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Review
. 2025 Mar 21;13(1):18.
doi: 10.1186/s40560-025-00785-z.

The Japanese Critical Care Nutrition Guideline 2024

Kensuke Nakamura  1 , Ryo Yamamoto  2 , Naoki Higashibeppu  3 , Minoru Yoshida  4 , Hiroomi Tatsumi  5 , Yoshiyuki Shimizu  6 , Hiroo Izumino  7 , Taku Oshima  8 , Junji Hatakeyama  9 , Akira Ouchi  10 , Rie Tsutsumi  11 , Norihiko Tsuboi  12 , Natsuhiro Yamamoto  13 , Ayumu Nozaki  14 , Sadaharu Asami  15 , Yudai Takatani  16 , Kohei Yamada  17 , Yujiro Matsuishi  18 , Shuhei Takauji  19 , Akihito Tampo  20 , Yusuke Terasaka  21 , Takeaki Sato  22 , Saiko Okamoto  23 , Hideaki Sakuramoto  24 , Tomoka Miyagi  25 , Keisei Aki  26 , Hidehito Ota  27 , Taro Watanabe  28 , Nobuto Nakanishi  29 , Hiroyuki Ohbe  30 , Chihiro Narita  31 , Jun Takeshita  32 , Masano Sagawa  33 , Takefumi Tsunemitsu  34 , Shinya Matsushima  35 , Daisuke Kobashi  36 , Yorihide Yanagita  37 , Shinichi Watanabe  38 , Hiroyasu Murata  39 , Akihisa Taguchi  40 , Takuya Hiramoto  41 , Satomi Ichimaru  42 , Muneyuki Takeuchi  43 , Joji Kotani  29
Affiliations
Review

The Japanese Critical Care Nutrition Guideline 2024

Kensuke Nakamura et al. J Intensive Care. .

Abstract

Nutrition therapy is important in the management of critically ill patients and is continuously evolving as new evidence emerges. The Japanese Critical Care Nutrition Guideline 2024 (JCCNG 2024) is specific to Japan and is the latest set of clinical practice guidelines for nutrition therapy in critical care that was revised from JCCNG 2016 by the Japanese Society of Intensive Care Medicine. An English version of these guidelines was created based on the contents of the original Japanese version. These guidelines were developed to help health care providers understand and provide nutrition therapy that will improve the outcomes of children and adults admitted to intensive care units or requiring intensive care, regardless of the disease. The intended users of these guidelines are all healthcare professionals involved in intensive care, including those who are not familiar with nutrition therapy. JCCNG 2024 consists of 37 clinical questions and 24 recommendations, covering immunomodulation therapy, nutrition therapy for special conditions, and nutrition therapy for children. These guidelines were developed in accordance with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system by experts from various healthcare professionals related to nutrition therapy and/or critical care. All GRADE-based recommendations, good practice statements (GPS), future research questions, and answers to background questions were finalized by consensus using the modified Delphi method. Strong recommendations for adults include early enteral nutrition (EN) within 48 h and the provision of pre/synbiotics. Weak recommendations for adults include the use of a nutrition protocol, EN rather than parenteral nutrition, the provision of higher protein doses, post-pyloric EN, continuous EN, omega-3 fatty acid-enriched EN, the provision of probiotics, and indirect calorimetry use. Weak recommendations for children include early EN within 48 h, bolus EN, and energy/protein-dense EN formulas. A nutritional assessment is recommended by GPS for both adults and children. JCCNG 2024 will be disseminated through educational activities mainly by the JCCNG Committee at various scientific meetings and seminars. Since studies on nutritional treatment for critically ill patients are being reported worldwide, these guidelines will be revised in 4 to 6 years. We hope that these guidelines will be used in clinical practice for critically ill patients and in future research.

Keywords: Critical illness; Guideline; ICU; Nutrition.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: All committee members and working group members submitted disclosure forms of financial and academic conflicts of interest (COI) prior to being requested to participate in individual activities. Detailed information of COI and the roles in creating these clinical guidelines are summarized in Additional file 6.

Figures

Fig. 1
Fig. 1
Nutrition delivery routes and methods for critically ill adult patients. Nutrition delivery routes and methods for critically ill adult patients answered in the guidelines are shown as a flowchart of clinical practice. Green boxes indicate answers recommended, red boxes indicate answers not recommended, and white boxes indicate answers for background questions. CQ: clinical question; GPS: good practice statements; EN: enteral nutrition; PN: parenteral nutrition; SPN: supplemental parenteral nutrition
Fig. 2
Fig. 2
Nutrition amounts and nutrients for critically ill adult patients. Nutrition amounts and nutrients for critically ill adult patients answered in the guidelines are shown as a flowchart of clinical practice. Green boxes indicate answers recommended, red boxes indicate answers not recommended, and white boxes indicate answers for background questions. CQ: clinical question; GPS: good practice statements; ECMO: extracorporeal membrane oxygenation; PP: prone position; OAM: open abdomen management; EE: energy expenditure
Fig. 3
Fig. 3
Nutrition therapy for critically ill pediatric patients. Nutrition therapy for critically ill pediatric patients answered in the guidelines is shown as a flowchart of clinical practice. Green boxes indicate answers recommended, red boxes indicate answers not recommended, and white boxes indicate answers for background questions. CQ: clinical question; GPS: good practice statements; EE: energy expenditure; EN: enteral nutrition; PN: parenteral nutrition; FRQ: future research question
See this image and copyright information in PMC

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