Impact of Dietitian-Guided Individualized Nutrition (DGIN) on ICU Outcomes in Critically Ill Patients: A Retrospective Cohort Study in Taiwan.

IF 5 2区 医学 Q1 NUTRITION & DIETETICS
Nutrients Pub Date : 2025-09-18 DOI:10.3390/nu17182995
Shih-Ching Lo, Hsing-Chun Lin, Yu-Hsun Wang, Ying-Ru Chen, Shun-Fa Yang
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引用次数: 0

Abstract

Background: On 1 October 2019, the Taiwan National Health Insurance (NHI) Administration introduced reimbursement for nutritional care services provided to intensive care unit (ICU) patients, under the category of nutritional care fees. These services included the implementation of structured, dietitian-guided individualized nutrition (DGIN) protocols designed to address the clinical needs of critically ill patients. Objectives: This study aimed to evaluate the effectiveness of DGIN in critically ill patients following the implementation of NHI coverage. Methods: This retrospective cohort study was conducted in the ICU of a tertiary medical center, including patients admitted between 1 September 2018 and 31 October 2020, encompassing periods both before and after the initiation of NHI coverage. Under NHI coverage, dietitian-guided individualized nutritional support was provided within the first two weeks of admission. The intervention group received DGIN within the first two weeks of ICU admission. A total of 5292 patients were screened; 2381 were included in the final analysis (1116 in the standard care (SC) group and 1265 in the DGIN group), categorized based on the timing of NHI coverage and the corresponding frequency of dietitian visits. The DGIN protocol comprised a baseline assessment within 24-48 h and three structured reviews during the first ICU week, while the comparator received SC. Demographic characteristics, daily nutritional data, and clinical outcomes were analyzed. Results: Significant baseline differences in nutritional intake and disease severity were observed. Following the introduction of the DGIN protocol, the intervention group received more structured and closely monitored nutrition management, which resulted in less aggressive caloric intake. This approach was associated with a significantly shorter ICU length of stay (SC: 8.1 ± 6.7 days vs. DGIN: 7.1 ± 7.4 days, p < 0.001). Conclusions: An ICU nutritional care plan involving frequent assessments and timely interventions by clinical dietitians is associated with a reduced ICU length of stay in critically ill patients. These findings support the effectiveness of integrating dietitian-led nutritional care into national health insurance coverage for ICU patients.

营养师指导的个体化营养(DGIN)对重症患者ICU预后的影响:台湾回顾性队列研究。
​这些服务包括实施结构化的、营养师指导的个性化营养(DGIN)方案,旨在满足危重病人的临床需求。目的:本研究旨在评估实施全民健康保险覆盖后DGIN在危重患者中的有效性。方法:本回顾性队列研究在一家三级医疗中心的ICU进行,包括2018年9月1日至2020年10月31日期间入院的患者,包括NHI覆盖开始之前和之后的时期。在全国健康保险覆盖下,在入院的前两周内提供营养师指导的个性化营养支持。干预组在ICU入院前两周内接受DGIN治疗。共筛查5292例患者;2381人被纳入最终分析(标准护理组1116人,DGIN组1265人),根据全国健康保险覆盖的时间和相应的营养师就诊频率进行分类。DGIN方案包括24-48小时内的基线评估和第一个ICU周内的三次结构化评估,而比较者接受SC。人口统计学特征,每日营养数据和临床结果进行分析。结果:观察到营养摄入和疾病严重程度的显著基线差异。在引入DGIN方案后,干预组接受了更加结构化和密切监测的营养管理,这导致了较少的侵略性热量摄入。该方法与ICU住院时间显著缩短相关(SC: 8.1±6.7天,DGIN: 7.1±7.4天,p < 0.001)。结论:由临床营养师进行频繁评估和及时干预的ICU营养护理计划与减少危重患者在ICU的住院时间有关。这些发现支持将营养师主导的营养护理纳入ICU患者的国家健康保险覆盖范围的有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Nutrients
Nutrients NUTRITION & DIETETICS-
CiteScore
9.20
自引率
15.30%
发文量
4599
审稿时长
16.74 days
期刊介绍: Nutrients (ISSN 2072-6643) is an international, peer-reviewed open access advanced forum for studies related to Human Nutrition. It publishes reviews, regular research papers and short communications. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced.
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