Efficacy of hypocaloric parenteral nutrition for surgical patients: A systematic review and meta-analysis

Jiang, Hua; Sun, Mingjian; Hefright, Brook; Chen, Wei; Lu, Charles Damien; Zeng, Jun

doi:10.1016/j.clnu.2011.05.006

Cited by 38 publications

(38 citation statements)

References 25 publications

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“…When the I 2 value was substantially lower in each stratified analysis, we compared the result of stratified analysis with the result of overall analysis. In such circumstances, our conclusion would be consistent with the result based on the homogenous and more methodologically rigorous trials [16]. Secondly, considering mortality is highly depends on the severity of condition when the patients were admitted and it is a core issue for any critical illness study, we therefore introduced a quantitative severity variant measurement method.…”

Section: Methodssupporting

confidence: 79%

“…The methodological quality assessment table below is based on the Cochrane Reviewers’ Handbook [14] and a modified Jadad scale (Table 2) [15,16]. The original Jadad scale is a 5-point system.…”

Section: Methodsmentioning

confidence: 99%

“…The original Jadad scale is a 5-point system. Because inadequate concealment of treatment allocation has been associated with an exaggeration of treatment effects, we decided to adopt a modified Jadad score scale, which assigns a maximum of 2 points for concealment [16,17]. Under this system, a maximum score of 7 was assigned.…”

Section: Methodsmentioning

confidence: 99%

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Is Omega-3 Fatty Acids Enriched Nutrition Support Safe for Critical Ill Patients? A Systematic Review and Meta-Analysis

et al. 2014

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Objective: To systematically review the effects of omega-3 poly unsaturated fatty acids (FA) enriched nutrition support on the mortality of critically illness patients. Methods: Databases of Medline, ISI, Cochrane Library, and Chinese Biomedicine Database were searched and randomized controlled trials (RCTs) were identified. We enrolled RCTs that compared fish oil enriched nutrition support and standard nutrition support. Major outcome is mortality. Methodological quality assessment was conducted based on Modified Jadad’s score scale. For control heterogeneity, we developed a method that integrated I2 test, nutritional support route subgroup analysis and clinical condition of severity. RevMan 5.0 software (The Nordic Cochrane Centre, Copenhagen, Denmark) was used for meta-analysis. Results: Twelve trials involving 1208 patients that met all the inclusion criteria. Heterogeneity existed between the trials. A random model was used, there was no significant effect on mortality RR, 0.82, 95% confidence interval (CI) (0.62, 1.09), p = 0.18. Knowing that the route of fish oil administration may affect heterogeneity, we categorized the trials into two sub-groups: parenteral administration (PN) of omega-3 and enteral administration (EN) of omega-3. Six trials administered omega-3 FA through PN. Pooled results indicated that omega-3 FA had no significant effect on mortality, RR 0.76, 95% CI (0.52, 1.10), p = 0.15. Six trials used omega-3 fatty acids enriched EN. After excluded one trial that was identified as source of heterogeneity, pooled data indicated omega-3 FA enriched EN significant reduce mortality, RR=0.69, 95% CI [0.53, 0.91] (p = 0.007). Conclusion: Omega-3 FA enriched nutrition support is safe. Due to the limited sample size of the included trials, further large-scale RCTs are needed.

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Section: Methodssupporting

confidence: 79%

Section: Methodsmentioning

confidence: 99%

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Is Omega-3 Fatty Acids Enriched Nutrition Support Safe for Critical Ill Patients? A Systematic Review and Meta-Analysis

et al. 2014

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“…RCTs in nonobese patients on PN have shown that permissive underfeeding in which 80% of caloric requirements are provided may reduce insulin resistance, avoid the potential for overfeeding, and improve outcome (72). In the past in the United States, the only parenteral lipid formulation available is a more inflammatory soy-based product, and as such simply withholding lipids over the first week of hospitalization may improve outcome (2).…”

Section: Role Of Pn In the Icu Settingmentioning

confidence: 98%

Feeding the Critically Ill Patient

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Martindale²,

Rice

et al. 2014

Critical Care Medicine

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Current evidence suggests that enteral nutrition, started as soon as possible after acute resuscitative efforts, may serve therapeutic roles beyond providing calories and protein. Although many new studies have further advanced our knowledge in this area, the appropriate level of standardization has not yet been achieved for nutrition therapy, as it has in other areas of critical care. Protocolized nutrition therapy should be modified for each institution based on available expertise, local barriers, and existing culture in the ICU to optimize evidence-based nutrition care for each critically ill patient.

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“…Despite its inability to prevent protein catabolism, perioperative hypocaloric nutrition may have clinical benefits, such as a reduced infectious complications and length of hospitalization. 109 Although little is known about the clinical advantage of early enteral nutrition after elective major surgery, some protocols, including ERAS programs advocate early recommencement of oral food intake. According to the results of one clinical trial, patients receiving preoperative carbohydrates and complete enteral feeding immediately after colorectal surgery remained normoglycemic and maintained a positive protein balance.…”

Section: Nutritionmentioning

confidence: 99%