Hospitalized mechanically ventilated patients are at higher risk of enteral underfeeding than non-ventilated patients.
OBJECTIVE
Enteral nutrition (EN) is the preferred method of nutrition support in hospitalized patients but only 50-90% of the required calories are actually delivered. In order to identify where our nutrition support team (NST) should focus its activity, we prospectively evaluated the level of coverage of energy and protein needs during the first 5 days of EN in intensive care unit (ICU) and non-ICU patients and the relationship of energy and protein coverage with serum albumin, transthryretin, insulin-like growth factor-1 (IGF-1) and C-reactive protein (CRP).


METHODS
Subjects (n=183) who required nutrition support and received EN were prospectively recruited. Calorie prescription was 20 and 25, 25 and 30 kcal/kg BW for women and men 60 years and <60 years, respectively. Protein needs were estimated as 1.2g protein/kg BW. Logistic regression analysis was used to estimate odds ratios (OR) for energy and protein delivery 66.6% and <66.6% and albumin, transthryretin, IGF-1 (low vs. normal) and CRP (high vs. normal) in ventilated vs. non-ventilated patients.


RESULTS
Significantly more mechanically ventilated than non-ventilated patients received <66.6% of energy (71% vs. 48%) and protein (96% vs. 65%). The ventilated patients were more likely to be energy (OR 2.1, CI 1.1-4.0) and protein (OR 15.7, CI 4.9-50.8) underfed than non-ventilated patients. There was a significant association on day 5 between low protein delivery and low albumin (OR 2.9, CI 1.3-6.5), low transthyretin (OR 3.0, CI 1.4-6.5), low IGF-1 (OR 2.8, CI 1.2-6.7) and high CRP (OR 3.5, CI 1.6-7.8).


CONCLUSIONS
The energy and protein needs of hospitalized patients are not met during the first 5 days of EN. Ventilated patients are more likely to be energy and protein underfed than non-ventilated patients and to have low plasma protein level. These findings support our decision to intensify EN monitoring by our NST in ventilated patients to optimize their nutritional coverage.
Kyle
Ursula G
UG
Division of Nutrition, Geneva University Hospital, 1211 Geneva, Switzerland.
Genton
Laurence
L
Heidegger
Claudia P
CP
Maisonneuve
Nadine
N
Karsegard
Veronique L
VL
Huber
Olivier
O
Mensi
Nouri
N
Andre Romand
Jacques
J
Jolliet
Philippe
P
Pichard
Claude
C
D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D016001:Confidence Intervals; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000592:standards*; D005260:Female; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D016017:Odds Ratio; D011228:Prealbumin / Q000378:metabolism; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism
D004044:Dietary Proteins; D011228:Prealbumin; D012709:Serum Albumin; D007334:Insulin-Like Growth Factor I; D002097:C-Reactive Protein