Advertisement

Micronutrient intake from enteral nutrition in critically ill adults: A systematic review of randomised controlled trials

  • Lina Breik
    Affiliations
    Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Level 3, 555 St Kilda Rd, Melbourne, VIC, 3004, Australia

    Nutrition and Dietetics Department, Box Hill Hospital, Eastern Health, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia
    Search for articles by this author
  • Oana A. Tatucu-Babet
    Affiliations
    Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Level 3, 555 St Kilda Rd, Melbourne, VIC, 3004, Australia
    Search for articles by this author
  • Emma J. Ridley
    Correspondence
    Corresponding author. Postal address: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Level 3, 555 St Kilda Rd, Melbourne, VIC, 3004, Australia.
    Affiliations
    Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Level 3, 555 St Kilda Rd, Melbourne, VIC, 3004, Australia

    Nutrition Department, Alfred Hospital, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
    Search for articles by this author
Published:October 27, 2021DOI:https://doi.org/10.1016/j.aucc.2021.09.001

      Abstract

      Objectives

      The primary objective was to compare the intake of important micronutrients provided from enteral nutrition to critically ill patients with the Australia and New Zealand recommended dietary intakes. A secondary objective was to compare the upper levels of intake and investigate prespecified subgroups.

      Review method used

      A systematic literature review was performed.

      Data sources

      MEDLINE, EMBASE, CINAHL, and CENTRAL were used.

      Review methods

      Databases were searched for randomised controlled trials that investigated an enteral nutrition intervention as the sole source of nutrition, were published in English between January 2000 and January 8th, 2021, and provided data to calculate micronutrient intake. The primary outcome was the % recommended dietary intake. The quality of individual trials was assessed using the Cochrane Risk of Bias Tool. Outcomes are presented as either mean ± standard deviation or median [interquartile range], with a p < 0.05 considered statistically significant.

      Results

      Thirteen trials were included (n = 1538 patients). Trials investigating hypocaloric nutrition were excluded from the primary outcome assessment (conducted in nine trials (n = 1220)). All nine trials delivered ≥104% of the recommended dietary intakes and <100% of the upper level of intakes of all micronutrients. In subgroup analyses, trials with ≥80% target energy delivered a higher % of the recommended dietary intake of vitamin B12, thiamine, zinc, and vitamin C. Acute Physiology and Chronic Health Evaluation scores ≥20 delivered a higher % of the recommended dietary intake of vitamin B12 and vitamin A. Antioxidant formulas compared with standard formulas delivered a higher % recommended dietary intake of vitamin C and thiamine. In the four trials that investigated hypocaloric feeding compared with control, there was no difference in micronutrient intake. The quality was low.

      Conclusions

      Enteral nutrition delivery frequently met the recommended dietary intakes for all micronutrients investigated and did not exceed the upper levels of intake set for health.

      PROSPERO Registration

      CRD42020178333.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Australian Critical Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lambell K.J.
        • Tatucu-Babet O.A.
        • Chapple L.A.
        • Gantner D.
        • Ridley E.J.
        Nutrition therapy in critical illness: a review of the literature for clinicians.
        Crit Care. 2020; 24: 35
        • Casaer M.P.
        • Bellomo R.
        Micronutrient deficiency in critical illness: an invisible foe?.
        Intensive Care Med. 2019; 45: 1136-1139
      1. Introduction – what are the nutrient reference values? [Internet] Commonwealth Australia, Canberra.: The National Health and Medical Research Council; [updated 2017 22 September; cited 2020 10 June]. Available from: https://www.nrv.gov.au/node/50.

