In a recent study done by the ICU team in King Abdulaziz Medical City entitled "The Impact of Hypocaloric Diet with Intensive Insulin Therapy on Mortality and Morbidity in Adult Critically Ill Patients" and published on January 26 online issue of the American Journal of Clinical Nutrition, it was found that in critically ill patients permissive underfeeding may be associated with lower mortality rates than target feeding. However, the appropriate caloric intake for critically ill patients remains ill defined.
Dr. Yaseen Arabi and colleagues from King Saud bin Abdulaziz University for Health Sciences randomly assigned 240 critically ill patients to permissive enteral underfeeding, with a target caloric goal of 60% to 70% of calculated requirement, or target enteral feeding, where the target caloric goal was 90% to 100% of calculated need. The patients were evenly divided to four groups and were well-matched for baseline characteristics.
Hospital mortality rate was significantly lower in the underfeeding arm than the target feeding arm and the 28-day all-cause mortality rate (the primary endpoint) was also lower. The same was also true for the 180-day mortality rate.
Twenty-eight-day all-cause mortality was 18.3% in the permissive underfeeding group compared with 23.3% in the target feeding group (relative risk: 0.79; 95% CI: 0.48, 1.29; P = 0.34). Hospital mortality was lower in the permissive underfeeding group than in the target group (30.0% compared with 42.5%, respectively; relative risk: 0.71; 95% CI: 0.50, 0.99; P = 0.04). No significant differences in outcomes were observed between the IIT and CIT groups.