Higher calorie prescription improves nutrient delivery during the first 5 days of enteral nutrition

Abstract

Aims: It is unclear whether prescribing a higher amount of calories by enteral nutrition (EN) increases actual delivery. This prospective controlled study aimed at comparing the progression of EN of two study populations with different levels of calorie prescriptions, during the first 5 days of EN.

Methods: The daily calorie prescription of group 1 (n=346) was 25 and 20 kcal/kg body weight for women <60 and > or =60 years, respectively, and 30 and 25 kcal/kg body weight for men <60 and > or =60 years, respectively. The prescription of group 2 (n=148) was 5 kcal/kg body weight higher than in group 1. Calorie intakes were expressed as percentage of resting energy expenditure (REE) and protein intakes as percentage of requirements estimated as 1.2 g/kg body weight/day. Patients were classified as <60 and > or =60 years and as medical or surgical patients. Statistical analysis was performed with ANOVA for repeated measures.

Results: Calorie and protein deliveries increased in both groups independently of age and ward categories (P< or =0.0001). Group 2 showed faster progressions of calorie and protein intakes than group 1 in patients altogether (P< or =0.002), > or =60 years (P< or =0.01) and in surgical patients (P< or =0.02). Differences of calorie and protein intakes between day 1 and day 5 were significantly higher in group 2 than group 1 for patients altogether (75+/-61 vs. 56+/-54% of REE; 41+/-30 vs. 31+/-/-27% of protein requirements), those over 60 years (76+/-67 of REE vs. 52+/-59 of protein requirements) and surgical patients (81+/-52 vs. 58+/-57% of REE; 44+/-27 vs. 33+/-29% of protein requirements).

Conclusions: Increasing the levels of EN prescriptions improved calorie and protein deliveries. While the mean energy delivery over 5 days was sufficient to cover requirements, the protein delivery by EN was insufficient, despite our nutritional support team.