Effects of high-fat, low-carbohydrate enteral nutrition in critically ill patients: A systematic review with meta-analysis

IF 6.6 2区 医学 Q1 NUTRITION & DIETETICS
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Abstract

Background & aims

High-fat, low-carbohydrate enteral nutrition has gained attention, with expectations of an improved respiratory condition, fewer complications, and lower mortality. The present study performed a systematic review and meta-analysis of randomized controlled trials to examine the effects of high-fat, low-carbohydrate enteral nutrition in critically ill adult patients.

Methods

We searched MEDLINE via Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), and ICHUSHI for randomized controlled trials comparing high-fat, low-carbohydrate enteral nutrition to standard enteral nutrition in critically ill adult patients who received enteral nutrition. The primary outcome was mortality. Secondary outcomes included intensive care unit (ICU) mortality, length of ICU stay, length of mechanical ventilation, and adverse events of diarrhea and gastric residual volume. We examined the risk of bias using the Cochrane risk-of-bias tool for randomized trials version 2. We assessed the overall certainty of evidence based on the Grading of Recommendations Assessment, Development, and Evaluation methodology. Synthesis results were calculated with risk ratios and 95% confidence intervals using a Mantel-Haenszel random-effects model.

Results

Eight trials with 607 patients were included. The effects of high-fat, low-carbohydrate enteral nutrition on mortality did not significantly differ from those of standard enteral nutrition (62/280 [22.1%] vs. 39/207 [18.8%], risk ratios = 1.14, 95% confidence intervals 0.80 to 1.62, P = 0.47). No significant differences were observed in ICU mortality, ICU length of stay, diarrhea, or gastric residual volume between the two groups. However, high-fat, low-carbohydrate enteral nutrition was associated with a significantly shorter duration of mechanical ventilation (mean difference −1.72 days, 95% confidence intervals −2.93 to −0.50, P = 0.005).

Conclusion

High-fat, low-carbohydrate enteral nutrition may not affect mortality, but may decrease the duration of mechanical ventilation in critically ill adult patients. Limitations include the small number of studies and potential for bias. Further research is needed to confirm these results and investigate effects on other outcomes and in a subgroup of patients requiring mechanical ventilation.

高脂肪、低碳水化合物肠内营养对重症患者的影响:系统回顾与荟萃分析
背景& 目的高脂肪、低碳水化合物肠内营养受到关注,人们期望它能改善呼吸状况、减少并发症并降低死亡率。本研究对随机对照试验进行了系统回顾和荟萃分析,以研究高脂低碳水化合物肠内营养对重症成人患者的影响。方法我们通过 Pubmed、Cochrane Central Register of Controlled Trials (CENTRAL) 和 ICHUSHI 对 MEDLINE 进行了检索,以寻找在接受肠内营养的重症成人患者中比较高脂低碳水化合物肠内营养与标准肠内营养的随机对照试验。主要结果是死亡率。次要结果包括重症监护室(ICU)死亡率、重症监护室住院时间、机械通气时间以及腹泻和胃残渣量等不良事件。我们使用科克伦随机试验偏倚风险工具 2 版检查了偏倚风险。我们根据建议分级评估、制定和评价方法对证据的整体确定性进行了评估。采用 Mantel-Haenszel 随机效应模型计算综合结果的风险比和 95% 置信区间。高脂肪、低碳水化合物肠内营养对死亡率的影响与标准肠内营养没有显著差异(62/280 [22.1%] vs. 39/207 [18.8%],风险比 = 1.14,95% 置信区间为 0.80 至 1.62,P = 0.47)。两组患者在重症监护室死亡率、重症监护室住院时间、腹泻或胃残渣量方面无明显差异。结论高脂肪、低碳水化合物肠内营养可能不会影响死亡率,但可缩短重症成人患者的机械通气时间。局限性包括研究数量少和可能存在偏倚。需要进一步的研究来证实这些结果,并调查对其他结果和需要机械通气的亚组患者的影响。
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来源期刊
Clinical nutrition
Clinical nutrition 医学-营养学
CiteScore
14.10
自引率
6.30%
发文量
356
审稿时长
28 days
期刊介绍: Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.
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