Micronutrient intake from enteral nutrition in critically ill adult patients: A retrospective observational study

Breik, Lina; Tatucu-Babet, Oana A.; Paul, Eldho; Duke, Graeme; Elliott, Andrea; Ridley, Emma J.

doi:10.1016/j.nut.2021.111543

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…Micronutrient administration during ICU stay is generally compared with the dietary reference intake (DRI) doses for healthy individuals. An observational study in 57 ICU patients on enteral nutrition for 5 days showed that delivery met the DRI for vitamin B12, vitamin C, thiamine and iron but not for vitamin D, vitamin A, folate, zinc and selenium [11]: of note, energy targets were covered in 47% of patients [11]. Further, a systematic review of the micronutrient intakes in nine RCTs with 1220 patients [12] shows that 104% of the DRI were delivered for vitamin B12, thiamine, zinc and vitamin C. So-called 'antioxidant formulas' delivered higher doses of vitamins C and B1 compared with standard formulas [12].…”

Section: Micronutrient Status and Intakementioning

confidence: 99%

An update on essential micronutrients in critical illness

Berger

2023

Current Opinion in Critical Care

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Purpose of review Numerous micronutrients are involved in antioxidant and immune defence, while their blood concentrations are frequently low in critically ill patients: this has fuelled many supplementation trials. Numerous observational, randomized studies have been published, which are presented herein. Recent findings Micronutrient concentrations must be analysed considering the context of the inflammatory response in critical illness. Low levels do not always indicate a deficiency without objective micronutrients losses with biological fluids. Nevertheless, higher needs and deficiencies are frequent for some micronutrients, such as thiamine, vitamins C and D, selenium, zinc and iron, and have been acknowledged with identifying patients at risk, such as those requiring continuous renal replacement therapy (CRRT). The most important trials and progress in understanding have occurred with vitamin D (25(OH)D), iron and carnitine. Vitamin D blood levels less than 12 ng/ml are associated with poor clinical outcomes: supplementation in deficient ICU patients generates favourable metabolic changes and decreases mortality. Single high-dose 25(OH)D should not be delivered anymore, as boluses induce a negative feedback mechanism causing inhibition of this vitamin. Iron-deficient anaemia is frequent and can be treated safely with high-dose intravenous iron under the guidance of hepcidin to confirm deficiency diagnosis. Summary The needs in critical illness are higher than those of healthy individuals and must be covered to support immunity. Monitoring selected micronutrients is justified in patients requiring more prolonged ICU therapy. Actual results point towards combinations of essential micronutrients at doses below upper tolerable levels. Finally, the time of high-dose micronutrient monotherapy is probably over.

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Section: Micronutrient Status and Intakementioning

confidence: 99%

An update on essential micronutrients in critical illness

Berger

2023

Current Opinion in Critical Care

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“…The micronutrient content in enteral formulas may be above or below the needs of patients with stable clinical conditions. In particular, the deviation from the DRIs should be given more attention for patients on long‐term enteral nutrition support, which may result in the clinical effects of deficiency or excess of micronutrients (Breik, Tatucu‐Babet, Paul, et al, 2022a ; Breik, Tatucu‐Babet, & Ridley, 2022b ; Casae & Bellomo, 2019 ). For this reason, an evaluation of the amount of vitamins, mineral elements, and trace elements in the currently available products widely used in clinical practice requires consideration.…”

Section: Introductionmentioning

confidence: 99%

Comparison of micronutrients in adult enteral formulas widely used in clinical practice

Yang

Hou²,

Sun³

et al. 2023

Food Science & Nutrition

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In recent decades, great progress in the area of enteral nutrition has provided a large variety and commercial availability of enteral formulas, usually produced by the nutrition divisions of several pharmaceutical or dairy manufacturers, with specific compositions for each type of disease or patient condition. Despite the widespread use of enteral formulas, both in hospitals and at home, studies performed on the micronutrient compositions of adult enteral formulas are few in China. The content of micronutrients in 31 commercially available adult enteral formulas in the Chinese market was compared with the Chinese dietary reference intakes (DRIs), the tolerable upper limits (UL), the limit requirements in Food Safety National Standards General Rules of Foods for Special Medical Purposes (GB 29922‐2013), and the European Society for Clinical Nutrition and Metabolism (ESPEN) micronutrient guideline (2022). The micronutrient content was calculated by multiplying the value provided on the nutrition label for each product by the daily energy dose of 1500 and 1800 Kcal/day. The research results showed that most adult enteral formulas were generally suitable for patients on long‐term total enteral nutrition support in the Chinese market, and foods for special medical purpose (FSMP) formulas were more suitable than enteral nutrition preparation (ENP) formulas. However, the vitamin D, vitamin K, and iron content in these formulas should be appropriately increased to the limit recommended by the ESPEN micronutrient guideline. The results could provide a basis for manufacturers to research and develop more suitable enteral formulas and help clinical dietitians administer more effective enteral nutrition support for patients on long‐term total enteral nutrition in clinical practice, especially individualized treatment.

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New randomized controlled trials on micronutrients in critical care nutrition: A narrative review

Halim,

Huang,

Lee

et al. 2024

Nut in Clin Prac

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There has been increasing interest in the role of micronutrient supplementation in critical care. This narrative review summarizes the recent studies on micronutrients in critically ill patients. We searched two databases for primary randomized controlled trials that investigated the effects of micronutrient supplementation in patients with critical illness published from January 2021 to August 2023. Personal files, reference lists of included studies, and previous reviews were also screened. Twelve studies reported on vitamin C, four studies on vitamin D, three studies on thiamin, two studies on multivitamins, and one study on cobalamin. The therapeutic effects of vitamin C appear mixed, although vitamin C monotherapy appears more promising than vitamin C combination therapy. Intramuscular administration of vitamin D appeared to lower mortality, mechanical ventilation duration, and intensive care unit stay, whereas enteral administration showed limited clinical benefits. Intravenous thiamin was not associated with improved outcomes in patients with septic shock or hypophosphatemia. Preliminary evidence suggests reduced vasopressor dose with cobalamin. Decreased disease severity and hospital stay in patients with COVID‐19 with vitamins A–E requires further investigation, whereas providing solely B‐group vitamins did not demonstrate therapeutic effects. It is currently premature to endorse the provision of high‐dose micronutrients in critical illness to improve clinical outcomes. This review may help to inform the design of future trials that will help better elucidate the optimal dosage and form of micronutrients, methods of administration, and subgroups of patients with critical illness who may most benefit.

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Micronutrient intake from enteral nutrition in critically ill adult patients: A retrospective observational study

Cited by 3 publications

References 16 publications

An update on essential micronutrients in critical illness

An update on essential micronutrients in critical illness

Comparison of micronutrients in adult enteral formulas widely used in clinical practice

New randomized controlled trials on micronutrients in critical care nutrition: A narrative review

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