement and the rise of basal metabolism were significantly correlated with the extubation time. On the other hand, the reduction in muscle weakness was not significantly correlated with the timing of extubation. Conclusions: Whey protein formula administration can significantly improve nutritional status and basal metabolism in ICU patients. This is reflected in improved muscle strength. Whey protein administration shows a tendency toward a rise in pennation angle. A similar and non-specific trend was observed upon HMB mixture add-one. Further prospective large-scale controlled studies are needed to confirm these promising results. Full article

(This article belongs to the Special Issue Nutritional Management in Intensive Care)

► Show Figures

Figure 1

15 pages, 1036 KiB

Open AccessArticle

Immunonutrition in Acute Geriatric Care: Clinical Outcomes, Inflammatory Profiles, and Immune Responses

by Virginia Boccardi, Luigi Cari, Mahdieh Naghavi Alhosseini, Patrizia Bastiani, Michela Scamosci, Giulia Caironi, Giulia Aprea, Francesca Mancinetti, Roberta Cecchetti, Carmelinda Ruggiero, Giuseppe Nocentini and Patrizia Mecocci

Nutrients 2024, 16(23), 4211; https://doi.org/10.3390/nu16234211 - 5 Dec 2024

Cited by 1 | Viewed by 1783

Abstract

Background and Aims: Malnutrition is common in acutely ill geriatric patients, worsening immune function and clinical outcomes. Immunonutrition, containing nutrients like omega-3 fatty acids, arginin and glutamine, may improve recovery in this population. This study aimed to evaluate the impact of immunonutrition on clinical outcomes, inflammatory markers, and immune responses in frail, hospitalized older adults. Methods: This is a retrospective observational study. In total, 36 subjects, during hospitalization, received either an immunonutrition formula or isoproteic and isocaloric enteral nutrition. The primary outcome was the length of hospital stay (LOS), with secondary outcomes focused on inflammatory cytokines and immune parameters within a week of hospitalization. Results: Patients were primarily oldest-old, with a mean age of 88.6 years ± 4.9 (range 79–96). The immunonutrition group had a significantly shorter LOS (11.37 ± 4.87 vs. 16.82 ± 10.83 days, p = 0.05) and showed increases in key cytokines (G-CSF, INF-α2, IL-12p70, IL-15, IL-2, and IL-3, p < 0.05) enhanced immune function. A decrease in T cells and an increased B/T cell ratio was also observed. No significant differences in infection rates or 90-day survival were found. Conclusions: Enteral immunonutrition improved clinical outcomes by reducing LOS and modulating immune responses in frail patients, suggesting potential benefits in recovery. Further studies are needed to confirm these findings. Full article

(This article belongs to the Special Issue Nutritional Management in Intensive Care)

► Show Figures

Figure 1

Review

Jump to: Research, Other

16 pages, 962 KiB

Open AccessReview

Understanding Refeeding Syndrome in Critically Ill Patients: A Narrative Review

by Raffaele Borriello, Giorgio Esposto, Maria Elena Ainora, Giorgio Podagrosi, Giuliano Ferrone, Irene Mignini, Linda Galasso, Antonio Gasbarrini and Maria Assunta Zocco

Nutrients 2025, 17(11), 1866; https://doi.org/10.3390/nu17111866 - 29 May 2025

Viewed by 1392

Abstract

Refeeding syndrome (RS) is defined as the spectrum of metabolic and biochemical disorders related to rapid nutritional replenishment after a prolonged period of fasting. It is caused by an abrupt shift in electrolytes and fluid among intra- and extracellular compartments, leading to metabolic disturbances like hypophosphatemia, vitamin deficiency, and fluid overload. RS often remains underdiagnosed due to variability in definition and diagnostic criteria adopted, overlapping clinical features with other complications and low awareness among clinicians. Critically ill individuals, particularly those admitted to intensive care units (ICUs), represent a cohort with peculiar features that may heighten RS risk due to their baseline frailty, frequent undernutrition, and the metabolic stress of acute illness. However, studies specifically conducted in ICU settings have yielded conflicting results regarding incidence rates, prognostic impact, and specific risk factors. Despite these differences, all evidence consistently highlights RS as a frequent and serious complication in critically ill patients. Early detection and prevention are essential, relying on prompt nutritional assessment at ICU admission, careful monitoring of serum electrolytes before and during refeeding, and a conservative caloric approach to nutrient reintroduction, alongside supportive therapy and electrolyte supplementation if RS manifestations occur. Clinicians should be aware of the significant prevalence and potential severity of RS in critically ill patients, along with the ongoing challenges related to its early recognition, prevention, and optimal nutritional management. This review aims to provide a comprehensive overview of the current knowledge on the incidence, prognostic impact, risk factors, clinical manifestations, and nutritional management of RS in critically ill patients while highlighting existing evidence gaps and key areas requiring clinical attention. Full article

