Nutritional Status in Intensive Care Unit: A Meta-Analysis and Systematic Review

  • Mohammed Ibrahim Mohialdeen Gubari 1. Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
  • Mohammad Javad Hosseinzadeh-Attar 1. Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran 2. Centre of Research Excellence in Translating, Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
  • Mostafa Hosseini 3. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  • Fadhil Ahmed Mohialdeen 4. Community Health Department, Technical College of Health, Sulaimani Polytechnic University, Sulaimani, Iraq
  • Haval Othman 5. General Shar Teaching Hospital, ICU Unit, Sulaimani, Iraq
  • Khalid Anwar Hama-ghareeb 6. General Director of Health, Research Center Department, Sulaimani, Iraq
  • Abdolreza Norouzy 1. Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
Keywords: Nutritional Status; Intensive Care Unit; Systematic Review; Meta-Analysis


It is important to consider the nutritional status of patients in the intensive care unit (ICU) since it is a key element in the ability to overcome and survive critical illnesses and clinical outcomes. The aim of the present study was to provide a meta-analysis and systematic overview in determining the nutritional status of patients in ICU by examining other studies. All studies published during 2015-2019 on nutritional status in ICU were retrieved from Medline (via PubMed), Embase, Scopus, and Web of Science databases. Finally, 23 articles were included in the meta-analysis. Results obtained from these studies showed that the nutritional status of patients in ICU was inappropriate (the pooled proportion of malnutrition was 0.51 in the type of study stratified), in which many patients in this unit had different degrees of malnutrition (moderate-mild malnourished and severe malnutrition is 0.46 and 20%, respectively). According to the results of this study, the nutritional status of patients in ICU was unsatisfactory; hence, it is necessary to consider the nutritional status along with other therapeutic measures at the beginning of the patient’s admission.[GMJ.2020;9:e1678]


Huynh TN, Kleerup EC, Raj PP, Wenger NS. The opportunity cost of futile treatment in the intensive care unit. Crit Care Med. 2014;42(9):1977.

PMid:24810527 PMCid:PMC4134705

Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79.


Shabanpur M, Nachvak SM, Moradi S, Hedayati S, Hosseinikia M, Pasdar Y, et al. Nutritional Care in Iranian Intensive Care Units. Clin Nutr Res. 2018;7(2):136-45.

PMid:29713622 PMCid:PMC5921331

Weijs P, Mogensen K, Rawn J, Christopher K. Protein intake, nutritional status and outcomes in icu survivors: A single center cohort study. J Clin Med. 2019;8(1):43.

PMid:30621154 PMCid:PMC6352154

Fuhrmann K, Panamonta N, Roaten S. Malnutrition in the ICU: Current recommendations for the assessment of nutritional status and a review of the use of albumin as an indicator of malnutrition. The Southwest Respiratory and Critical Care Chronicles. 2013;1(4):8-14.

Webb A. Oxford textbook of critical care: Oxford University Press; 2016.

Berger MM, Pichard C. Best timing for energy provision during critical illness. Crit Care. 2012;16(2):215.

PMid:22429787 PMCid:PMC3681360

Shayesteh F, Poudineh S, Pouryazdanpanah-Kermani M, Sadat Ayoudi S, Norouzy A. Assessment of nutritional intake in intensive care unit patients of Ghaem hospital. Iran J Basic Med Sci. 2015;58(4):217-24.

Osooli F, Abbas S, Farsaei S, Adibi P. Identifying critically ill patients at risk of malnutrition and underfeeding: a prospective study at an academic hospital. Adv Pharm Bull. 2019; 9(2): 314-320.

PMid:31380259 PMCid:PMC6664107

Powers J, Samaan K. Malnutrition in the ICU patient population. Crit Care Nurs Clin North Am. 2014;26(2):227-42.


Verghese PP, Mathai AS, Abraham V, Kaur P. Assessment of malnutrition and enteral feeding practices in the critically ill: A single-centre observational study. Indian J Anaesth. 2018;62(1):29.

PMid:29416148 PMCid:PMC5787887

Singh N, Gupta D, Aggarwal AN, Agarwal R, Jindal SK. An assessment of nutritional support to critically ill patients and its correlation with outcomes in a respiratory intensive care unit. Respir Care. 2009;54(12):1688-96.

Ramprasad R, Kapoor MC. Nutrition in intensive care. J Anaesthesiol Clin Pharmacol. 2012;28(1):1.

PMid:22345935 PMCid:PMC3275938

Agarwal E, Ferguson M, Banks M, Bauer J, Capra S, Isenring E. Nutritional status and dietary intake of acute care patients: results from the Nutrition Care Day Survey 2010. Clin Nutr. 2012;31(1):41-7.


Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Jama. 2000;283(15):2008-12.


