Greater Nutrient Intake Is Associated With Lower Mortality in Western and Eastern Critically Ill Patients With Low BMI: A Multicenter, Multinational Observational Study

JPEN J Parenter Enteral Nutr. 2019 Jan;43(1):63-69. doi: 10.1002/jpen.1180. Epub 2018 Jun 30.


Background: Little is known about the impact of feeding adequacy by NUTrition Risk in the Critically Ill (NUTRIC) groups in critically ill patients with body mass index (BMI) <20. Our purpose was to assess whether adequacy of protein/energy intake impacts mortality in patients with BMI <20 in Western/Eastern intensive care units (ICUs) and high/low NUTRIC groups.

Methods: Data from the International Nutrition Survey 2013-2014 were dichotomized into Western/Eastern ICU settings; BMI <20 or ≥20; and high (≥5)/low (<5) NUTRIC groups. Association of BMI <20 with 60-day mortality was compared in unadjusted and adjusted (Western/Eastern, age, medical/surgical admission, high/low NUTRIC group) logistic regression models. The impact of adequacy of protein/energy on 60-day mortality relationship was tested using general estimating equations in high/low NUTRIC groups, in unadjusted and adjusted models.

Results: Western (n = 4274) patients had higher mean BMI (27.9 ± 7.7 versus (vs) 23.4 ± 4.9, P < 0.0001) than Eastern (n = 1375), respectively. BMI <20 was associated with greater mortality (adjusted odds ratio [OR] 1.30, 95% confidence interval [CI] 1.07-1.57), with no interaction between BMI group and Western/Eastern ICU site. Among patients with BMI <20 and high NUTRIC score, 10% greater protein and energy adequacy was associated with 5.7% and 5.5% reduction in 60-day mortality, respectively. Results were not significantly different between Western and Eastern ICUs.

Conclusions: The benefit of greater protein/energy intake in high-NUTRIC patients was observed regardless of geographic origin or low BMI, suggesting a consistent response to nutrition support in this group. Clinical guidelines and research projects focused on improving care in high-risk critically ill patients can be applied across geographic boundaries.

Keywords: NUTrition Risk in the Critically Ill (NUTRIC) group; adequacy, energy/protein; body mass index; intensive care unit; mortality.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Americas
  • Australasia
  • Body Mass Index*
  • Critical Illness / mortality
  • Critical Illness / therapy*
  • Dietary Proteins / administration & dosage
  • Energy Intake*
  • Europe
  • Female
  • Hospitalization
  • Humans
  • Intensive Care Units*
  • Logistic Models
  • Male
  • Middle Aged
  • Nutrients / therapeutic use
  • Nutrition Surveys
  • Nutritional Status*
  • Nutritional Support*
  • Odds Ratio
  • Risk Factors
  • Thinness / complications*
  • Weight Loss


  • Dietary Proteins