Effects of Energy Deficiency: A Focus on Hospitalized and Critically Ill Patients

  • Lisa Santoriello
  • Rafael Barrera
Living reference work entry


Malnutrition is a broad term used to describe any imbalance in nutrition that can develop as a result of dietary intake, increase in basal requirements, poor absorption, excessive nutrient losses due to an underlying disease state, or any combination of such factors. Upon admission, 15–60% of hospitalized patients are at risk or already qualify as being malnourished, with 30–40% of hospitalized patients experiencing further nutritional decline during their hospital course. When left unnoticed, malnourishment, especially in the hospitalized patient, is associated with several negative sequelae, including immunosuppression, higher infection rates, increased muscle loss with delayed functional recovery, impaired wound healing, increased risk of treatment complications, fewer ventilator-free days, longer hospital stays, higher overall treatment costs, and increased mortality rates. Several nutritional risk scoring systems exist to help clinicians risk-stratify these patients upon admission, with the goal of starting early nutritional therapy when deemed necessary.


Malnutrition Energy deficiency Critical illness Nutritional assessment Nutritional therapy Caloric deficiency NUTRIC NRS-2002 Enteral Parenteral 

List of Abbreviations


Acute Physiology and Chronic Health Evaluation II


American Society for Parenteral and Enteral Nutrition


Body mass index


Docosahexaenoic acid


Eicosapentaenoic acid


Gut-Associated Lymphoid Tissue


Indirect calorimetry


Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation


Society of Critical Care Medicine


Sequential organ failure assessment


  1. Alberta C, Gramlich L, Jones N et al (2009) The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multi-center observational study. Intensive Care Med 35(10):1728–1737CrossRefGoogle Scholar
  2. Bartlett RH, Dechert RE, Mault JR et al (1982) Measurement of metabolism in multiple organ failure. Surgery 92(4):771–779PubMedGoogle Scholar
  3. Dickerson RN, Boschert KJ, Kudsk KA et al (2002) Hypocaloric enteral tube feeds in critically ill obese patients. Nutrition 18(3):241–246CrossRefPubMedGoogle Scholar
  4. Drover JW et al (2011) Perioperative use of arginine-supplemented diets: a systematic review of the evidence. J Am Coll Surg 212(3):385–399CrossRefPubMedGoogle Scholar
  5. Gibran NS (2006) Committee on organization and delivery of burn care, American burn association: practice guidelines for burn care, 2006. J Burn Care Res 27:437–438CrossRefPubMedGoogle Scholar
  6. Heyland DK, Dhaliwal R, Jiang X et al (2011) Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care 15:R268CrossRefPubMedPubMedCentralGoogle Scholar
  7. Hiesmayr M, Schindler K, Pernicka E et al (2009) NutritionDay audit team: decreased food intake is a risk factor for mortality in hospitalized patients: the nutrition day survey 2006. Nutrition 28:484–491Google Scholar
  8. Jabbar A, Chang WK, Dryden GW et al (2003) Gut immunology and the differential response to feeding and starvation. Nutr Clin Pract 18(6):461–482CrossRefPubMedGoogle Scholar
  9. Kang W, Kudsk KA (2007) Is there evidence that the gut contributes to mucosal immunity in humans? JPEN 31(3):246–258CrossRefGoogle Scholar
  10. Kudsk KA (2002) Current aspects of mucosal immunology and its influence by nutrition. J Surg 183(4):390–398CrossRefGoogle Scholar
  11. Lassen K, Kjaeve J, Fetveit T et al (2008) Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity: a randomized multicenter trial. Ann Surg 247:721–729CrossRefPubMedGoogle Scholar
  12. Marimuthu K, Varadhan KK, Ljungqvist O et al (2012) A meta-analysis of the effect of combinations of immune modulating nutrients on outcome in patients undergoing major open gastrointestinal surgery. Annals 255(6):1060–1068Google Scholar
  13. Martindale RG, McClave SA, Vanek VW et al (2009) Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for parenteral and enteral nutrition: executive summary. Crit Care Med 37(5):1757–1761CrossRefPubMedGoogle Scholar
  14. Mauldin K, O’Leary-Kelly C (2015) New guidelines for the assessment of malnutrition in adults. Crit Care Nurse 35(4):24–30CrossRefPubMedGoogle Scholar
  15. McClave SA, Taylor BE, Martindale RG et al (2016) Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. JPEN 40(2):159–211CrossRefGoogle Scholar
  16. Naber THJ, Schermer T, de Bree A et al (1997) Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Clin Nutr 66(5):1232–1239Google Scholar
  17. Norman K, Pichard C, Lochs H et al (2008) Prognostic impact of disease-related malnutrition. Clin Nutr 27(1):5–15CrossRefPubMedGoogle Scholar
  18. Pearl ML, Frandina M, Mahler L et al (2002) A randomized controlled trial of a regular diet as the first meal in gynecologic oncology patients undergoing intraabdominal surgery. Obstet 100:230–234Google Scholar
  19. Plank LD (2013) Protein for the critically ill patient - what and when? Eur Clin Nutr 67:565–568CrossRefGoogle Scholar
  20. Raguso CA, Dupertuis YM, Pichard C (2003) The role of visceral proteins in the nutritional assessment of intensive care unit patients. Clin Nut Metab Care 6:211–216CrossRefGoogle Scholar
  21. Rousseau AF, Losser MR, Ichai C et al (2013) ESPEN endorsed recommendations: nutritional therapy in major burns. Clin Nutr 32:497–502CrossRefPubMedGoogle Scholar
  22. Taylor BE, McClave SA, Martindale RG et al (2016) Guidelines for the provision and assessment of nutritional support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for parenteral and enteral nutrition. Brit Care Med 44(2):390–438CrossRefGoogle Scholar
  23. Villet S, Chiolerob RL, Bollmann MD et al (2005) Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 24(4):502–509CrossRefPubMedGoogle Scholar
  24. Weijs PJ, Sauerwein HP, Kondrup J (2012) Protein recommendations in the ICU: g protein/kg body weight - which body weight for underweight and obese patients? Clin Nutr 31:462–468CrossRefGoogle Scholar
  25. Whitson M, Barrera R (2014) Nutritional support in the ICU. In: Pastors S (ed) Adult multiprofessional critical care review, pp 291–308Google Scholar
  26. Windsor AC, Kanwar S, Li AGK et al (1998) Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 42(3):431–435CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Emergency/Internal/Critical Care Medicine, Long Island Jewish Medical CenterNorthwell Health, Hofstra School of MedicineNew Hyde ParkUSA
  2. 2.Department of Surgery, Long Island Jewish Medical CenterNorthwell Health, Hofstra School of MedicineNew Hyde ParkUSA

Personalised recommendations