ReviewCritical care (London, England)2023
Toward nutrition improving outcome of critically ill patients: How to interpret recent feeding RCTs?
Review in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
36 citing papers in PubMed, 1 synthesis or guideline pooled it, 68 citations in OpenAlex.
- The urea-to-creatinine ratio as an emerging biomarker in critical care: a scoping review and meta-analysis.Critical care (London, England) · 2025Pooled it
- Early phosphate changes as potential indicator of unreadiness for artificial feeding: a secondary analysis of the EPaNIC RCT.Critical care (London, England) · 2025Trial
- Impact of withholding early parenteral nutrition on 2-year mortality and functional outcome in critically ill adults.Intensive care medicine · 2024Trial
- Association between urea trajectory and protein dose in critically ill adults: a secondary exploratory analysis of the effort protein trial (RE-EFFORT).Critical care (London, England) · 2024Trial
- Individualising blood glucose control in ICU patients: evidence and practical implementations.Critical care (London, England) · 2026Review
- Association between energy adequacy and clinical outcomes in septic intensive care unit patients stratified by modified Nutrition Risk in the Critically Ill score.Journal of the Chinese Medical Association : JCMA · 2026Article
- Prognostic Value of Nutritional Risk Scores in Septic ICU Patients: A Survival Analysis Using mNUTRIC, PNI, and CONUT.Diagnostics (Basel, Switzerland) · 2026Article
- The impact of early nutritional support on in-hospital mortality in patients with sepsis caused by bacterial or viral infections: a retrospective cohort study.European journal of medical research · 2025Article
- The metabolic response to stress in critical illness: updated review on the pathophysiological mechanisms, consequences, and therapeutic implications.Annals of intensive care · 2025Review
- The flux of energy in critical illness and the obesity paradox.Physiological reviews · 2025Review
- Challenges in Implementing High Protein Nutrition for ICU Patients.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025Article
- Author Response: Challenges in Implementing High Protein Nutrition for ICU Patients.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025Article
- The Impact of Protein Feed on the Urea-to-Creatinine Ratio-A Retrospective Single-Center Study.Nutrients · 2025Article
- Review
- On how to feed critically ill children in intensive care: A slowly shifting paradigm.Clinical nutrition (Edinburgh, Scotland) · 2025Review
- The use of protein supplements in children with cerebral palsy: A scoping literature review.PloS one · 2025Article
- Advances in Intermittent Fasting Applications for Critically Ill Patients.International journal of general medicine · 2025Review
- Relationship between timing of achieving energy sufficiency and clinical outcomes in critically ill patients.Frontiers in nutrition · 2025Article
- Protective nutrition strategy in the acute phase of critical illness: why, what and how to protect.Frontiers in nutrition · 2025Review
- The hockey-stick association of energy supply in the first 72 h of critical illness may apply only to patients with a normal body mass index: aFrontiers in nutrition · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
Abstract
Although numerous observational studies associated underfeeding with poor outcome, recent randomized controlled trials (RCTs) have shown that early full nutritional support does not benefit critically ill patients and may induce dose-dependent harm. Some researchers have suggested that the absence of benefit in RCTs may be attributed to overrepresentation of patients deemed at low nutritional risk, or to a too low amino acid versus non-protein energy dose in the nutritional formula. However, these hypotheses have not been confirmed by strong evidence. RCTs have not revealed any subgroup benefiting from early full nutritional support, nor benefit from increased amino acid doses or from indirect calorimetry-based energy dosing targeted at 100% of energy expenditure. Mechanistic studies attributed the absence of benefit of early feeding to anabolic resistance and futile catabolism of extra provided amino acids, and to feeding-induced suppression of recovery-enhancing pathways such as autophagy and ketogenesis, which opened perspectives for fasting-mimicking diets and ketone supplementation. Yet, the presence or absence of an anabolic response to feeding cannot be predicted or monitored and likely differs over time and among patients. In the absence of such monitor, the value of indirect calorimetry seems obscure, especially in the acute phase of illness. Until now, large feeding RCTs have focused on interventions that were initiated in the first week of critical illness. There are no large RCTs that investigated the impact of different feeding strategies initiated after the acute phase and continued after discharge from the intensive care unit in patients recovering from critical illness.
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.