title: High-protein hypocaloric vs normocaloric enteral nutrition in critically ill patients: A randomized clinical trial.
abstract: Appropriate caloric intake in critically ill patients receiving enteral nutrition is controversial. This study evaluates the impact of different caloric regimens on severity of organ failure measured with Sequential Organ Failure Assessment (SOFA).
  
  
  
  We conducted a randomized prospective controlled trial. Study population included adult intensive care unit (ICU) patients expected to require enteral nutrition for more than 96 hours. Goals in the intervention group were hypocaloric (15 kcal/kg per day) enteral nutrition compared to normocaloric (25 kcal/kg per day) enteral nutrition, both with hyperproteic intake (1.7 g of protein/kg per day). Primary end point was change in SOFA score (ΔSOFA) from baseline at 48 hours. Secondary end points were ΔSOFA at 96 hours, insulin requirements, hyperglycemia or hypoglycemic episodes, length of ICU stay, days on ventilator, and 28-day mortality.
  
  
  
  After screening 443 patients, 120 patients were analyzed. There were no differences between groups in baseline characteristics. We did not find a statistically significant difference in ΔSOFA at 48 hours. Patients in the hypocaloric group showed lower average daily insulin requirements and percentage of patients requiring any insulin.
  
  
  
  Hyperproteic, hypocaloric nutrition did not show different outcomes compared to normocaloric nutrition, except lower insulin requirements. Hypocaloric nutrition could provide a more physiologic approach with lower need for care and metabolic impact.
authors.affiliation: Surgery Department, Pontificia Universidad Javeriana, Medical School, Hospital Universitario San Ignacio, Bogota, Colombia. Electronic address: saul.rugeles@gmail.com.
authors.forename: Saúl
authors.initials: S
authors.lastname: Rugeles
authors.affiliation: Surgery Department, Pontificia Universidad Javeriana, Medical School, Hospital Universitario San Ignacio, Bogota, Colombia. Electronic address: luisga.villa@gmail.com.
authors.forename: Luis Gabriel
authors.initials: LG
authors.lastname: Villarraga-Angulo
authors.affiliation: Surgery Department, Pontificia Universidad Javeriana, Medical School, Hospital Universitario San Ignacio, Bogota, Colombia. Electronic address: anibal_ariza@hotmail.com.
authors.forename: Aníbal
authors.initials: A
authors.lastname: Ariza-Gutiérrez
authors.affiliation: Pontificia Universidad Javeriana, Medical School, Bogota, Colombia. Electronic address: santiago.chaverra@gmail.com.
authors.forename: Santiago
authors.initials: S
authors.lastname: Chaverra-Kornerup
authors.affiliation: Pontificia Universidad Javeriana, Medical School, Bogota, Colombia. Electronic address: plasalvia@javeriana.edu.co.
authors.forename: Pieralessandro
authors.initials: P
authors.lastname: Lasalvia
authors.affiliation: Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia. Electronic address: diego.rosselli@gmail.com.
authors.forename: Diego
authors.initials: D
authors.lastname: Rosselli
mesh_terms: D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D009752:Nutritional Status; D063305:Organ Dysfunction Scores; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Critical care; Energy intake; Enteral nutrition; Intensive care units; Nutritional support; Randomized controlled trial