title: Permissive Underfeeding or Standard Enteral Feeding in High- and Low-Nutritional-Risk Critically Ill Adults. Post Hoc Analysis of the PermiT Trial.
abstract: The optimal nutritional strategy for critically ill adults at high nutritional risk is unclear.
  
  
  
  To examine the effect of permissive underfeeding with full protein intake compared with standard feeding on 90-day mortality in patients with different baseline nutritional risk.
  
  
  
  This is a post hoc analysis of the PermiT (Permissive Underfeeding versus Target Enteral Feeding in Adult Critically Ill Patients) trial.
  
  
  
  Nutritional risk was categorized by the modified Nutrition Risk in Critically Ill score, with high nutritional risk defined as a score of 5-9 and low nutritional risk as a score of 0-4. Additional analyses were performed by categorizing patients by body mass index, prealbumin, transferrin, phosphate, urinary urea nitrogen, and nitrogen balance. Based on the Nutrition Risk in Critically Ill score, 378 of 894 (42.3%) patients were categorized as high nutritional risk and 516 of 894 (57.7%) as low nutritional risk. There was no association between feeding strategy and mortality in the two categories; adjusted odds ratio (aOR) of 0.84 (95% confidence interval [CI], 0.56-1.27) for high nutritional risk and 1.01 (95% CI, 0.64-1.61) for low nutritional risk (interaction P = 0.53). Findings were similar in analyses using other definitions, with the exception of prealbumin. The association of permissive underfeeding versus standard feeding and 90-day mortality differed when patients were categorized by baseline prealbumin level (≤0.10 g/L: aOR, 0.57 [95% CI, 0.31-1.05]; >0.10 and ≤0.15 g/L: aOR, 0.79 [95% CI, 0.42-1.48]; >0.15 g/L: aOR, 1.55 [95% CI, 0.80, 3.01]; interaction P = 0.009).
  
  
  
  Among patients with high and low nutritional risk, permissive underfeeding with full protein intake was associated with similar outcomes as standard feeding.
authors: 1 King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors: Yaseen M
authors: 0000-0001-5735-6241
authors: YM
authors: Arabi
authors: 1 King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors: Abdulaziz S
authors: AS
authors: Aldawood
authors: 1 King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors: Hasan M
authors: HM
authors: Al-Dorzi
authors: 1 King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.|2 Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors: Hani M
authors: HM
authors: Tamim
authors: 1 King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors: Samir H
authors: SH
authors: Haddad
authors: 3 Division of Critical Care Medicine, Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada.
authors: Gwynne
authors: G
authors: Jones
authors: 3 Division of Critical Care Medicine, Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada.
authors: Lauralyn
authors: L
authors: McIntyre
authors: 4 King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors: Othman
authors: O
authors: Solaiman
authors: 1 King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors: Maram H
authors: MH
authors: Sakkijha
authors: 1 King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors: Musharaf
authors: M
authors: Sadat
authors: 1 King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors: Shihab
authors: S
authors: Mundekkadan
authors: 5 Section of Critical Care Medicine, Health Sciences Centre, University of Manitoba, Manitoba, Canada.
authors: Anand
authors: A
authors: Kumar
authors: 6 Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
authors: Sean M
authors: SM
authors: Bagshaw
authors: 7 Interdepartmental Division of Critical Care Medicine, Division of Respirology, Department of Medicine, University of Toronto, Toronto, Canada; and.|8 Mount Sinai Hospital, Toronto, Canada.
authors: Sangeeta
authors: S
authors: Mehta
mesh_terms: D000328:Adult; D031204:Caloric Restriction / Q000379:methods* / Q000401:mortality; D002170:Canada; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D016017:Odds Ratio; D012306:Risk; D012529:Saudi Arabia
keywords: caloric intake; caloric restriction; critical care; enteral nutrition; permissive underfeeding