(This article belongs to the Special Issue Nutritional Management in Intensive Care)

► Show Figures

Figure 1

14 pages, 701 KiB

Open AccessReview

Transition from Enteral to Oral Nutrition in Intensive Care and Post Intensive Care Patients: A Scoping Review

by Gioia Vinci, Nataliia Yakovenko, Elisabeth De Waele and Reto Stocker

Nutrients 2025, 17(11), 1780; https://doi.org/10.3390/nu17111780 - 24 May 2025

Viewed by 724

Abstract

Background: Limited information exists regarding the current practice of transitioning from enteral nutrition (EN) to oral nutrition (ON) and the effect of this process on the relationship between energy and protein requirement, provision, and nutritional status of intensive care and post-intensive care patients. Current practices and policies to the transition from EN to ON based on perspectives, experiences and opinions of health professionals and patients, are neither widely understood nor consistently implemented. Aim: The scoping review aims to summarize the current state of research on the transition process from EN to ON in intensive care unit (ICU) patients and post-ICU patients. The aim is to understand the impact of this process on the relationship between energy and protein requirements, and provision, as well as the impact on nutritional status. Additionally, the review aims to gather insights into the perspectives, experiences and opinions of healthcare professionals and patients regarding the transition process and the removal of enteral feeding tubes. Design: The literature search was conducted in PubMed, Cochrane Library and Scopus. Keywords and MeSH terms were applied, with additional papers identified by snowballing. Publications were manually screened based on inclusion and exclusion criteria to determine eligibility for inclusion. Results: A total of six studies were identified on this topic. One study found that, after the feeding tube was removed after ICU discharge, energy intake decreased from 97.3% to 65% and protein intake decreased from 91.5% to 60.6% of target values within one day after removal. Five additional studies revealed that the removal of feeding tubes is often a primary goal for nurses and physicians on the ward, and the decision to remove the tube is not based on an assessment of potential oral energy and protein intake. Reinsertion of a feeding tube is viewed as a setback by nurses and physicians. The process and decision-making of the tube removal seems to be unclear as well as the involvement of patients in the process. No studies were found examining the correlation between nutritional status and the transition process. Conclusions: Energy and protein intake appear to decrease directly after removal of the feeding tube. The decision to remove a feeding tube is often influenced by the personal opinion of healthcare professionals or institutional practices, rather than on the basis of an assessment of oral energy and protein intake. Additional studies are needed to further explore the transition process, the perspectives and experiences of healthcare professionals, and the impact of the process on energy and protein adequacy as well as the nutritional status of ICU and post-ICU patients. Full article

(This article belongs to the Special Issue Nutritional Management in Intensive Care)

► Show Figures

Graphical abstract

26 pages, 1575 KiB

Open AccessReview

Personalized Nutrition Strategies for Patients in the Intensive Care Unit: A Narrative Review on the Future of Critical Care Nutrition

by Mircea Stoian, Adina Andone, Sergiu Rareș Bândilă, Danusia Onișor, Dragoș-Florin Babă, Raluca Niculescu, Adina Stoian and Leonard Azamfirei

Nutrients 2025, 17(10), 1659; https://doi.org/10.3390/nu17101659 - 13 May 2025

Viewed by 1609

Abstract

Introduction: Critically ill patients in intensive care units (ICUs) are at high risk of malnutrition, which can result in muscle atrophy, polyneuropathy, increased mortality, or prolonged hospitalizations with complications and higher costs during the recovery period. They often develop ICU-acquired weakness, exacerbated by sepsis, immobilization, and drug treatments, leading to rapid muscle mass loss and long-term complications. Studies indicate that adequate protein and calorie intake can decrease mortality and improve prognosis and recovery. However, optimal implementation remains a critical challenge. Objectives: This narrative review aims to summarize recent advances in nutritional strategies for critically ill patients. It highlights the benefits and limitations of current approaches including enteral (EN) and parenteral nutrition (PN) and examines their impact on clinical outcomes and overall mortality. Additionally, the review explores the emerging role of precision nutrition in critical care using technologies such as metabolomics and artificial intelligence (AI) to provide valuable insights into optimizing nutritional care in critically ill patients. Methods: A comprehensive literature search was conducted to identify recent studies, clinical guidelines, and expert consensus papers on nutritional support for ICU patients. The investigation focused on critical aspects such as the optimal timing for intervention, the route of administration, specific protein and energy targets, and technological innovations to support personalized nutrition, ensuring that each patient receives tailored support based on their unique needs. Results: Guidelines recommend initiating EN or PN nutrition within the first 48 h of admission, using indirect calorimetry (IC) to estimate energy needs, and supplementing protein up to 1.2 g/kg/day after stabilization. IC has gained importance in assessing energy needs but is still underused in the ICU. EN is preferred because it maintains intestinal integrity, reduces the risk of infections, and is recommended within the first 48 h of ICU admission. PN is used when EN is infeasible, but it increases the risk of infection. By integrating metabolomics with transcriptomic and genomic data, we can gain a deeper understanding of the effect of nutrition on cellular homeostasis, facilitating personalized treatments and enhancing the recovery of critically ill patients. Conclusions: AI is becoming increasingly important in monitoring and evaluating artificial nutrition, providing a more accurate and efficient alternative to traditional methods. AI can assist in identifying and managing malnutrition and is effective for estimating caloric and nutrient intake. AI minimizes human error, enables continuous monitoring, and integrates various data sources. The nutritional care of critically ill patients requires collaboration among specialists from diverse fields, including physicians, nutritionists, pharmacists, radiologists, IT experts, and policymakers. Full article

