Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Japan; Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Japan.
Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Japan.
Clin Nutr. 2024 Oct;43(10):2399-2406. doi: 10.1016/j.clnu.2024.09.023. Epub 2024 Sep 12.
BACKGROUND & AIMS: High-fat, low-carbohydrate enteral nutrition has gained attention, with expectations of an improved respiratory condition, fewer complications, and lower mortality. The present study performed a systematic review and meta-analysis of randomized controlled trials to examine the effects of high-fat, low-carbohydrate enteral nutrition in critically ill adult patients.
We searched MEDLINE via Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), and ICHUSHI for randomized controlled trials comparing high-fat, low-carbohydrate enteral nutrition to standard enteral nutrition in critically ill adult patients who received enteral nutrition. The primary outcome was mortality. Secondary outcomes included intensive care unit (ICU) mortality, length of ICU stay, length of mechanical ventilation, and adverse events of diarrhea and gastric residual volume. We examined the risk of bias using the Cochrane risk-of-bias tool for randomized trials version 2. We assessed the overall certainty of evidence based on the Grading of Recommendations Assessment, Development, and Evaluation methodology. Synthesis results were calculated with risk ratios and 95% confidence intervals using a Mantel-Haenszel random-effects model.
Eight trials with 607 patients were included. The effects of high-fat, low-carbohydrate enteral nutrition on mortality did not significantly differ from those of standard enteral nutrition (62/280 [22.1%] vs. 39/207 [18.8%], risk ratios = 1.14, 95% confidence intervals 0.80 to 1.62, P = 0.47). No significant differences were observed in ICU mortality, ICU length of stay, diarrhea, or gastric residual volume between the two groups. However, high-fat, low-carbohydrate enteral nutrition was associated with a significantly shorter duration of mechanical ventilation (mean difference -1.72 days, 95% confidence intervals -2.93 to -0.50, P = 0.005).
High-fat, low-carbohydrate enteral nutrition may not affect mortality, but may decrease the duration of mechanical ventilation in critically ill adult patients. Limitations include the small number of studies and potential for bias. Further research is needed to confirm these results and investigate effects on other outcomes and in a subgroup of patients requiring mechanical ventilation.
高脂肪、低碳水化合物的肠内营养受到关注，人们期望它能改善呼吸状况、减少并发症和降低死亡率。本研究对随机对照试验进行了系统评价和荟萃分析，以检查高脂肪、低碳水化合物的肠内营养对接受肠内营养的危重症成年患者的影响。
我们通过 MEDLINE 旗下的 Pubmed、Cochrane 对照试验中心注册库（CENTRAL）和 ICHUSHI 检索了比较高脂肪、低碳水化合物肠内营养与标准肠内营养在接受肠内营养的危重症成年患者中的随机对照试验。主要结局是死亡率。次要结局包括重症监护病房（ICU）死亡率、ICU 住院时间、机械通气时间以及腹泻和胃残留量的不良事件。我们使用 Cochrane 随机对照试验风险偏倚工具评估了风险偏倚，并根据推荐评估、制定与评价（GRADE）方法评估证据的总体确定性。使用 Mantel-Haenszel 随机效应模型，计算风险比和 95%置信区间来综合结果。
纳入了 8 项试验，共 607 例患者。高脂肪、低碳水化合物肠内营养对死亡率的影响与标准肠内营养无显著差异（62/280 [22.1%] vs. 39/207 [18.8%]，风险比 1.14，95%置信区间 0.80 至 1.62，P=0.47）。两组间 ICU 死亡率、ICU 住院时间、腹泻或胃残留量无显著差异。然而，高脂肪、低碳水化合物肠内营养与机械通气时间明显缩短相关（平均差-1.72 天，95%置信区间-2.93 至-0.50，P=0.005）。
高脂肪、低碳水化合物的肠内营养可能不会影响死亡率，但可能会缩短危重症成年患者机械通气的持续时间。本研究的局限性包括研究数量少和存在偏倚的可能性。需要进一步的研究来证实这些结果，并研究其对其他结局以及需要机械通气的患者亚组的影响。
