• Nutrition · Sep 2020

    Failure to achieve proteic goals in non-critical patients increases risk for death: Old discussion, ongoing problem.

    • Nayara Cristina da Silva, Letícia Oliveira Cardoso, Cinara Knychala Muniz, Isaías Valente Prestes, and Geórgia das Graças Pena.
    • Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil.
    • Nutrition. 2020 Sep 1; 77: 110894.

    ObjectivesProviding adequate nutritional support for hospitalized patients continues to be a challenge. The aim of this study was to evaluate the association of energy and protein provision with in-hospital mortality in non-critically ill patients.MethodsA retrospective study (2014-2016) was performed with all patients >18 y of age who were admitted to medical and surgical clinic wards and given exclusive enteral therapy. The mean of energy and protein was estimated per day and per kilogram of body mass from the enteral prescription data, over the entire period of hospitalization. A prescription mean was considered hypocaloric or hypoproteic at <20 kcal · kg · d-1 or <0.8 g · kg · d-1, respectively.ResultsOf the 240 patients, 58.3% were >60 y of age and 60% were men. The frequencies of in-hospital mortality (19.2%) and malnutrition (78.8%) were high. The means of protein (0.75 g· kg· d-1) and energy (17.60 kcal · kg · d-1) were below the general recommendations and 37.8% did not reach a mean of 20 kcal · kg · d-1 during the entire hospitalization period. Hypocaloric (hazard ratio [HR], 5.78; 95% confidence interval [CI], 1.59-21.04) and hypoproteic nutrition (HR, 3.69; 95% CI, 1.25-10.93) were predictors of all-cause in-hospital mortality in adjusted multivariate models. However, when we adjusted the hypoprotein nutrition by energy (non-protein calories to nitrogen ratio), hypoprotein nutrition seems to maintain the increased risk for death (HR, 3.15; 95% CI, 1.04-9.53).ConclusionsHypoproteic nutrition appears to be more significant than hypocaloric nutrition in predicting all-cause in-hospital mortality. Protocols should be implemented to ensure that target caloric and protein levels are reached as quickly as possible to optimize patient survival.Copyright © 2020 Elsevier Inc. All rights reserved.

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