        • Berger M.M.
        • Pantet O.
        • Schneider A.
        • Ben-Hamouda N.
        Micronutrient deficiencies in medical and surgical inpatients.
        J Clin Med. 2019; 8: 931
        • Ridley E.J.
        • Peake S.L.
        • Jarvis M.
        • Deane A.M.
        • Lange K.
        • Davies A.R.
        • et al.
        Nutrition therapy in Australia and New Zealand intensive care units: an international comparison study.
        JPEN – J Parenter Enter Nutr. 2018; 42: 1349-1357
        • Gramlich L.
        • Kichian A.
        • PInilla J.
        • Rodych N.
        • Dhaliwal R.
        • Heyland D.
        Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature.
        Nutrition. 2004; 20: 843-848
        • Food for Special Medical Purposes
        Food standards Australia New Zealand.
        2010
        • Berger M.
        • Ben-Hamouda N.
        Trace element and vitamin deficiency: quantum medicine or essential prescription?.
        Curr Opin Crit Care. 2020; 26: 355-362
        • Mehta N.M.
        Micronutrients in critical illness: essential and enigmatic.
        Pediatr Crit Care Med. 2018; 19: 907-908
        • Oh W.C.
        • Mafrici B.
        • Rigby M.
        • Harvey D.
        • Sharman A.
        • Allen J.C.
        • et al.
        Micronutrient and amino acid losses during renal replacement therapy for acute kidney injury.
        Kidney Int Rep. 2019; 4: 1094-1108
        • Reintam Blaser A.
        • Malbrain M.L.
        • Starkopf J.
        • Fruhwald S.
        • Jakob S.M.
        • De Waele J.
        • et al.
        Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems.
        Intensive Care Med. 2012; 38: 384-394
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • Mulrow C.
        • Gotzsche P.
        • Ioannidis J.
        The PRISMA statement for reporting systemative reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339 (b2700)
        • Higgins J.
        • Green S.
        • Cochrane Collaboration
        Cochrane Handbook for systematic reviews of interventions.
        Wiley-Blackwell, Chichester, UK. Hoboken, NJ2008: 649
        • Tacconelli E.
        CRD's guidance for undertaking reviews in health care.
        Lancet Infect Dis. 2010; 10: 226
        • Simpson F.D.G.
        Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle.
        Intensive Care Med. 2005; 31: 12-23
        • Mousavian S.Z.
        • Pasdar Y.
        • Ranjbar G.
        • Jandari S.
        • Akhlaghi S.
        • Almasi A.
        • et al.
        Randomized controlled trial of comparative hypocaloric vs full-energy enteral feeding during the first week of hospitalization in neurosurgical patients at the intensive care unit.
        J Parenter Enteral Nutr. 2020 Nov; 44: 1475-1483
        • McKeever L.
        • Peterson S.J.
        • Lateef O.
        • Freels S.
        • Fonseca T.L.
        • Bocco B.
        • et al.
        Higher caloric exposure in critically ill patients transiently accelerates thyroid hormone activation.
        J Clin Endocrinol Metab. 2020; 105
        • Rice T.W.
        • Files D.C.
        • Morris P.E.
        • Bernard A.C.
        • Ziegler T.R.
        • Drover J.W.
        • et al.
        Dietary management of blood glucose in medical critically ill overweight and obese patients: an open-label randomized trial.
        JPEN – J Parenter Enter Nutr. 2019; 43: 471-480
        • Rugeles S.
        • Villarraga-Angulo L.G.
        • Ariza-Gutierrez A.
        • Chaverra-Kornerup S.
        • Lasalvia P.
        • Rosselli D.
        High-protein hypocaloric vs normocaloric enteral nutrition in critically ill patients: a randomized clinical trial.
        J Crit Care. 2016; 35: 110-114
      2. Vitamin B12 [Internet]. Commonwealth Australia, Canberra: The National Health and Medical Research Council; [updated 2018 31 January; cited 2020 14 June]. Available from: https://www.nrv.gov.au/nutrients/vitamin-b12.

      3. Thiamin [Internet]. Commonwealth Australia, Canberra: The National Health and Medical Research Council; [updated 2014 9 September; cited 2020 14 June]. Available from: https://www.nrv.gov.au/nutrients/thiamin.

