Keywords
Intensive Care Unit
Trace Elements
Vitamins
Minerals
How to Cite
Copyright © | All rights reserved.
The journal holds the exclusive copyright for the publication of this article under the terms of Brazilian law 9610/98.
Partial reproduction
The use of parts of the texts, figures and questionnaire of the article is free, being mandatory the citation of the authors and journal.
Total reproduction
It is expressly prohibited and must be authorized by the journal.
Abstract
Objective: To assess the adequacy of micronutrients in patients admitted to the Intensive Care Unit (ICU) receiving exclusive enteral nutrition. Methods: Data were collected from electronic medical records and computerized databases. Micronutrient intake adequacy was evaluated using the Dietary Reference Intakes (DRIs). Results: The study included 179 patients hospitalized in the ICU receiving exclusive enteral nutrition, with a median age of 67 years (IQR = 58.00 - 76.00), and 57% were male. The most prevalent reason for admission was respiratory system diseases (56.4%). Nine micronutrients showed a higher prevalence of values below the recommendation, such as sodium, calcium, potassium, chloride, magnesium, folic acid, copper, vitamin A, and vitamin D, with 81.6%, 67.6%, 100%, 100%, 85.5%, 97.8%, 50.3%, 44.7%, 54.7%, respectively. Conclusion: Enteral nutrition administration did not meet recommended dietary intakes for nine micronutrients and satisfactorily did not exceed the upper tolerable intake level.
References
ABILÉS J, et al. Valoración de la ingesta de nutrientes y energía en paciente crítico bajo terapia nutricional enteral. Nutrición Hospitalaria, 2005; 20(2), 110-114.
AMAYA-FARFAN J, et al. DRI: síntese comentada das novas propostas sobre recomendações nutricionais para antioxidantes. Revista De Nutrição, 2001; 14(1), 71-78.
AMREIN K, et al. Vitamin D and critical illness: what endocrinology can learn from intensive care and vice versa. Endocr Connect, 2018; 7(12): R304-R315.
AN Y, et al. The Role of Copper Homeostasis in Brain Disease. Int J Mol Sci, 2022; 23(22): 13850.
BEREND K, et al. Chloride: the queen of electrolytes?. Eur J Intern Med, 2012; 23(3): 203-211.
BERGER MM, et al. ESPEN micronutrient guideline. Clin Nutr, 2022; 41(6): 1357-1424.
BREIK L, et al. Micronutrient intake from enteral nutrition in critically ill adult patients: A retrospective observational study. Nutrition, 2022; 95: 111543.
CASTRO MG, et al. Diretriz BRASPEN de Terapia Nutricional no Paciente Grave. BRASPEN Journal, 2023; 38(2, Supl 2): 0-0.
CHA JK, et al. Effect of Early Nutritional Support on Clinical Outcomes of Critically Ill Patients with Sepsis and Septic Shock: A Single-Center Retrospective Study. Nutrients, 2022; 14(11): 2318.
COZZOLINO SM. Biodisponibilidade de nutrientes. Barueri: Manole, 2020; 910 p.
DA SILVA JSV, et al. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutr Clin Pract, 2020; 35(2): 178-195.
FAISY C, et al. Impact of energy deficit calculated by a predictive method on outcome in medical patients requiring prolonged acute mechanical ventilation. British Journal of Nutrition, 2008; 101(7): 1079-1087.
GREEN CL, LAMMING DW. Regulation of metabolic health by essential dietary amino acids. Mech Ageing Dev, 2019; 177: 186-200.
IACONE R, et al. Micronutrient content in enteral nutrition formulas: comparison with the dietary reference values for healthy populations. Nutr J, 2016; 15: 30.
INSTITUTE OF MEDICINE (US) STANDING COMMITTEE ON THE SCIENTIFIC EVALUATION OF DIETARY REFERENCE INTAKES. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington (DC): National Academies Press (US), 1997.
KASTI AN, et al. Factors Associated with Interruptions of Enteral Nutrition and the Impact on Macro- and Micronutrient Deficits in ICU Patients. Nutrients, 2023; 15(4): 917.
KIM H, et al. Enteral nutritional intake in adult korean intensive care patients. Am J Crit Care, 2013; 22(2): 126-135.
KIM H, et al. Why patients in critical care do not receive adequate enteral nutrition?. A review of the literature. J Crit Care, 2012; 27(6): 702-713.
KLEIN CJ, et al. Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc, 1998; 98(7): 795-806.
KOEKKOEK WAC, et al. Micronutrient deficiencies in critical illness. Clin Nutr, 2021; 40(6): 3780-3786.
KRAUSE MV, et al. Alimentos, nutrição e dietoterapia. Rio de Janeiro: Elsevier, 2022; 1164 p.
LEE JW. Fluid and electrolyte disturbances in critically ill patients. Electrolyte Blood Press, 2010; 8(2): 72-81.
LEW CCH, et al. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review. JPEN J Parenter Enteral Nutr, 2017; 41(5): 744-758.
LIPSKI PS, et al. A study of nutritional deficits of long-stay geriatric patients. Age Ageing, 1993; 22(4): 244-255.
MCGOWAN JE, et al. An exploratory study of sodium, potassium, and fluid nutrition status of tube-fed nonambulatory children with severe cerebral palsy. Appl Physiol Nutr Metab, 2012; 37(4): 715-723.
MCLEAN RM, WANG NX. Potassium. Adv Food Nutr Res, 2021; 96: 89-121.
OSLAND EJ, et al. Micronutrient deficiency risk in long-term enterally fed patients: A systematic review. Clin Nutr ESPEN, 2022; 52: 395-420.
PADOVANI RM, et al. Dietary reference intakes: aplicabilidade das tabelas em estudos nutricionais. Rev Nutr, 2006; 19(6): 741-760.
REID C. Frequency of under- and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J Hum Nutr Diet, 2006; 19(1): 13-22.
RIBEIRO LM, et al. Adequacy of energy and protein balance of enteral nutrition in intensive care: what are the limiting factors?. Rev Bras Ter Intensiva, 2014; 26(2): 155-162.
RITTER CG, et al. Fatores de risco para a inadequação proteico-calórica em pacientes de unidade de terapia intensiva. Rev bras ter intensiva, 2019; 31(4): 504-510.
RUBINSON L, et al. Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med, 2004; 32(2): 350-357.
SHKEMBI B, HUPPERTZ T. Calcium Absorption from Food Products: Food Matrix Effects. Nutrients, 2021; 14(1): 180.
TAKO E. Dietary Trace Minerals. Nutrients, 2019; 11(11): 2823.
TRUMBO P, et al. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc, 2002; 102(11): 1621-1630.
VERONESE N, et al. Enteral tube feeding and mortality in hospitalized older patients: A multicenter longitudinal study. Clin Nutr, 2020; 39(5): 1608-1612.
VIANA LA, et al. Refeeding syndrome: clinical and nutritional relevance. Arq Bras Cir Dig, 2012; 25(1): 56-59.
WAITZBERG DL. Nutrição Oral, Enteral e Parenteral na pratica clínica. v.2. 5ª ed. São Paulo: Atheneu, 2017; 3296 p.
WEIJS PJ, et al. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care, 2014; 18(6): 701.
WISCHMEYER PE. Overcoming challenges to enteral nutrition delivery in critical care. Curr Opin Crit Care, 2021; 27(2): 169-176.