Nutrition Interventions to Support Oral Intake in Acute and Critical Care: A Systematic Review of Randomized...

Critical care research has primarily focused on patients receiving artificial nutrition, despite insufficient nutrition provision for orally fed patients. Oral nutrition strategies used in other hospitalized populations may benefit critically ill patients.

This systematic review examined the effect of oral nutrition interventions on hospital mortality in adults admitted to the intensive care unit (ICU) or acute ward.

A systematic review and meta-analysis (CRD42024558960) were conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology. Four databases were searched (from June 1, 2024, to May 21, 2025) for randomized controlled trials investigating oral nutrition interventions that significantly improved energy and/or protein intake in critically ill or acutely hospitalized patients.

The primary outcome was hospital mortality. Secondary outcomes included intakes of energy (kcal/d) and protein (g/d) and mortality at the latest time point. The Cochrane Risk of Bias 2 Tool was used to assess bias. Standardized mean differences were pooled via random effects models for continuous outcomes and odds ratios (ORs) via fixed-effects for binomial outcomes.

Sixteen trials (3795 participants) were included, all from acute care. One study had low overall bias, while most showed some concerns or high risk. No trials were performed exclusively within ICU settings; therefore, the evidence was entirely derived from acute care settings. Interventions in acute settings were associated with improved hospital mortality (3 trials: OR, 0.50; 95% CI, 0.25-0.98; P = .04), energy provision (8 trials: mean difference, 240.50 kcal/d; 95% CI, 121.27-359.73; P = .002), protein provision (7 trials: mean difference, 12.10 g/d; 95% CI, 6.01-18.18; P = .003), and mortality at the latest time point (9 trials: OR, 0.75; 95% CI, 0.59, 0.96, P = .02).

Oral nutrition interventions in acute care that improved energy and/or protein intake were associated with improved mortality. However, evidence quality was limited; few trials were available and interventions were heterogenous. Further robust trials are required to confirm these findings and assess applicability to critical care.

PROSPERO registration No. [CRD42024558960].