{"title":"危重患者的能量密集与常规肠内营养：一项系统回顾和荟萃分析。","authors":"Zonghong Zhang, Chuanlai Zhang, Huiling Pan, Ruiqi Yang, Yin Fang","doi":"10.3389/fnut.2025.1645211","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aim: </strong>Critically ill patients often experience low target attainment rates with enteral nutrition (EN), leading to malnutrition and poor clinical outcomes. Energy-dense EN may improve caloric delivery and reduce the risk of malnutrition. However, its effects on other clinical outcomes remain unclear. This systematic review aimed to evaluate the impact of energy-dense EN in critically ill patients.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Clinical Trials, China Knowledge Network Infrastructure (CNKI), Wanfang Data, and Weipu databases from inception to December 2024. Two researchers independently screened studies and extracted data. Randomized controlled trials (RCTs) comparing energy-dense EN with routine EN in critically ill patients were included. Outcomes assessed included diarrhea, gastric residual volume (GRV), vomiting or reflux, mortality, total hospital length of stay (LOS), intensive care unit (ICU) LOS, duration of mechanical ventilation, and nutritional status. The risk of bias was assessed using the Cochrane RoB 2.0 tool. Meta-analyses were performed using Review Manager (RevMan), and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>A total of 380 studies were identified, and 10 RCTs comprising 4,473 patients were included. Compared with routine EN, energy-dense EN significantly reduced the duration of mechanical ventilation (MD = -37.41, 95% CI: -60.57 to -14.25, <i>I</i> <sup>2</sup> = 75%) and ICU LOS (MD = -1.24, 95% CI: -1.49 to -0.99, <i>I</i> <sup>2</sup> = 17%). Nutritional indicators such as albumin (MD = 4.92, 95% CI: 2.69-7.16, <i>I</i> <sup>2</sup> = 89%) and prealbumin (MD = 55.97, 95% CI: 39.04-72.90, <i>I</i> <sup>2</sup> = 86%) were significantly improved. However, there were no significant differences in total hospital LOS, mortality, or gastrointestinal complications such as diarrhea and vomiting/reflux. A slight increase in the risk of high GRV was observed (relative risk (RR) = 1.28, 95% CI: 1.19-1.37, <i>I</i> <sup>2</sup> = 2%).</p><p><strong>Conclusion: </strong>Energy-dense EN appears to be safe and effective for critically ill patients, with benefits in nutritional status and reductions in ICU LOS and mechanical ventilation duration. However, this study has limitations, including potential bias in the included RCTs and inconsistent definitions of GRV. Future large-scale, high-quality, and multicenter RCTs with rigorous methodology are needed to validate these findings.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/recorddashboard.</p>","PeriodicalId":12473,"journal":{"name":"Frontiers in Nutrition","volume":"12 ","pages":"1645211"},"PeriodicalIF":4.0000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434126/pdf/","citationCount":"0","resultStr":"{\"title\":\"Energy-dense versus routine enteral nutrition in critically ill patients: a systematic review and meta-analysis.\",\"authors\":\"Zonghong Zhang, Chuanlai Zhang, Huiling Pan, Ruiqi Yang, Yin Fang\",\"doi\":\"10.3389/fnut.2025.1645211\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aim: </strong>Critically ill patients often experience low target attainment rates with enteral nutrition (EN), leading to malnutrition and poor clinical outcomes. Energy-dense EN may improve caloric delivery and reduce the risk of malnutrition. However, its effects on other clinical outcomes remain unclear. This systematic review aimed to evaluate the impact of energy-dense EN in critically ill patients.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Clinical Trials, China Knowledge Network Infrastructure (CNKI), Wanfang Data, and Weipu databases from inception to December 2024. Two researchers independently screened studies and extracted data. Randomized controlled trials (RCTs) comparing energy-dense EN with routine EN in critically ill patients were included. Outcomes assessed included diarrhea, gastric residual volume (GRV), vomiting or reflux, mortality, total hospital length of stay (LOS), intensive care unit (ICU) LOS, duration of mechanical ventilation, and nutritional status. The risk of bias was assessed using the Cochrane RoB 2.0 tool. Meta-analyses were performed using Review Manager (RevMan), and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>A total of 380 studies were identified, and 10 RCTs comprising 4,473 patients were included. Compared with routine EN, energy-dense EN significantly reduced the duration of mechanical ventilation (MD = -37.41, 95% CI: -60.57 to -14.25, <i>I</i> <sup>2</sup> = 75%) and ICU LOS (MD = -1.24, 95% CI: -1.49 to -0.99, <i>I</i> <sup>2</sup> = 17%). Nutritional indicators such as albumin (MD = 4.92, 95% CI: 2.69-7.16, <i>I</i> <sup>2</sup> = 89%) and prealbumin (MD = 55.97, 95% CI: 39.04-72.90, <i>I</i> <sup>2</sup> = 86%) were significantly improved. However, there were no significant differences in total hospital LOS, mortality, or gastrointestinal complications such as diarrhea and vomiting/reflux. A slight increase in the risk of high GRV was observed (relative risk (RR) = 1.28, 95% CI: 1.19-1.37, <i>I</i> <sup>2</sup> = 2%).