Greater Nutrient Intake Is Associated With Lower Mortality in Western and Eastern Critically Ill Patients With Low BMI: A Multicenter, Multinational Observational Study

Charlene Compher, Jesse Chittams, Therese Sammarco, Naoki Higashibeppu, Takashi Higashiguchi, Daren K. Heyland

Research output: Contribution to journalArticle

Abstract

Background: Little is known about the impact of feeding adequacy by NUTrition Risk in the Critically Ill (NUTRIC) groups in critically ill patients with body mass index (BMI) <20. Our purpose was to assess whether adequacy of protein/energy intake impacts mortality in patients with BMI <20 in Western/Eastern intensive care units (ICUs) and high/low NUTRIC groups. Methods: Data from the International Nutrition Survey 2013–2014 were dichotomized into Western/Eastern ICU settings; BMI <20 or ≥20; and high (≥5)/low (<5) NUTRIC groups. Association of BMI <20 with 60-day mortality was compared in unadjusted and adjusted (Western/Eastern, age, medical/surgical admission, high/low NUTRIC group) logistic regression models. The impact of adequacy of protein/energy on 60-day mortality relationship was tested using general estimating equations in high/low NUTRIC groups, in unadjusted and adjusted models. Results: Western (n = 4274) patients had higher mean BMI (27.9 ± 7.7 versus (vs) 23.4 ± 4.9, P < 0.0001) than Eastern (n = 1375), respectively. BMI <20 was associated with greater mortality (adjusted odds ratio [OR] 1.30, 95% confidence interval [CI] 1.07–1.57), with no interaction between BMI group and Western/Eastern ICU site. Among patients with BMI <20 and high NUTRIC score, 10% greater protein and energy adequacy was associated with 5.7% and 5.5% reduction in 60-day mortality, respectively. Results were not significantly different between Western and Eastern ICUs. Conclusions: The benefit of greater protein/energy intake in high-NUTRIC patients was observed regardless of geographic origin or low BMI, suggesting a consistent response to nutrition support in this group. Clinical guidelines and research projects focused on improving care in high-risk critically ill patients can be applied across geographic boundaries.

LanguageEnglish
Pages63-69
Number of pages7
JournalJournal of Parenteral and Enteral Nutrition
Volume43
Issue number1
DOIs
Publication statusPublished - 01-01-2019

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Critical Illness
Observational Studies
Body Mass Index
Food
Mortality
Intensive Care Units
Energy Intake
Proteins
Logistic Models
Nutrition Surveys
Odds Ratio
Guidelines
Confidence Intervals
Research

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

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title = "Greater Nutrient Intake Is Associated With Lower Mortality in Western and Eastern Critically Ill Patients With Low BMI: A Multicenter, Multinational Observational Study",
abstract = "Background: Little is known about the impact of feeding adequacy by NUTrition Risk in the Critically Ill (NUTRIC) groups in critically ill patients with body mass index (BMI) <20. Our purpose was to assess whether adequacy of protein/energy intake impacts mortality in patients with BMI <20 in Western/Eastern intensive care units (ICUs) and high/low NUTRIC groups. Methods: Data from the International Nutrition Survey 2013–2014 were dichotomized into Western/Eastern ICU settings; BMI <20 or ≥20; and high (≥5)/low (<5) NUTRIC groups. Association of BMI <20 with 60-day mortality was compared in unadjusted and adjusted (Western/Eastern, age, medical/surgical admission, high/low NUTRIC group) logistic regression models. The impact of adequacy of protein/energy on 60-day mortality relationship was tested using general estimating equations in high/low NUTRIC groups, in unadjusted and adjusted models. Results: Western (n = 4274) patients had higher mean BMI (27.9 ± 7.7 versus (vs) 23.4 ± 4.9, P < 0.0001) than Eastern (n = 1375), respectively. BMI <20 was associated with greater mortality (adjusted odds ratio [OR] 1.30, 95{\%} confidence interval [CI] 1.07–1.57), with no interaction between BMI group and Western/Eastern ICU site. Among patients with BMI <20 and high NUTRIC score, 10{\%} greater protein and energy adequacy was associated with 5.7{\%} and 5.5{\%} reduction in 60-day mortality, respectively. Results were not significantly different between Western and Eastern ICUs. Conclusions: The benefit of greater protein/energy intake in high-NUTRIC patients was observed regardless of geographic origin or low BMI, suggesting a consistent response to nutrition support in this group. Clinical guidelines and research projects focused on improving care in high-risk critically ill patients can be applied across geographic boundaries.",
author = "Charlene Compher and Jesse Chittams and Therese Sammarco and Naoki Higashibeppu and Takashi Higashiguchi and Heyland, {Daren K.}",
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Greater Nutrient Intake Is Associated With Lower Mortality in Western and Eastern Critically Ill Patients With Low BMI : A Multicenter, Multinational Observational Study. / Compher, Charlene; Chittams, Jesse; Sammarco, Therese; Higashibeppu, Naoki; Higashiguchi, Takashi; Heyland, Daren K.

