542830
research-article2015
PENXXX10.1177/0148607114542830Journal of Parenteral and Enteral Nutrition X(X)
Letters to the Editor Journal of Parenteral and Enteral Nutrition Volume 39 Number 2 February 2015 143–145 © 2015 American Society for Parenteral and Enteral Nutrition jpen.sagepub.com hosted at online.sagepub.com
More Questions Than Answers DOI: 10.1177/0148607114542830
We urge caution in overinterpreting the randomized trial by Braunschweig et al1 published in the Journal of Parenteral and Enteral Nutrition. From a single center, a total of 78 patients were randomized to an intensive medical nutrition therapy (IMNT) designed to provide patients >75% of their estimated energy and protein requirements compared with standard care. At the first interim analysis, the investigators observed a statistically significant increase in mortality in the INMT group compared with standard nutrition care (40% vs 16%, P = .02). Randomized trials that are terminated prematurely are likely to significantly overestimate the treatment effect.2 Moreover, a small study from 1 center has limited generalizability and should not inform practice patterns worldwide. In our opinion, to draw the conclusion that “provision of IMNT to hospital discharge increases mortality” seems premature. Nevertheless, the results cannot be ignored, and further questions about this trial are warranted. We note that with very broad inclusion criteria (patients aged ≥18 years with acute lung injury), there was no intention to enroll nutritionally “at-risk” patients3 and that most were normo-nourished, with a body mass index that is shown to be insensitive to the provision of macronutrients.4 When trying to understand the results of this trial, we think it is important to separate the nutrition intervention into its components. Patients were moderately dosed with protein and received only approximately 82 g/d or
research-article2015
PENXXX10.1177/0148607114542830Journal of Parenteral and Enteral Nutrition X(X)
Letters to the Editor Journal of Parenteral and Enteral Nutrition Volume 39 Number 2 February 2015 143–145 © 2015 American Society for Parenteral and Enteral Nutrition jpen.sagepub.com hosted at online.sagepub.com
More Questions Than Answers DOI: 10.1177/0148607114542830
We urge caution in overinterpreting the randomized trial by Braunschweig et al1 published in the Journal of Parenteral and Enteral Nutrition. From a single center, a total of 78 patients were randomized to an intensive medical nutrition therapy (IMNT) designed to provide patients >75% of their estimated energy and protein requirements compared with standard care. At the first interim analysis, the investigators observed a statistically significant increase in mortality in the INMT group compared with standard nutrition care (40% vs 16%, P = .02). Randomized trials that are terminated prematurely are likely to significantly overestimate the treatment effect.2 Moreover, a small study from 1 center has limited generalizability and should not inform practice patterns worldwide. In our opinion, to draw the conclusion that “provision of IMNT to hospital discharge increases mortality” seems premature. Nevertheless, the results cannot be ignored, and further questions about this trial are warranted. We note that with very broad inclusion criteria (patients aged ≥18 years with acute lung injury), there was no intention to enroll nutritionally “at-risk” patients3 and that most were normo-nourished, with a body mass index that is shown to be insensitive to the provision of macronutrients.4 When trying to understand the results of this trial, we think it is important to separate the nutrition intervention into its components. Patients were moderately dosed with protein and received only approximately 82 g/d or
