Dietary intake distribution patterns in post-intensive care patients

Adequate oral food intake remains a challenge in Intensive Care Unit (ICU) survivors on the general hospital ward, with evidence suggesting that daily energy and protein intake from oral food intake are inadequate during recovery from critical illness. Currently, limited evidence is available regarding meal intake distribution patterns and the impact of prolonged enteral tube feeding on oral intake in survivors of critical illness. This study aimed to: (1) investigate daily distribution of energy and protein intake patterns of oral meals; and (2) evaluate the impact of enteral tube feeding on oral food intake, including potential differences across mealtimes, in post-ICU patients during the first 14 days of recovery after critical illness on the ward.

This was a pre-post comparison of two prospective observational cohorts (PROSPECT-I and II) conducted at Hospital Gelderse Vallei (the Netherlands) before and after the implementation of a tailored nutrition protocol in post-ICU patients during recovery on the general hospital ward. Adult ICU survivors who stayed ≥72 h in the ICU and were receiving enteral tube feeding at ICU discharge were included. Daily energy and protein content from oral food consumption during the first 14 days post-ICU were analysed. Ordered and consumed intake data were pooled by mealtime (breakfast, lunch, and dinner) and intake distributions across mealtimes (within-group comparisons) were compared using the Kruskal-Wallis test, with Dunn's post-hoc test applied in case of significant differences.

Oral food consumption data from 90 participants (n = 24 pre-implementation and n = 66 post-implementation) with a median hospital stay of 10 days post-ICU discharge were analysed. For all ordered meals, median oral energy content ranged from approximately 481 to 555 kcal across main meals, and median oral protein content ranged from 22.1 g to 28.2 g. However, median energy intake from consumed meals ranged from 302 to 354 kcal, with no differences between specific meal moments (all p > 0.05). Absolute protein intake did not differ across meals (p = 0.423), with median values ranging from 14.5 to 15.0 g per mealtime. Following implementation of the tailored nutrition protocol, patients received enteral tube feeding for a longer duration (median 5 vs. 3 days, p = 0.002). Patients had lower energy and protein intake from oral food intake (both p < 0.001). The tailored nutrition intervention resulted in higher total daily energy (2115 vs. 1816 kcal, p < 0.001) and protein intake levels (108.1 vs. 91.5 g, p < 0.001).

Post-ICU patients showed an even distribution of energy and protein intake from oral food consumption throughout the day, suggesting a per-meal intake threshold. The introduction of a tailored nutrition protocol resulted in prolonged enteral tube feeding post-ICU, increased energy and protein adequacy, but reduced oral meal consumption.