      4. Converting units of measure for folate, niacin, and vitamins A, D, and E on the nutrition and supplement facts labels: guidance for industry. U.S. Department of Health and Human Services. Food and Drug Administration. Center for Food Safety and Applied Nutrition, 2019
        • Wan X.
        • Wang W.
        • Liu J.
        • Tong T.
        Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.
        BMC Med Res Methodol. 2014; 14
        • Griffiths R.
        • Bongers T.
        Nutrition support for patients in the intensive care unit.
        Postgrad Med. 2005; 81: 629-636
        • Drover J.
        • Cahill N.
        • Kutsogiannis D.
        • Pagliarello G.
        • Wischmeyer P.
        • Wang M.
        • et al.
        Nutrition therapy for the critically ill surgical patient: we need to do better!.
        JPEN – J Parenter Enteral Nutr. 2010; 34: 644-652
        • Iacone R.
        • Scanzano C.
        • Santarpia L.
        • D'Isanto A.
        • Contaldo F.
        • Pasanisi F.
        Micronutrient content in enteral nutrition formulas: comparison with the dietary reference values for healthy populations.
        Nutr J. 2016; 15: 30
        • Singer P.
        • Blaser A.R.
        • Berger M.M.
        • Alhazzani W.
        • Calder P.C.
        • Casaer M.P.
        • et al.
        ESPEN guideline on clinical nutrition in the intensive care unit.
        Clin Nutr. 2019; 38: 48-79
        • Desachy A.
        • Clavel M.
        • Vuagnat A.
        • Normand S.
        • Gissot V.
        • Francois B.
        Initial efficacy and tolerability of early enteral nutrition with immediate or gradual introduction in intubated patients.
        Intensive Care Med. 2008; 34: 1054-1059
        • Doola R.
        • Deane A.M.
        • Tolcher D.M.
        • Presneill J.J.
        • Barrett H.L.
        • Forbes J.M.
        • et al.
        The effect of a low carbohydrate formula on glycaemia in critically ill enterally-fed adult patients with hyperglycaemia: a blinded randomised feasibility trial.
        Clin Nutr ESPEN. 2019; 31: 80-87
        • Grau-Carmona T.
        • Moran-Garcia V.
        • Garcia-de-Lorenzo A.
        • Heras-de-la-Calle G.
        • Quesada-Bellver B.
        • Lopez-Martinez J.
        • et al.
        Effect of an enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid and anti-oxidants on the outcome of mechanically ventilated, critically ill, septic patients.
        Clin Nutr. 2011; 30: 578-584
        • Kieft H.
        • Roos A.N.
        • van Drunen J.D.
        • Bindels A.J.
        • Bindels J.G.
        • Hofman Z.
        Clinical outcome of immunonutrition in a heterogeneous intensive care population.
        Intensive Care Med. 2005; 31: 524-532
        • Pontes-Arruda A.
        • Aragao A.M.
        • Albuquerque J.D.
        Effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock.
        Crit Care Med. 2006; 34: 2325-2333
        • Shirai K.
        • Yoshida S.
        • Matsumaru N.
        • Toyoda I.
        • Ogura S.
        Effect of enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with sepsis-induced acute respiratory distress syndrome.
        J Intensive Care. 2015; 3: 24
        • Singer P.
        • Theilla M.
        • Fisher H.
        • Gibstein L.
        • Grozovski E.
        • Cohen J.
        Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury.
        Crit Care Med. 2006; 34: 1033-1038
        • Tuncay P.
        • Arpaci F.
        • Doganay M.
        • Erdem D.
        • Sahna A.
        • Ergun H.
        • et al.
        Use of standard enteral formula versus enteric formula with prebiotic content in nutrition therapy: a randomized controlled study among neuro-critical care patients.
        Clin Nutr. 2018; 25: 26-36
        • Wewalka M.
        • Drolz A.
