The Effect of Hypocaloric-High Protein Feeding Protocol on Adult Critically Ill Obese Patients: A Systematic Review and Meta- Analysis

Abstract

Abstract: Background: Use of a hypocaloric high protein feeding approach for critically ill obese patients has been recommended by several organisations and institutes with the goal being to avoid overfeeding and its complications that may worsen patients' overall status. Objective: To assess the efficacy of hypocaloric-high protein feeding protocol on mortality and ventilator-associated pneumonia (VAP) incidences among critically ill obese patients. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) methodology was used to search PubMed, EMBASE and MIDLINE databases. All papers published from 1989 to July 2021 with mortality and VAP incidence as primary outcomes were retrieved. The secondary outcomes were average daily caloric intake and length of intensive care unit (ICU) stay. Results: This systematic review and meta-analysis includes six papers from a total of 206 potentially relevant studies identified across all databases with total of 526 adult critically ill obese participants from both genders' male and females. No significant reduction in the mortality incidence when the hypocaloric-high protein feeding approach was used (RR 0.74, 95% CI 0.35 to 1.56, P= 0.43), similarly, no significant reduction in VAP incidence were observed when the hypocaloric-high protein feeding approach was used (RR 0.84, 95% CI 0.50 to 1.41, P= 0.52). Additionally, no significant reduction in the mean ICU days when the hypocaloric-high protein feeding approach was used (MD -0.82 days, 95% CI -5.90 to 4.27, P=0.75), but there was a significant reduction in mean daily caloric intake in the hypocaloric-high protein feeding approach groups (MD -4.80 kcal/kg/day, 95% CI -6.99 to -2.62, P<0.0001). Conclusion: There is no superiority indication of hypocaloric high protein feeding approach to eucaloric or standard feeding approach in regards of mortality, VAP incidence and length of ICU stay. There was a significant reduction in daily caloric between hypocaloric high protein feeding compared with eucaloric or standard feeding approach, with no impact on the outcomes.