• Anwar Elias Owais, Syed Irfan Kabir, Clare Mcnaught, Marcel Gatt, and John MacFie.
• The Combined Gastroenterology Research Unit, Scarborough General Hospital, Woodlands Drive, Scarborough YO12 6QL, United Kingdom.
• Clin Nutr. 2014 Dec 1; 33 (6): 997-1001.

Background & AimsThe importance of adequate nutritional support is well established, but characterising what 'adequate nutrition' represents remains contentious. In recent years there has been increasing interest in the concept of 'permissive underfeeding' where patients are intentionally prescribed less nutrition than their calculated requirements. The aim of this study was to evaluate the effect of permissive underfeeding on septic and nutrition related morbidity in patients requiring short term parenteral nutrition (PN).MethodsThis was a single-blinded randomised clinical trial of 50 consecutive patients requiring parenteral nutritional support. Patients were randomized to receive either normocaloric or hypocaloric feeding (respectively 100% vs. 60% of estimated requirements). The primary end point was septic complications. Secondary end points included the metabolic, physiological and clinical outcomes to the two feeding protocols.ResultsPermissive underfeeding was associated with fewer septic complications (3 vs. 12 patients; p = 0.003), and a lower incidence of the systemic inflammatory response syndrome (9 vs. 16 patients; p = 0.017). Permissively underfed patients had fewer feed related complications (2 vs. 9 patients; p = 0.016).ConclusionPermissive underfeeding in patients requiring short term PN appears to be safe and may results in reduced septic and feed-related complications.Trial RegistrationNCT01154179 TRIAL REGISTRY: http://clinicaltrials.gov/ct2/show/NCT01154179.Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

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