Nutrition delivery during hospitalisation after critical illness in Australia and New Zealand: a multicentre, prospective observational study

Emma J Ridley; Kate Ainscough; Michael Bailey; Rebecca Baskett; Allison Bone; Lewis Campbell; Eleanor Capel; Lee-Anne Chapple; Andrew Cheng; Adam M Deane; Ra'eesa Doola; Suzie Ferrie; Kate Fetterplace; Eileen Gilder; Alisa M Higgins; Carol L Hodgson; Victoria King; Andrea P Marshall; Alistair Nichol; Sandra Peake; Mahesh Ramanan; Ary Serpa Neto; Andrew Udy; Patricia Williams; Jacinta Winderlich; Paul J Young; NUTRIENT Study Investigators and ANZICS Clinical Trials Group

doi:10.1111/jhn.13385

Nutrition delivery during hospitalisation after critical illness in Australia and New Zealand: a multicentre, prospective observational study

J Hum Nutr Diet. 2025 Feb;38(1):e13385. doi: 10.1111/jhn.13385.

Authors

Emma J Ridley^{1

2}, Kate Ainscough³, Michael Bailey¹, Rebecca Baskett⁴, Allison Bone^{1

5}, Lewis Campbell^{6

7}, Eleanor Capel⁸, Lee-Anne Chapple^{9

10}, Andrew Cheng^{11

12}, Adam M Deane^{13

14}, Ra'eesa Doola^{15

16

17}, Suzie Ferrie^{18

19}, Kate Fetterplace^{14

20}, Eileen Gilder^{4

21}, Alisa M Higgins^{1

22}, Carol L Hodgson^{1

22

23

24}, Victoria King¹, Andrea P Marshall^{25

26}, Alistair Nichol^{1

3

27}, Sandra Peake^{1

10

28}, Mahesh Ramanan^{22

29

30}, Ary Serpa Neto^{1

31

32

33}, Andrew Udy^{1

27}, Patricia Williams^{1

10

28}, Jacinta Winderlich^{1

34

35}, Paul J Young^{1

24

36

37}; NUTRIENT Study Investigators and ANZICS Clinical Trials Group

Affiliations

¹ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
² Dietetics and Nutrition, The Alfred, Melbourne, Victoria, Australia.
³ Clinical Research Centre, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin, Ireland.
⁴ Cardiovascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.
⁵ Intensive Care Unit, University Hospital Geelong, Geelong, Australia.
⁶ Intensive Care Unit, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
⁷ Menzies School of Health Research, Darwin, Northern Territory, Australia.
⁸ Dietetics Department, Northeast Health Wangaratta, Wangaratta, Australia.
⁹ Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
¹⁰ Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
¹¹ Department of Intensive Care, The St George Hospital, Kogarah, New South Wales, Australia.
¹² Intensive Care Unit, Shoalhaven District Memorial Hospital, Nowra, New South Wales, Australia.
¹³ Intensive Care Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
¹⁴ Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁵ Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia.
¹⁶ Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
¹⁷ PA-Southside Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
¹⁸ Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
¹⁹ School of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
²⁰ Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
²¹ School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
²² Critical Care Division, The George Institute for Global Health, Sydney, New South Wales, Australia.
²³ Physiotherapy Department, The Alfred, Melbourne, Victoria, Australia.
²⁴ Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia.
²⁵ Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia.
²⁶ School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia.
²⁷ Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
²⁸ Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
²⁹ Caboolture and the Prince Charles Hospitals, Metro North Hospital and Health Services, Brisbane, Queensland, Australia.
³⁰ James Mayne Academy of Critical Care, The University of Queensland, St Lucia, Queensland, Australia.
³¹ Department of Intensive Care, Austin Hospital, Melbourne, Australia.
³² Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia.
³³ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
³⁴ Nutrition and Dietetics, Monash Children's Hospital, Melbourne, Victoria, Australia.
³⁵ Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, VIC, Australia.
³⁶ Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.
³⁷ Medical Research Institute of New Zealand, Wellington, New Zealand.

PMID: 39587763
DOI: 10.1111/jhn.13385

Abstract

Background and aims: Energy and protein provision for critically ill patients who receive oral nutrition often falls below recommended targets. We compared characteristics and nutrition processes during hospital stay (within and post-intensive care unit [ICU] stay) of those who received oral nutrition as the sole nutrition source to those who first commenced enteral (EN) or parenteral nutrition (PN) within an Australian or New Zealand (ANZ) ICU.

Methods: Multicentre, observational study of routine nutrition care in 44 hospitals across ANZ, including adult patients within ICU admitted for at least 48 h. Those receiving oral nutrition as the sole source of nutrition (with or without oral nutrition supplements) were included in the 'oral nutrition' group and those who first received EN and/or PN in the ICU as the 'EN/PN group'. The primary outcome was median daily energy delivery in ICU. Data are presented as number (%) or median [interquartile range].

Results: Of the 409 patients enroled, median [IQR] age was 64 [51-74] years and 257 patients (62%) were male. APACHE II score, use of invasive ventilation and hospital length of stay (LOS) were all lower in those receiving oral nutrition (n = 200) compared to those receiving EN/PN (n = 209). In ICU, 63 (31.5%) and 169 (81%) (p < 0.001), patients who were receiving oral nutrition and in the EN/PN group received a nutrition assessment, respectively. Oral nutrition supplements were provided for 40 (20%) patients in the oral nutrition group and 31 of 94 (33%) of those receiving oral nutrition in the EN/PN group (p = 0.019). Energy and protein intake in ICU for the oral nutrition group was 716 [597-1069] kcal/day and 37 [19-46] g/day versus 1158 [664-1583] kcal/day and 57 [31-77] g/day for those receiving EN/PN (p = 0.020 energy, p = 0.016 protein). Quantification of oral nutrition was attempted in 78/294 (27%) patients in ICU and completed on 27/78 (36%) occasions. On the ward, attempts were made for 120/273 (44%) patients, with 60/120 (50%) complete.

Conclusion: Patients who received oral nutrition as the sole nutrition source in ICU had lower illness severity, rates of nutrition assessment and provision of oral supplements compared to those who first received EN/PN. Quantification of oral nutrition was often incomplete for all patients in ICU and on the ward.

Keywords: critical illness; enteral nutrition; nutrition practice; oral nutrition; parenteral nutrition.

Publication types

Observational Study
Multicenter Study

MeSH terms

APACHE
Aged
Australia
Critical Care / methods
Critical Care / statistics & numerical data
Critical Illness* / therapy
Dietary Proteins / administration & dosage
Energy Intake*
Enteral Nutrition* / methods
Enteral Nutrition* / statistics & numerical data
Female
Hospitalization* / statistics & numerical data
Humans
Intensive Care Units* / statistics & numerical data
Length of Stay* / statistics & numerical data
Male
Middle Aged
New Zealand
Nutritional Status
Parenteral Nutrition* / statistics & numerical data
Prospective Studies

Substances

Dietary Proteins

Abstract

Publication types

MeSH terms

Substances

Grants and funding