The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials
Background: The optimal protein dose in critical illness is unknown. We aim to conduct a systematic review of randomized controlled trials (RCTs) to compare the effect of higher versus lower protein delivery (with similar energy delivery between groups) on clinical and patient-centered outcomes in c...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BioMed Central
2021
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| Online Access: | http://psasir.upm.edu.my/id/eprint/95389/ http://psasir.upm.edu.my/id/eprint/95389/1/The%20effect%20of%20higher%20versus%20lower%20protein%20delivery%20in%20critically%20ill%20patients.pdf |
| _version_ | 1848862146832629760 |
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| author | Zheng, Yii Lee Cindy, Sing Ling Yap Hasan, M. Shahnaz Engkasan, Julia Patrick Barakatun-Nisak, Mohd Yusof Day, Andrew G. Patel, Jayshil J. Heyland, Daren K. |
| author_facet | Zheng, Yii Lee Cindy, Sing Ling Yap Hasan, M. Shahnaz Engkasan, Julia Patrick Barakatun-Nisak, Mohd Yusof Day, Andrew G. Patel, Jayshil J. Heyland, Daren K. |
| author_sort | Zheng, Yii Lee |
| building | UPM Institutional Repository |
| collection | Online Access |
| description | Background: The optimal protein dose in critical illness is unknown. We aim to conduct a systematic review of randomized controlled trials (RCTs) to compare the effect of higher versus lower protein delivery (with similar energy delivery between groups) on clinical and patient-centered outcomes in critically ill patients. Methods: We searched MEDLINE, EMBASE, CENTRAL and CINAHL from database inception through April 1, 2021.We included RCTs of (1) adult (age ≥ 18) critically ill patients that (2) compared higher vs lower protein with (3) similar energy intake between groups, and (4) reported clinical and/or patient-centered outcomes. We excluded studies on immunonutrition. Two authors screened and conducted quality assessment independently and in duplicate. Random-effect meta-analyses were conducted to estimate the pooled risk ratio (dichotomized outcomes) or mean difference (continuous outcomes). Results: Nineteen RCTs were included (n = 1731). Sixteen studies used primarily the enteral route to deliver protein. Intervention was started within 72 h of ICU admission in sixteen studies. The intervention lasted between 3 and 28 days. In 11 studies that reported weight-based nutrition delivery, the pooled mean protein and energy received in higher and lower protein groups were 1.31 ± 0.48 vs 0.90 ± 0.30 g/kg and 19.9 ± 6.9 versus 20.1 ± 7.1 kcal/kg, respectively. Higher vs lower protein did not significantly affect overall mortality [risk ratio 0.91, 95% confidence interval (CI) 0.75-1.10, p = 0.34] or other clinical or patient-centered outcomes. In 5 small studies, higher protein significantly attenuated muscle loss (MD -3.44% per week, 95% CI -4.99 to -1.90; p < 0.0001). Conclusion: In critically ill patients, a higher daily protein delivery was not associated with any improvement in clinical or patient-centered outcomes. Larger, and more definitive RCTs are needed to confirm the effect of muscle loss attenuation associated with higher protein delivery. PROSPERO registration number: CRD42021237530. |
| first_indexed | 2025-11-15T13:12:23Z |
| format | Article |
| id | upm-95389 |
| institution | Universiti Putra Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-15T13:12:23Z |
| publishDate | 2021 |
| publisher | BioMed Central |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | upm-953892023-01-04T08:30:03Z http://psasir.upm.edu.my/id/eprint/95389/ The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials Zheng, Yii Lee Cindy, Sing Ling Yap Hasan, M. Shahnaz Engkasan, Julia Patrick Barakatun-Nisak, Mohd Yusof Day, Andrew G. Patel, Jayshil J. Heyland, Daren K. Background: The optimal protein dose in critical illness is unknown. We aim to conduct a systematic review of randomized controlled trials (RCTs) to compare the effect of higher versus lower protein delivery (with similar energy delivery between groups) on clinical and patient-centered outcomes in critically ill patients. Methods: We searched MEDLINE, EMBASE, CENTRAL and CINAHL from database inception through April 1, 2021.We included RCTs of (1) adult (age ≥ 18) critically ill patients that (2) compared higher vs lower protein with (3) similar energy intake between groups, and (4) reported clinical and/or patient-centered outcomes. We excluded studies on immunonutrition. Two authors screened and conducted quality assessment independently and in duplicate. Random-effect meta-analyses were conducted to estimate the pooled risk ratio (dichotomized outcomes) or mean difference (continuous outcomes). Results: Nineteen RCTs were included (n = 1731). Sixteen studies used primarily the enteral route to deliver protein. Intervention was started within 72 h of ICU admission in sixteen studies. The intervention lasted between 3 and 28 days. In 11 studies that reported weight-based nutrition delivery, the pooled mean protein and energy received in higher and lower protein groups were 1.31 ± 0.48 vs 0.90 ± 0.30 g/kg and 19.9 ± 6.9 versus 20.1 ± 7.1 kcal/kg, respectively. Higher vs lower protein did not significantly affect overall mortality [risk ratio 0.91, 95% confidence interval (CI) 0.75-1.10, p = 0.34] or other clinical or patient-centered outcomes. In 5 small studies, higher protein significantly attenuated muscle loss (MD -3.44% per week, 95% CI -4.99 to -1.90; p < 0.0001). Conclusion: In critically ill patients, a higher daily protein delivery was not associated with any improvement in clinical or patient-centered outcomes. Larger, and more definitive RCTs are needed to confirm the effect of muscle loss attenuation associated with higher protein delivery. PROSPERO registration number: CRD42021237530. BioMed Central 2021-07-23 Article PeerReviewed text en http://psasir.upm.edu.my/id/eprint/95389/1/The%20effect%20of%20higher%20versus%20lower%20protein%20delivery%20in%20critically%20ill%20patients.pdf Zheng, Yii Lee and Cindy, Sing Ling Yap and Hasan, M. Shahnaz and Engkasan, Julia Patrick and Barakatun-Nisak, Mohd Yusof and Day, Andrew G. and Patel, Jayshil J. and Heyland, Daren K. (2021) The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Critical Care, 25. art. no. 260. pp. 1-15. ISSN 1466-609X https://ccforum.biomedcentral.com/articles/10.1186/s13054-021-03693-4 10.1186/s13054-021-03693-4 |
| spellingShingle | Zheng, Yii Lee Cindy, Sing Ling Yap Hasan, M. Shahnaz Engkasan, Julia Patrick Barakatun-Nisak, Mohd Yusof Day, Andrew G. Patel, Jayshil J. Heyland, Daren K. The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials |
| title | The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials |
| title_full | The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials |
| title_fullStr | The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials |
| title_full_unstemmed | The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials |
| title_short | The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials |
| title_sort | effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials |
| url | http://psasir.upm.edu.my/id/eprint/95389/ http://psasir.upm.edu.my/id/eprint/95389/ http://psasir.upm.edu.my/id/eprint/95389/ http://psasir.upm.edu.my/id/eprint/95389/1/The%20effect%20of%20higher%20versus%20lower%20protein%20delivery%20in%20critically%20ill%20patients.pdf |