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Practical implications of "personalized nutrition therapy".

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Indirect calorimetry (IC) offers precise energy targets for personalized nutrition therapy in the ICU, but predictive equations (PEs) are more common. Evidence for early IC use remains inconclusive, suggesting a need for new patient identifiers.

Keywords:
critical careindirect calorimetrynutritionpersonalized nutrition therapypredictive equations

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Area of Science:

  • Critical care medicine
  • Nutritional science
  • Metabolic research

Background:

  • Personalized nutrition therapy in ICUs often defaults to indirect calorimetry (IC), but predictive equations (PEs) are more prevalent due to practical constraints.
  • A shift in critical illness nutrition support questions the necessity of exact energy targets for personalized therapy.

Purpose of the Study:

  • To review evidence comparing IC and PE-based nutrition support in ICUs.
  • To examine practical issues like timing, patient selection, and nutrition adequacy.
  • To redefine the focus of personalized nutrition therapy in critical care.

Main Methods:

  • Systematic reviews and meta-analyses from 2020-2025 were analyzed.
  • Evidence comparing indirect calorimetry (IC) and predictive equations (PEs) for nutrition support in the ICU was examined.
  • Practical considerations and outcomes of IC vs. PEs were highlighted.

Main Results:

  • Systematic reviews show mixed results: some suggest IC reduces short-term mortality, while others indicate increased mechanical ventilation days.
  • IC-based protocols tend to deliver more calories than PE-based methods, risking overfeeding.
  • Significant discrepancies between measured and predicted energy expenditure exist in special populations (burns, obesity, elderly).

Conclusions:

  • Indirect calorimetry (IC) provides more accurate metabolic demand assessment than PEs, particularly in complex patients, but faces logistical challenges and uncertainty regarding optimal calorie targets.
  • Current evidence for early IC implementation in the ICU is inconclusive.
  • Future personalized critical care nutrition may rely on novel patient identifiers (phenotypic, metabolomic, mechanistic).