BackgroundThis study aimed to evaluate the feasibility and validity of the Global Leadership Initiative on Malnutrition (GLIM) criteria in the intensive care unit (ICU).MethodsThis was a cohort study involving critically ill patients. Diagnoses of malnutrition by the Subjective Global Assessment (SGA) and GLIM criteria within 24 h after ICU admission were prospectively performed. Patients were followed up until hospital discharge to assess the hospital/ICU length of stay (LOS), mechanical ventilation duration, ICU readmission, and hospital/ICU mortality. Three months after discharge, the patients were contacted to record outcomes (readmission and death). Agreement and accuracy tests and regression analyses were performed.ResultsGLIM criteria could be applied to 377 (83.7%) of 450 patients (64 [54–71] years old, 52.2% men). Malnutrition prevalence was 47.8% (n = 180) by SGA and 65.5% (n = 247) by GLIM criteria, presenting an area under the curve equal to 0.835 (95% confidence interval [CI], 0.790–0.880), sensitivity of 96.6%, and specificity of 70.3%. Malnutrition by GLIM criteria increased the odds of prolonged ICU LOS by 1.75 times (95% CI, 1.08–2.82) and ICU readmission by 2.66 times (95% CI, 1.15–6.14). Malnutrition by SGA also increased the odds of ICU readmission and the risk of ICU and hospital death more than twice.ConclusionThe GLIM criteria were highly feasible and presented high sensitivity, moderate specificity, and substantial agreement with the SGA in critically ill patients. It was an independent predictor of prolonged ICU LOS and ICU readmission, but it was not associated with death such as malnutrition diagnosed by SGA.

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The American Society of Parenteral and Enteral Nutrition recommends nutritional risk (NR) screening in critically ill patients with NRS-2002 ≥ 3 as NR and ≥ 5 as high NR. The present study aimed to evaluate the predictive validity of different cut-off points of the NRS-2002 in the intensive care unit (ICU). A prospective cohort study was conducted with critically ill adult patients who were screened using the NRS-2002. Hospital and ICU length of stay (LOS), hospital and ICU mortality, and ICU readmission were evaluated as outcomes. Logistic and Cox regression analyses were performed to evaluate the prognostic value of NRS-2002, and an ROC curve was constructed to determine the best cut-off point for NRS-2002. A total of 374 patients (61.9±14.3 years, 51.1% males) were included in the study. Of these, 13.1% were classified as without NR, whereas 48.9% and 38.0% were classified as NR and high NR, respectively. An NRS-2002 score of ≥ 5 was associated with prolonged hospital LOS. The best cut-off point for NRS-2002 was a score ≥ 4, which was associated with prolonged hospital LOS (OR=2.13; 95% CI: 1.39–3.28), ICU readmission (OR=2.44; 95% CI: 1.14–5.22), ICU admission (HR=2.91; 95% CI: 1.47–5.78), and hospital mortality (HR=2.01; 95% CI: 1.24–3.25), but not with ICU prolonged LOS (p=0.688). Therefore, NRS-2002 ≥ 4 presented the most satisfactory predictive validity and should be considered for NR screening in the ICU setting. Future studies should confirm the cut-off point and its validity in predicting nutrition therapy interaction with outcomes.

Background: We aimed to evaluate the mean time to reach the energy (EAR) and protein (PAR) achievement rate among patients with coronavirus disease 2019 (COVID-19) who did or did not undergo prone position (PP) therapy in the first week of their stay in the intensive care unit (ICU), and the interaction of these nutrition therapy indicators on the association between PP and clinical outcomes. Methods: This cohort study used retrospective data collected from medical records of patients with COVID-19 admitted to the ICU (≥18 years). We collected nutrition data, clinical information, prescription of PP, and its frequency during the first week, and clinical outcomes.Results: PP therapy was administered to 75.2% of 153 patients (61.5 ± 14.8 years, 57.6% males) during the first week of their ICU stay. Patients who underwent PP reached nutrition therapy goals later (4 [3-6] vs 3 [2-4] days; P = 0.030) and had lower EAR (91.9 ± 25.7 vs 101.6 ± 84.0; P = 0.002) and PAR (88.0 ± 27.7 vs 98.1 ± 13.5; P = 0.009) in comparison to those who did not receive PP. Grouping patients who underwent PP according to the EAR (≥70% or <70%) did not show any differences in the incidence of ICU death, duration of mechanical ventilation, or ICU stay (P > 0.05). Conclusions:In this exploratory study, PP was associated with a delayed time to reach the nutrition target and the lowest EAR and estimated protein requirement on the seventh day of ICU stay in patients with COVID-19. Permissive enteral nutrition prescription in patients who underwent PP was not associated with worse clinical outcomes.

Background and AimsNutrition societies recommended remote hospital nutrition care during the coronavirus disease 2019 (COVID‐19) pandemic. However, the pandemic's impact on nutrition care quality is unknown. We aimed to evaluate the association between remote nutrition care during the first COVID‐19 wave and the time to start and achieve the nutrition therapy (NT) goals of critically ill patients.MethodsA cohort study was conducted in an intensive care unit (ICU) that assisted patients with COVID‐19 between May 2020 and April 2021. The remote nutrition care lasted approximately 6 months, and dietitians prescribed the nutrition care based on medical records and daily telephone contact with nurses who were in direct contact with patients. Data were retrospectively collected, patients were grouped according to the nutrition care delivered (remote or in person), and we compared the time to start NT and achieve the nutrition goals.ResultsOne hundred fifty‐eight patients (61.5 ± 14.8 years, 57% male) were evaluated, and 54.4% received remote nutrition care. The median time to start NT was 1 (1–3) day and to achieve the nutrition goals was 4 (3–6) days for both groups. The percentage of energy and protein prescribed on day 7 of the ICU stay concerning the requirements did not differ between patients with remote and patients with in‐person nutrition care [95.5% ± 20.4% × 92.1% ± 26.4% (energy) and 92.9% ± 21.9% × 86.9% ± 29.2% (protein); P > 0.05 for both analyses].ConclusionRemote nutrition care in patients critically ill with COVID‐19 did not impact the time to start and achieve the NT goals.