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JPEN J Parenter Enteral Nutr. 2019 Jan;43(1):63-69. doi: 10.1002/jpen.1180. Epub 2018 Jun 30.

Greater Nutrient Intake Is Associated With Lower Mortality in Western and Eastern Critically Ill Patients With Low BMI: A Multicenter, Multinational Observational Study.

Author information

1
University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
2
Kobe City Medical Center General Hospital, Kobe, Japan.
3
Surgery and Palliative Medicine, Fujita Health University School of Medicine, Toyoake-City, Aichi, Japan.
4
Department of Medicine, Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.

Abstract

BACKGROUND:

Little is known about the impact of feeding adequacy by NUTrition Risk in the Critically Ill (NUTRIC) groups in critically ill patients with body mass index (BMI) <20. Our purpose was to assess whether adequacy of protein/energy intake impacts mortality in patients with BMI <20 in Western/Eastern intensive care units (ICUs) and high/low NUTRIC groups.

METHODS:

Data from the International Nutrition Survey 2013-2014 were dichotomized into Western/Eastern ICU settings; BMI <20 or ≥20; and high (≥5)/low (<5) NUTRIC groups. Association of BMI <20 with 60-day mortality was compared in unadjusted and adjusted (Western/Eastern, age, medical/surgical admission, high/low NUTRIC group) logistic regression models. The impact of adequacy of protein/energy on 60-day mortality relationship was tested using general estimating equations in high/low NUTRIC groups, in unadjusted and adjusted models.

RESULTS:

Western (n = 4274) patients had higher mean BMI (27.9 ± 7.7 versus (vs) 23.4 ± 4.9, P < 0.0001) than Eastern (n = 1375), respectively. BMI <20 was associated with greater mortality (adjusted odds ratio [OR] 1.30, 95% confidence interval [CI] 1.07-1.57), with no interaction between BMI group and Western/Eastern ICU site. Among patients with BMI <20 and high NUTRIC score, 10% greater protein and energy adequacy was associated with 5.7% and 5.5% reduction in 60-day mortality, respectively. Results were not significantly different between Western and Eastern ICUs.

CONCLUSIONS:

The benefit of greater protein/energy intake in high-NUTRIC patients was observed regardless of geographic origin or low BMI, suggesting a consistent response to nutrition support in this group. Clinical guidelines and research projects focused on improving care in high-risk critically ill patients can be applied across geographic boundaries.

KEYWORDS:

NUTrition Risk in the Critically Ill (NUTRIC) group; adequacy, energy/protein; body mass index; intensive care unit; mortality

PMID:
29959851
DOI:
10.1002/jpen.1180

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