The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomizedstudies in meta-analyses. [

Sabbagh HJ, Hassan MH, Innes NP, Elkodary HM, Little J, Mossey PA. Passive smoking in the etiology of non-syndromic orofacial clefts: a systematic review and meta-analysis. PloS one. 2015;10(3):e0116963.

PMid:25760440 PMCid:PMC4356514

Viechtbauer W. Conducting meta-analyses in R with the metafor package. Journal of Statistical Software. 2010;36(3):1-48.

Michael Borenstein LH, Hannah Rothstein. Meta-Analysis Fixed effect vs. random effects. 2007.

Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629.

PMid:9310563 PMCid:PMC2127453

Begg CB, Mazumdar M. Operating Characteristics of a Rank Correlation Test for Publication Bias. Biometrics. 1994;50(4):1088-101.

Al-Kalaldeh M, Alghabeesh S, Suleiman K, Abu-Sharour L. Assessment of Nutritional Status of Critically Ill Patients Using the Malnutrition Universal Screening Tool and Phase Angle. Topics in Clin Nutr. 2018;33(2):134-43.

Auiwattanakul S, Chittawatanarat K, Chaiwat O, Morakul S, Kongsayreepong S, Ungpinitpong W, et al. Effects of nutrition factors on mortality and sepsis occurrence in a multicenter university-based surgical intensive care unit in Thailand (THAI-SICU study). Nutrition. 2019;58:94-9.


Ceniccola G, Holanda T, Pequeno R, Mendonça V, Oliveira A, Carvalho L, et al. Relevance of AND-ASPEN criteria of malnutrition to predict hospital mortality in critically ill patients: A prospective study. J Crit Care. 2018;44:398-403.


Coltman A, Peterson S, Roehl K, Roosevelt H, Sowa D. Use of 3 tools to assess nutrition risk in the intensive care unit. JPEN J Parenter Enteral Nutr. 2015;39(1):28-33.


Santos HVDd, Araújo ISd. Impact of protein intake and nutritional status on the clinical outcome of critically ill patients. Rev Bras Ter Intensiva. 2019;31(2):210-6.

Fetterplace K, Deane AM, Tierney A, Beach LJ, Knight LD, Presneill J, et al. Targeted full energy and protein delivery in critically ill patients: a pilot randomized controlled trial (FEED trial). JPEN J Parenter Enteral Nutr. 2018;42(8):1252-62.


Hiura G, Lebwohl B, Seres DS. Malnutrition Diagnosis in Critically Ill Patients Using 2012 Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Standardized Diagnostic Characteristics Is Associated With Longer Hospital and Intensive Care Unit Length of Stay and Increased In-Hospital Mortality. JPEN J Parenter Enteral Nutr. 2020;44(2):256-264.


Hope AA, Hsieh S, Petti A, Hurtado-Sbordoni M, Verghese J, Gong MN. Assessing the usefulness and validity of frailty markers in critically ill adults. Ann Am Thorac Soc. 2017;14(6):952-9.

PMid:28358584 PMCid:PMC5566304

Kalaiselvan M, Renuka M, Arunkumar A. Use of nutrition risk in critically ill (nutric) score to assess nutritional risk in mechanically ventilated patients: A prospective observational study. Indian J Crit Care Med. 2017;21(5):253.

PMid:28584426 PMCid:PMC5455016

Kanekiyo S, Takeda S, Iida M, Nishiyama M, Kitahara M, Shindo Y, et al. Efficacy of perioperative immunonutrition in esophageal cancer patients undergoing esophagectomy. Nutrition. 2019;59:96-102.


Karst FP, Vieira RM, Barbiero S. Relationship between adductor pollicis muscle thickness and subjective global assessment in a cardiac intensive care unit. Rev Bras Ter Intensiva. 2015;27(4):369-75.

PMid:26761475 PMCid:PMC4738823

Lazarow H, Nicolo M, Compher C, Kucharczuk CR, Stadtmauer EA, Landsburg DJ. Nutrition-Related Outcomes for Autologous Stem Cell Transplantation Patients. Clin Lymphoma Myeloma Leuk. 2019.


Lew CCH, Cheung KP, Chong MFF, Chua AP, Fraser RJ, Miller M. Combining 2 commonly adopted nutrition instruments in the critical care setting is superior to administering either one alone. JPEN J Parenter Enteral Nutr. 2018;42(5):872-6.


Lew C, Wong G, Cheung K, Chua A, Chong M, Miller M. Association between malnutrition and 28-day mortality and intensive care length-of-stay in the critically ill: a prospective cohort study. Nutrients. 2018;10(1):10.

