We urge caution in overinterpreting the randomized trial by Braunschweig et al 1 published in the Journal of Parenteral and Enteral Nutrition. From a single center, a total of 78 patients were randomized to an intensive medical nutrition therapy (IMNT) designed to provide patients >75% of their estimated energy and protein requirements compared with standard care. At the first interim analysis, the investigators observed a statistically significant increase in mortality in the INMT group compared with standard nutrition care (40% vs 16%, P = .02). Randomized trials that are terminated prematurely are likely to significantly overestimate the treatment effect. 2 Moreover, a small study from 1 center has limited generalizability and should not inform practice patterns worldwide. In our opinion, to draw the conclusion that "provision of IMNT to hospital discharge increases mortality" seems premature. Nevertheless, the results cannot be ignored, and further questions about this trial are warranted.We note that with very broad inclusion criteria (patients aged ≥18 years with acute lung injury), there was no intention to enroll nutritionally "at-risk" patients 3 and that most were normo-nourished, with a body mass index that is shown to be insensitive to the provision of macronutrients. 4 When trying to understand the results of this trial, we think it is important to separate the nutrition intervention into its components. Patients were moderately dosed with protein and received only approximately 82 g/d or <1 g/kg/d-it is implausible that such protein doses are associated with harm, especially given recent recommendations for doses around 2-2.5 g/kg/d. 5 Patients were targeted to receive 30 kcal/kg and received approximately 85% of their prescriptions. From examination of Figure 2, it appears that some patients received more than 100% of their prescription, which is already high since most guidelines recommend 20-25 kcal/kg/d. Moreover, we note that patients in the IMNT group received more parenteral nutrition (PN) and significantly more parenteral lipids. If these are soybean-based emulsions, this may explain the excess mortality. 6 It may be useful to report the rates of overfeeding per group and the amount of calories from parenteral and enteral sources rather than just combined. We think it is also important to separate the INMT intervention into its 2 phases: in the intensive care unit (ICU) and following extubation or post-ICU discharge. Can the investigators report the % calorie and protein received in these 2 phases separately? As the investigators note, the increased mortality was due to early deaths or an early separation in the survival curves. It is difficult to fathom how optimal nutrition intake in the post-ICU phase of this study caused an early separation of the survival curves.Our main concern is that this study may represent overfeeding with parenteral calories in a normo-nourished or low-nutrition risk patient population in the early phase of critical illness. We acknowledge this may not be a benefi...