Early vs delayed enteral nutrition or parenteral nutrition in hospitalized patients: An umbrella review of systematic reviews and meta‐analyses of randomized trials

Zeraattalab-Motlagh, Sheida; Vajdi, Mahdi; Nielsen, Sabrina Mai; Talebi, Ali; Ghavami, Abed; Moradi, Sajjad; Sadeghi, Erfan; Ranjbar, Mahsa; Habibi, Sajedeh; Sadeghi, Sara; Mohammadi, Hamed

doi:10.1002/ncp.10976

Cited by 7 publications

(6 citation statements)

References 100 publications

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“…The absence of EN induces a distinct change in the mucosal architecture, which impairs the gastrointestinal barrier [3]. Early EN (EEN) effectively reduces the incidence of infectious complications because EN maintains intestinal immune function [4,5].…”

Section: Introductionmentioning

confidence: 99%

Effects of early enteral nutrition on persistent inflammation, immunosuppression, and catabolism syndrome in critically ill patients

Kashiwagi,

Kanda,

Yoshida

et al. 2024

Preprint

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Purpose: Early enteral nutrition (EEN) is controversial whether to reduce infectious complications via preserving intestinal immunity in critically ill patients. Herein, we investigated the association between EEN and an immunocompromised state after critical illness as persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Methods: This propensity score matching analysis utilized the administrative claims database of inpatients. Patients admitted to the intensive care unit (ICU) for more than 3 consecutive days were included. A composite of mortality and PICS: at least two of the following conditions of CRP >2.0 mg/dL, albumin <3.0 g/dL and a lymphocyte count <800/μL on day 14 after admission, was compared as the primary outcome between the EEN group, which received enteral nutrition (EN) on the first 3 days (day 0, 1, or 2), and the late EN (LEN) group, which received EN on days 3 through 7. Results: 7,530 matched pairs were generated. The primary outcome was significantly lower in the EEN group (risk difference -3.0%, 95% confidence interval (CI) -4.5 to -1.4%), whereas mortality did not significantly differ. The 28-day composite outcome was also similar. There was no significant difference in in-hospital mortality between the EEN and LEN groups; however, the Barthel index at discharge was higher in the EEN group (the medians, 50 vs 45, P=0.001). Laboratory data showed lower Albumin and CRP on day 14 in the EEN group. Conclusions: EEN was associated with a lower incidence of PICS on days 14 and 28 in the critically ill patients.

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Section: Introductionmentioning

confidence: 99%

Effects of early enteral nutrition on persistent inflammation, immunosuppression, and catabolism syndrome in critically ill patients

Kashiwagi,

Kanda,

Yoshida

et al. 2024

Preprint

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“…Preclinical studies have demonstrated that earlier enteral nutrition can protect human intestinal epithelial barrier function ( 15 , 16 ). For hospitalized patients, early enteral nutrition may be beneficial ( 17 ). A recent study found that early administration of enteral nutrition reduces the incidence of ventilator-associated pneumonia in patients with severe trauma who require invasive ventilation ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

Early versus delayed enteral nutrition in ICU patients with sepsis: a propensity score-matched analysis based on the MIMIC-IV database

Xu,

et al. 2024

Front. Nutr.

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BackgroundEarly enteral nutrition (EN) is recommended for sepsis management, but its optimal timing and clinical benefits remain uncertain. This study evaluates whether early EN improves outcomes compared to delayed EN in patients with sepsis.MethodsWe analyzed data of septic patients from the MIMIC-IV 2.2 database, focusing on those in the Medical Intensive Care Unit (MICU) and Surgical Intensive Care Unit (SICU). Patients who initiated EN within 3 days were classified into the early EN group, while those who started EN between 3 and 7 days were classified into the delayed EN group. Propensity score matching was used to compare outcomes between the groups.ResultsAmong 1,111 patients, 786 (70.7%) were in the early EN group and 325 (29.3%) were in the delayed EN group. Before propensity score matching, the early EN group demonstrated lower mortality (crude OR = 0.694; 95% CI: 0.514–0.936; p = 0.018) and shorter ICU stays (8.3 [5.2, 12.3] vs. 10.0 [7.5, 14.2] days; p < 0.001). After matching, no significant difference in mortality was observed. However, the early EN group had shorter ICU stays (8.3 [5.2, 12.4] vs. 10.1 [7.5, 14.2] days; p < 0.001) and a lower incidence of AKI stage 3 (49.3% vs. 55.5%; p = 0.030). Subgroup analysis revealed that early EN significantly reduced the 28-day mortality rate in sepsis patients with lactate levels ≤4 mmol/L, with an adjusted odds ratio (aOR) of 0.579 (95% CI: 0.361, 0.930; p = 0.024).ConclusionEarly enteral nutrition may not significantly reduce overall mortality in sepsis patients but may shorten ICU stays and decrease the incidence of AKI stage 3. Further research is needed to identify specific patient characteristics that benefit most from early EN.

