SYSTEMATIC REVIEW article
Front. Nutr.
Sec. Clinical Nutrition
Effects of nutritional support on mortality in critically ill patients with different nutritional risks: a systematic review with meta-analysis
Provisionally accepted
- The First Hospital of Jilin University, Changchun, China
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Background: To explore appropriate nutritional support strategies for critically ill patients with different nutritional risks. Methods: We systematically searched PubMed, MEDLINE, Cochrane Library, and Embase from inception until May 19, 2025, that included critically ill patients with high risk (5-9) and low risk (0-4) groups based on the modified Nutrition Risk in the Critically Ill score. We extracted data on study characteristics, patient demographics and nutritional support details. The primary outcome was all-cause mortality after nutritional support among critically ill patients stratified by nutritional risk. Meta-regression was conducted to explore the influence of covariates on effect size and to identify potential sources of heterogeneity. Trial sequential analysis (TSA) was performed to assess the robustness and reliability of the pooled effect estimates. Results: Eleven eligible trials, with a total of 7,442 participants, were included in this systematic review. The meta-analysis demonstrated that high nutritional risk was significantly associated with increased mortality (OR: 2.26, 95%CI: 1.80–2.83, P< 0.0001). Adequate energy intake may associated with a significantly lower 28-day mortality in high nutritional risk patients (OR: 0.60, 95% CI: 0.38–0.94, P = 0.03). However, in randomized controlled trials, adequate energy support did not reduce 28-day mortality (OR: 1.09, 95%CI:0.74-1.60) or 90-day mortality (OR: 1.03, 95%CI:0.87-1.23) in high risk. Conclusion: The mNUTRIC score is a validated prognostic tool in critically ill patients, but its utility in guiding energy support remains limited.
Keywords: Nutritional Support, critically ill patients, mNUTRIC score, Energy Intake, PROTEIN INTAKE
Received: 16 Jul 2025; Accepted: 31 Oct 2025.
Copyright: © 2025 Bao, Wang, Li, Zhang and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hongxiang Li, li_hx@jlu.edu.cn
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