PMid:29295506 PMCid:PMC5793238

Lew CCH, Wong GJY, Cheung KP, Fraser RJ, Chua AP, Chong MFF, et al. The association between nutritional adequacy and 28-day mortality in the critically ill is not modified by their baseline nutritional status and disease severity. Crit Care. 2019;23(1):222.

PMid:31215498 PMCid:PMC6580600

Marshall AP, Lemieux M, Dhaliwal R, Seyler H, MacEachern KN, Heyland DK. Novel, Family-Centered Intervention to Improve Nutrition in Patients Recovering From Critical Illness: A Feasibility Study. Nutr Clin Pract. 2017;32(3):392-9.


Rus VA, Chitu M, Cernea S, Benedek I, Hodas R, Zavate R, et al. Altered nutritional status, inflammation and systemic vulnerability in patients with acute myocardial infarction undergoing percutaneous coronary revascularisation: A prospective study in a level 3 cardiac critical care unit. Rus VA, Chitu M, Cernea S, Benedek I, Hodas R, Zavate R, et al. Altered nutritional status, inflammation and systemic vulnerability in patients with acute myocardial infarction undergoing percutaneous coronary revascularisation: A prospective study in a level 3 cardiac critical care unit. Nutrition & Dietetics. 2019.


Sharma Y, Miller M, Kaambwa B, Shahi R, Hakendorf P, Horwood C, et al. Factors influencing early and late readmissions in Australian hospitalised patients and investigating role of admission nutrition status as a predictor of hospital readmissions: a cohort study. BMJ open. 2018;8(6):e022246.

PMid:29950478 PMCid:PMC6020977

Vallejo KP, Martínez CM, Adames AAM, Fuchs-Tarlovsky V, Nogales GCC, Paz RER, et al. Current clinical nutrition practices in critically ill patients in Latin America: a multinational observational study. Crit Care. 2017;21(1):227.

PMid:28841885 PMCid:PMC6389103

Velayati A, Shariatpanahi MV, Shahbazi E, Shariatpanahi ZV. The association between preoperative nutritional status and postoperative delirium in individuals with coronary artery bypass graft surgery: A Prospective Cohort Study. Nutrition. 2019.


Velayati A, Vahdat Shariatpanahi M, Shahbazi E, Vahdat Shariatpanahi Z. Association between preoperative nutritional status and postoperative delirium in individuals with coronary artery bypass graft surgery: A prospective cohort study. Nutrition. 2019;66:227-32.


Martins RCFdC, Vital WC, Amaral JFd, Volp ACP. Perfil nutricional de pacientes internados em unidade de terapia intensiva. 2017.

de Queiroz Fischer M, Poll FA. Relação entre o estado nutricional, nutrição precoce, hiperglicemia e desfecho clínico de pacientes internados em uma unidade de terapia intensiva. Revista de Epidemiologia e Controle de Infecção. 2019;9(1).

Lucas MCS, Fayh APT. Nutritional status, hyperglycemia, early nutrition, and mortality of patients hospitalized in an intensive care unit. Rev Bras Ter Intensiva. 2012;24(2):157-61.


Costa CA, Tonial CT, Garcia PCR. Association between nutritional status and outcomes in critically-ill pediatric patients-a systematic review. Jornal de pediatria. 2016;92(3):223-9.


Mo YH, Rhee J, Lee E-K. Effects of nutrition support team services on outcomes in ICU patients. Yakugaku Zasshi. 2011;131(12):1827-33.


Park YE, Park SJ, Park Y, Cheon JH, Kim TI, Kim WH. Impact and outcomes of nutritional support team intervention in patients with gastrointestinal disease in the intensive care unit. Medicine. 2017;96(49).

PMid:29245235 PMCid:PMC5728850

Terblanche E. The role of dietitians in critical care. J Intensive Care Soc. 2018:1751143718774715.

PMid:31447920 PMCid:PMC6693112

Sioson MS, Martindale R, Abayadeera A, Abouchaleh N, Aditianingsih D, Bhurayanontachai R, et al. Nutrition therapy for critically ill patients across the Asia-Pacific and Middle East regions: A consensus statement. Clin Nutr ESPEN. 2018;24:156-64.


Doig GS, Simpson F, Finfer S, Delaney A, Davies AR, Mitchell I, et al. Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial. Jama. 2008;300(23):2731-41.


Barr J, Hecht M, Flavin KE, Khorana A, Gould MK. Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol. Chest. 2004;125(4):1446-57.


Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36(1):49-64.


How to Cite
Gubari, M. I. M., Hosseinzadeh-Attar, M. J., Hosseini, M., Mohialdeen, F. A., Othman, H., Hama-ghareeb, K. A., & Norouzy, A. (2020). Nutritional Status in Intensive Care Unit: A Meta-Analysis and Systematic Review. Galen Medical Journal, 9, e1678.
Review Article