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“…Preclinical studies have demonstrated that earlier enteral nutrition can protect human intestinal epithelial barrier function [15,16]. For hospitalized patients, early enteral nutrition may be beneficial [17]. A recent study found that early administration of enteral nutrition reduces the incidence of ventilator-associated pneumonia in patients with severe trauma who require invasive ventilation [18].…”

Section: Introductionmentioning

confidence: 99%

Early versus delayed enteral nutrition in ICU patients with sepsis: a propensity score- matched analysis based on the MIMIC-IV database

Xu,

et al. 2023

Preprint

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Background Nutrition therapy is an integral part of the management of patients with sepsis. Recently, published guidelines recommend early initiation of enteral nutrition in adults with sepsis who can be fed enterally. However, early enteral nutrition's optimal timing and clinical benefits are still unclear. This study aimed to evaluate whether early enteral nutrition improves clinical outcomes in patients with sepsis compared with delayed enteral nutrition. Methods We utilized data from septic patients in the Medical Information Mart for Intensive Care (MIMIC)-IV 2.2 database and categorized those who began enteral nutrition (EN) within 3 days of admission to the ICU as the early enteral nutrition (EEN) group and those who began EN between 3–7 days after ICU admission as the delayed enteral nutrition (DEN) group. The main outcome was 28-day mortality. We conducted propensity score-matched analyses to compare outcomes between the two groups. Subgroup analyses were performed to determine whether different groups of septic patients had better outcomes with early enteral nutrition. Results We identified 2267 eligible patients, including 1594 patients (70.3%) in the early EN group and 673 (29.7%) in the delayed EN group. Before propensity matching, we found that the EEN group had lower 28-day mortality than the DEN group (crude OR = 0.789 (0.637–0.977); p = 0.030), fewer ICU stays (8.36 (5.00-12.99) vs. 10.42 (7.83-15.00); p < 0.001), and a lower incidence of stage 3 AKI (35.1% vs. 50.2%; p < 0.001). After propensity score matching, there was no significant difference in 28-day mortality (OR = 0.808 (0.622–1.050); p = 0.111). However, the duration of ICU stay in the early EN group was still lower than that in the delayed EN group (8.83 (5.03-13.00) vs. 10.41 (7.83–14.89); p < 0.001), and the incidence of stage 3 AKI was lower (39.6% vs. 49.3%; p < 0.001). Subgroup analysis showed that the MICU group (adjusted OR = 0,631 (0,428-0,930); p = 0.020) and the male group (adjusted OR = 0,668 (0,455-0,981), p = 0,040) were associated with reduced 28-day mortality with early enteral nutrition. Conclusions For septic patients, early enteral nutrition may not reduce mortality. However, early enteral nutrition reduced the ICU length of stay and incidence of stage 3 AKI in sepsis patients. We also found that patients with sepsis in the MICU and males may benefit more from early enteral nutrition through subgroup analysis. Which patients with sepsis may benefit from early enteral nutrition needs to be further investigated.

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Early vs delayed enteral nutrition or parenteral nutrition in hospitalized patients: An umbrella review of systematic reviews and meta‐analyses of randomized trials

Cited by 7 publications

References 100 publications

Effects of early enteral nutrition on persistent inflammation, immunosuppression, and catabolism syndrome in critically ill patients

Effects of early enteral nutrition on persistent inflammation, immunosuppression, and catabolism syndrome in critically ill patients

Early versus delayed enteral nutrition in ICU patients with sepsis: a propensity score-matched analysis based on the MIMIC-IV database

Early versus delayed enteral nutrition in ICU patients with sepsis: a propensity score- matched analysis based on the MIMIC-IV database

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