Commonly Used "Nutrition" Indicators Do Not Predict Outcome in the Critically Ill: A Systematic Review

Nutrition in Clinical Practice. 2013 Aug; 28(4):463-84. doi: 10.1177/0884533613486297.
Ferrie, S., & Allman-Farinelli, M.


Background: In everyday practice, clinicians use a variety of anthropometric, biochemical, and clinical indicators to monitor nutrition therapy, but these have limitations in the critically ill. This systematic review of randomized controlled trials aimed to assess whether commonly used anthropometric, biochemical, and clinical nutrition indicators are predictive of patient outcomes in the critically ill.

Materials and Methods: A computerized bibliographic search was performed using MEDLINE, EMBASE, and CINAHL from 1950 to December 2012, as well as a citation review of relevant articles. Randomized clinical trials of any nutrition interventions in critically ill patients were included if they reported any nutrition indicator after baseline and any clinically meaningful outcome variables. Information about study quality, setting, and findings was extracted using standardized protocols. Because of the heterogeneity of study characteristics, only a narrative synthesis was undertaken.

Results: Of 223 studies obtained with the search strategy, 2 independent reviewers identified selected 51 studies meeting the eligibility criteria. These reported indicators such as serum albumin, serum prealbumin (transthyretin), retinol-binding protein, transferrin, and lymphocytes. Thirty studies did not report a significant difference in clinical outcomes. Of the remainder, the number of studies supporting a statistical relationship between outcome and particular nutrition indicators was equal to, or outnumbered by, the studies not supporting such a relationship.

Conclusion: None of the commonly used nutrition monitoring parameters demonstrated consistent associations with outcome in randomized controlled trials. Development of nutrition indicators other than laboratory tests that are more closely linked to the patient's clinical progress should be a priority.

Information NutriBib

Reference work for leading, current and selected literature in the field of clinical nutrition

Publications on clinical nutrition have grown steadily in recent years and the scientific evidence has been improved by numerous observational as well as intervention studies. Various umbrella organisations, such as the Swiss Society for Clinical Nutrition (GESKES), the German Society for Nutritional Medicine (DGEM) or the European Society for Clinical Nutrition and Metabolism (ESPEN) publish guidelines on nutrition in various clinical situations at regular intervals. Thus, a large amount of literature is available for evidence-based nutritional medicine.

The NutriBib aims to filter out authoritative publications in the various fields of nutritional medicine and thus to provide an overview of the abundance of literature. A large number of experienced nutrition experts contributed to the selection of relevant sources and allow a broadly based selection. Nevertheless, the literature selection cannot be considered exhaustive. Specific literature can be found by entering search words (using the magnifying glass at the top right) or by searching the table of contents.

Is important literature still missing? We would be very pleased to hear from you:

List of abbreviations

DGEM German Society for Nutritional Medicine (German Deutsche Gesellschaft für Ernährungsmedizin)
GESKES  Swiss Society for Clinical Nutrition (German Gesellschaft für klinische Ernährung der Schweiz) 
ESPEN European Society of Clinicl Nutrition and Metabolism