(This article belongs to the Special Issue Nutritional Management in Intensive Care)

► Show Figures

Graphical abstract

16 pages, 3684 KiB

Open AccessReview

Combined Effects of Early Mobilization and Nutrition on ICU-Acquired Weakness

by Paolo Formenti, Alessandro Menozzi, Giovanni Sabbatini, Miriam Gotti, Andrea Galimberti, Giovanni Bruno, Angelo Pezzi and Michele Umbrello

Nutrients 2025, 17(6), 1073; https://doi.org/10.3390/nu17061073 - 19 Mar 2025

Cited by 1 | Viewed by 2042

Abstract

Intensive Care Unit-Acquired Weakness (ICUAW) is a very common condition in patients admitted to intensive care units (ICUs), even after relatively short stays. This weakness can develop with a pre-existing background of sarcopenia or cachexia, although these conditions are not always the direct cause. Over the years, much of the literature has focused on the nutritional aspect of the issue, leading to the development of widely accepted guidelines recommending the initiation of early nutrition, with the goal of achieving caloric and protein targets within the first five days of ICU admission. Despite adherence to these guidelines, several studies have shown a significant loss of muscle mass in critically ill patients, which directly impacts their ability to generate strength. However, it has become increasingly evident that nutrition alone is not sufficient to counteract this muscle loss, which is often closely linked to the prolonged immobility experienced by ICU patients due to a variety of clinical and logistical factors. In particular, there is growing evidence suggesting that even the introduction of early and minimal rehabilitation—including passive mobilization—when combined with appropriate nutritional support, can be a valuable strategy to help reduce the incidence of ICUAW. In this narrative review, we aim to summarize the current scientific knowledge on this topic, emphasizing the importance of an integrated approach that combines nutrition and early mobilization. Such a combined strategy not only holds the potential to reduce the acute incidence of ICUAW but also contributes to better recovery outcomes and, eventually, improved quality of life for these patients. Full article

(This article belongs to the Special Issue Nutritional Management in Intensive Care)

► Show Figures

Figure 1

Other

Jump to: Research, Review

15 pages, 1311 KiB

Open AccessSystematic Review

Comparison of Early Enteral Nutrition Versus Early Parenteral Nutrition in Critically Ill Patients: A Systematic Review and Meta-Analysis

by Seung Min Baik, Mina Kim and Jae Gil Lee

Nutrients 2025, 17(1), 10; https://doi.org/10.3390/nu17010010 - 24 Dec 2024

Cited by 3 | Viewed by 5358

Abstract

Background: Nutritional support is crucial in critically ill patients to enhance recovery, reduce infections, and improve outcomes. This meta-analysis compared early enteral nutrition (EEN) and early parenteral nutrition (EPN) to evaluate their efficacy in adult critically ill patients. Methods: A systematic review of 14 studies involving 7618 patients was conducted, including randomized controlled trials, prospective cohorts, and retrospective analyses. The primary outcomes were mortality and infectious complications, while secondary outcomes included intensive care unit length of stay (ICU-LOS), hospital length of stay (H-LOS), mechanical ventilation days, and gastrointestinal (GI) complications. Results: The results showed no significant difference in mortality between EEN and EPN (OR 1.03, 95% CI 0.93–1.14). EEN reduced bloodstream infections (OR 0.73, 95% CI 0.57–0.93), ICU-LOS (MD −0.18 days, 95% CI −0.33 to −0.04), and H-LOS (MD −1.15 days, 95% CI −1.38 to −0.93). However, EEN was associated with higher GI complications, such as vomiting and diarrhea (OR 2.25, 95% CI 1.97–2.58), while mechanical ventilation days showed no significant difference. Conclusions: These findings support prioritizing EEN in critically ill patients with functional gastrointestinal systems to improve infection control and recovery while emphasizing the importance of careful monitoring to mitigate gastrointestinal complications. Full article

(This article belongs to the Special Issue Nutritional Management in Intensive Care)

► Show Figures

Journal Menu

Journal Browser

Nutritional Management in Intensive Care

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (7 papers)

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI