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Nutritional Risk Screening Recommendations for Critically Ill Patients: A Meta-Research Study and Quality Appraisal
Audrey Machado Dos Reis1, Millena Dorneles Pinheiro1, Daniela Barbieri Hauschild1
1Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
None:
Clinical practice guidelines (CPGs) are essential tools to support evidence-based nutritional care in critically ill patients; however, the methodological quality and credibility of recommendations for nutritional risk screening remain unclear. This study aimed to evaluate the methodological quality of CPGs addressing nutritional risk screening in critically ill adults and to critically appraise the evidence supporting these recommendations. A systematic search was conducted between January and April 2026 in Embase, PubMed, SciELO, Scopus, LILACS, Google Scholar, and guideline repositories. CPGs, consensus statements, and position papers, including nutritional risk screening recommendations for critically ill adults were eligible. Guideline quality was assessed using the AGREE II and AGREE-REX instruments. Original studies and systematic reviews supporting nutritional risk screening recommendations were critically appraised using ROBINS-E and AMSTAR 2, respectively. Four CPGs were included. AGREE II assessment demonstrated satisfactory methodological quality overall, particularly in Scope and Purpose (84.4%) and Clarity of Presentation (92.0%), whereas Applicability showed the lowest performance (50.0%). AGREE-REX evaluation demonstrated moderate overall recommendation quality (64.8%), with the Chinese Society of Critical Care Medicine guideline presenting the highest score (77.8%). Most original studies supporting recommendations were classified as having high or very high risk of bias, and one systematic review was classified as critically low confidence. Although the included guidelines demonstrated satisfactory methodological quality, important limitations were identified regarding recommendation credibility, applicability, and evidence quality. These findings highlight the need for higher-quality evidence synthesis, transparent risk-of-bias assessment, and improved implementation strategies in future guideline development.