In: Journal of Parenteral and Enteral Nutrition, Vol. 43, No. 1, 01.01.2019, p. 63-69.

Research output: Contribution to journalArticle

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T1 - Greater Nutrient Intake Is Associated With Lower Mortality in Western and Eastern Critically Ill Patients With Low BMI

T2 - Journal of Parenteral and Enteral Nutrition

AU - Compher, Charlene

AU - Chittams, Jesse

AU - Sammarco, Therese

AU - Higashibeppu, Naoki

AU - Higashiguchi, Takashi

AU - Heyland, Daren K.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Little is known about the impact of feeding adequacy by NUTrition Risk in the Critically Ill (NUTRIC) groups in critically ill patients with body mass index (BMI) <20. Our purpose was to assess whether adequacy of protein/energy intake impacts mortality in patients with BMI <20 in Western/Eastern intensive care units (ICUs) and high/low NUTRIC groups. Methods: Data from the International Nutrition Survey 2013–2014 were dichotomized into Western/Eastern ICU settings; BMI <20 or ≥20; and high (≥5)/low (<5) NUTRIC groups. Association of BMI <20 with 60-day mortality was compared in unadjusted and adjusted (Western/Eastern, age, medical/surgical admission, high/low NUTRIC group) logistic regression models. The impact of adequacy of protein/energy on 60-day mortality relationship was tested using general estimating equations in high/low NUTRIC groups, in unadjusted and adjusted models. Results: Western (n = 4274) patients had higher mean BMI (27.9 ± 7.7 versus (vs) 23.4 ± 4.9, P < 0.0001) than Eastern (n = 1375), respectively. BMI <20 was associated with greater mortality (adjusted odds ratio [OR] 1.30, 95% confidence interval [CI] 1.07–1.57), with no interaction between BMI group and Western/Eastern ICU site. Among patients with BMI <20 and high NUTRIC score, 10% greater protein and energy adequacy was associated with 5.7% and 5.5% reduction in 60-day mortality, respectively. Results were not significantly different between Western and Eastern ICUs. Conclusions: The benefit of greater protein/energy intake in high-NUTRIC patients was observed regardless of geographic origin or low BMI, suggesting a consistent response to nutrition support in this group. Clinical guidelines and research projects focused on improving care in high-risk critically ill patients can be applied across geographic boundaries.

AB - Background: Little is known about the impact of feeding adequacy by NUTrition Risk in the Critically Ill (NUTRIC) groups in critically ill patients with body mass index (BMI) <20. Our purpose was to assess whether adequacy of protein/energy intake impacts mortality in patients with BMI <20 in Western/Eastern intensive care units (ICUs) and high/low NUTRIC groups. Methods: Data from the International Nutrition Survey 2013–2014 were dichotomized into Western/Eastern ICU settings; BMI <20 or ≥20; and high (≥5)/low (<5) NUTRIC groups. Association of BMI <20 with 60-day mortality was compared in unadjusted and adjusted (Western/Eastern, age, medical/surgical admission, high/low NUTRIC group) logistic regression models. The impact of adequacy of protein/energy on 60-day mortality relationship was tested using general estimating equations in high/low NUTRIC groups, in unadjusted and adjusted models. Results: Western (n = 4274) patients had higher mean BMI (27.9 ± 7.7 versus (vs) 23.4 ± 4.9, P < 0.0001) than Eastern (n = 1375), respectively. BMI <20 was associated with greater mortality (adjusted odds ratio [OR] 1.30, 95% confidence interval [CI] 1.07–1.57), with no interaction between BMI group and Western/Eastern ICU site. Among patients with BMI <20 and high NUTRIC score, 10% greater protein and energy adequacy was associated with 5.7% and 5.5% reduction in 60-day mortality, respectively. Results were not significantly different between Western and Eastern ICUs. Conclusions: The benefit of greater protein/energy intake in high-NUTRIC patients was observed regardless of geographic origin or low BMI, suggesting a consistent response to nutrition support in this group. Clinical guidelines and research projects focused on improving care in high-risk critically ill patients can be applied across geographic boundaries.

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