</p><p><strong>Conclusion: </strong>Energy-dense EN appears to be safe and effective for critically ill patients, with benefits in nutritional status and reductions in ICU LOS and mechanical ventilation duration. However, this study has limitations, including potential bias in the included RCTs and inconsistent definitions of GRV. Future large-scale, high-quality, and multicenter RCTs with rigorous methodology are needed to validate these findings.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/recorddashboard.</p>\",\"PeriodicalId\":12473,\"journal\":{\"name\":\"Frontiers in Nutrition\",\"volume\":\"12 \",\"pages\":\"1645211\"},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434126/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Nutrition\",\"FirstCategoryId\":\"97\",\"ListUrlMain\":\"https://doi.org/10.3389/fnut.2025.1645211\",\"RegionNum\":2,\"RegionCategory\":\"农林科学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"NUTRITION & DIETETICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Nutrition","FirstCategoryId":"97","ListUrlMain":"https://doi.org/10.3389/fnut.2025.1645211","RegionNum":2,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}
Energy-dense versus routine enteral nutrition in critically ill patients: a systematic review and meta-analysis.
Background and aim: Critically ill patients often experience low target attainment rates with enteral nutrition (EN), leading to malnutrition and poor clinical outcomes. Energy-dense EN may improve caloric delivery and reduce the risk of malnutrition. However, its effects on other clinical outcomes remain unclear. This systematic review aimed to evaluate the impact of energy-dense EN in critically ill patients.
Methods: A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Clinical Trials, China Knowledge Network Infrastructure (CNKI), Wanfang Data, and Weipu databases from inception to December 2024. Two researchers independently screened studies and extracted data. Randomized controlled trials (RCTs) comparing energy-dense EN with routine EN in critically ill patients were included. Outcomes assessed included diarrhea, gastric residual volume (GRV), vomiting or reflux, mortality, total hospital length of stay (LOS), intensive care unit (ICU) LOS, duration of mechanical ventilation, and nutritional status. The risk of bias was assessed using the Cochrane RoB 2.0 tool. Meta-analyses were performed using Review Manager (RevMan), and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results: A total of 380 studies were identified, and 10 RCTs comprising 4,473 patients were included. Compared with routine EN, energy-dense EN significantly reduced the duration of mechanical ventilation (MD = -37.41, 95% CI: -60.57 to -14.25, I2 = 75%) and ICU LOS (MD = -1.24, 95% CI: -1.49 to -0.99, I2 = 17%). Nutritional indicators such as albumin (MD = 4.92, 95% CI: 2.69-7.16, I2 = 89%) and prealbumin (MD = 55.97, 95% CI: 39.04-72.90, I2 = 86%) were significantly improved. However, there were no significant differences in total hospital LOS, mortality, or gastrointestinal complications such as diarrhea and vomiting/reflux. A slight increase in the risk of high GRV was observed (relative risk (RR) = 1.28, 95% CI: 1.19-1.37, I2 = 2%).
Conclusion: Energy-dense EN appears to be safe and effective for critically ill patients, with benefits in nutritional status and reductions in ICU LOS and mechanical ventilation duration. However, this study has limitations, including potential bias in the included RCTs and inconsistent definitions of GRV. Future large-scale, high-quality, and multicenter RCTs with rigorous methodology are needed to validate these findings.
期刊介绍：
No subject pertains more to human life than nutrition. The aim of Frontiers in Nutrition is to integrate major scientific disciplines in this vast field in order to address the most relevant and pertinent questions and developments. Our ambition is to create an integrated podium based on original research, clinical trials, and contemporary reviews to build a reputable knowledge forum in the domains of human health, dietary behaviors, agronomy & 21st century food science. Through the recognized open-access Frontiers platform we welcome manuscripts to our dedicated sections relating to different areas in the field of nutrition with a focus on human health.
Specialty sections in Frontiers in Nutrition include, for example, Clinical Nutrition, Nutrition & Sustainable Diets, Nutrition and Food Science Technology, Nutrition Methodology, Sport & Exercise Nutrition, Food Chemistry, and Nutritional Immunology. Based on the publication of rigorous scientific research, we thrive to achieve a visible impact on the global nutrition agenda addressing the grand challenges of our time, including obesity, malnutrition, hunger, food waste, sustainability and consumer health.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
