Normal Versus Hypocaloric Feeding Outcomes in Septic Critically Ill Adults: A Systematic Review

Abstract

Sepsis is a life-threatening condition characterized by a dysregulated immune response to infection, resulting in organ dysfunction, increased nutritional requirements, and potential mortality. In critically ill adults, nutritional management typically involves hypocaloric or normocaloric feeding. This systematic review synthesized evidence from 19 studies to assess the effects of these feeding strategies on mortality, length of stay (LOS), and glycemic control. Overall, no consistent differences in mortality were observed, although some subgroup analyses suggested context-specific benefits. Hypocaloric feeding was more consistently associated with shorter LOS and improved glycemic control, potentially due to reduced metabolic stress and better feeding tolerance. However, heterogeneity in study design, caloric targets, timing of nutrition initiation, insulin protocols, and patient populations limited the strength of conclusions. Current guidelines from ASPEN, SSCM, and ESPEN provide broad recommendations, emphasizing individualized nutrition, though evidence to support precise caloric targets remains insufficient. Hypocaloric feeding appears safe and may offer LOS and glycemic control benefits, though its impact on mortality remains unclear. Nutrition management should consider patient-specific comorbidities, illness severity, and baseline nutritional status. Further research with standardized protocols and varied patient populations is needed to optimize feeding strategies in critically ill adults with sepsis.