        • Seeland B.
        • Schneeweiss M.
        • Schmid M.
        • Schneeweiss B.
        • et al.
        Different enteral nutrition formulas have no effect on glucose homeostasis but on diet-induced thermogenesis in critically ill medical patients: a randomized controlled trial.
        Eur J Clin Nutr. 2018; 72: 496-503
        • Abiles J.
        • de la Cruz A.P.
        • Castano J.
        • Rodriguez-Elvira M.
        • Aguayo E.
        • Moreno-Torres R.
        • et al.
        Oxidative stress is increased in critically ill patients according to antioxidant vitamins intake, independent of severity: a cohort study.
        Crit Care. 2006; 10: R146
        • Heyland D.K.
        • Dhaliwal R.
        • Suchner U.
        • Berger M.M.
        Antioxidant nutrients: a systematic review of trace elements and vitamins in the critically ill patient.
        Intensive Care Med. 2005; 31: 327-337
        • Manzanares W.
        • Dhaliwal R.
        • Jiang X.
        • Murch L.
        • Heyland D.K.
        Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis.
        Crit Care. 2012; 16: R66
        • Heyland D.
        • Muscedere J.
        • Wischmeyer P.E.
        • Cook D.
        • Jones G.
        • Albert M.
        • et al.
        A randomized trial of glutamine and antioxidants in critically ill patients.
        N Engl J Med. 2013; 368: 1489-1497
        • Fujii T.
        • Luethi N.
        • Young P.
        • Frei D.
        • Eastwood G.
        • French C.
        • et al.
        Effect of vitamin C, hydrocortisone, and thiamine vs hydrocortisone alone on time alive and free of vasopressor support among patients with septic shock: the VITAMINS randomized clinical trial.
        JAMA. 2020; 323
        • Andrews P.
        • Avenell A.
        • Nobel D.
        • Campbell M.
        • Croal B.
        • Simpson W.
        • et al.
        Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients.
        BMJ. 2011; : 342
        • Heyland D.
        • Elke G.
        • Cook D.
        • Berger M.M.
        • Wischmeyer P.
        • Albert M.
        • et al.
        Glutamine and antioxidants in the critically ill patient: a post hoc analysis of a large-scale randomized trial.
        JPEN – J Parenter Enteral Nutr. 2015; 39: 401-409
        • Masse M.-H.
        • Ménard J.
        • Sprague S.
        • Battista M.-C.
        • Cook D.J.
        • Guyatt G.H.
        • et al.
        Lessening Organ dysfunction with VITamin C (LOVIT): protocol for a randomized controlled trial.
        Trials. 2020; 21: 42
      5. Vitamin A [Internet]. Commonwealth Australia, Canberra: The National Health and Medical Research Council; [updated 2014 14 April; cited 2020 3 July]. Available from: https://www.nrv.gov.au/nutrients/vitamin-a.

        • Heyland D.K.
        • Dhaliwal R.
        • Drover J.W.
        • Gramlich L.
        • Dodek P.
        Canadian Critical Care Clinical Practice Guidelines C. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients.
        JPEN – J Parenter Enter Nutr. 2003; 27: 355-373
        • McClave S.A.
        • Taylor B.E.
        • Martindale R.G.
        • Warren M.M.
        • Johnson D.R.
        • Braunschweig C.
        • et al.
        Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).
        JPEN – J Parenter Enter Nutr. 2016; 40: 159-211
        • Taverny G.
        • Lescot T.
        • Pardo E.
        • Thonon F.
        • Maarouf M.
        • Alberti C.
        Outcomes used in randomised controlled trials of nutrition in the critically ill: a systematic review.
        Crit Care. 2019; 23: 12
        • Chapple L.
        • Summers M.
        • Weinel L.
        • Deane A.M.
        Outcome measures in critical care nutrition interventional trials: a systematic review.
        Nutr Clin Pract. 2020; 35