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Comparison of the effects of different models of nutrient supply on nutritional status and clinical outcomes in ICU patients: a systematic review and network meta-analysis

European Journal of Clinical Nutrition (2026)Cite this article

Subjects

Abstract

Objectives

Nutrition support improves ICU patients’ nutritional status and outcomes, but optimal models remain unclear. We performed a Bayesian and frequentist network meta-analysis (NMA) and systematic review to assess improvements in nutritional indicators and clinical outcomes.

Methods

We systematically searched PubMed, Embase, Cochrane, and Web of Science up to November 23, 2023 for Randomised controlled trials (RCT), case-control studies, and cohort studies. Outcomes mainly included serum albumin values, length of hospitalization, infection rates, feeding-related complication rates and mortality. All the analyses were conducted using STATA 17.0 and R software version 4.5.1.

Results

A total of 26 studies were included, enrolling 7698 critically ill ICU patients receiving four different types of nutrition support, including parenteral nutrition (PN), enteral nutrition (EN), enteral immunonutrition (EIN), and parenteral nutrition combined with enteral nutrition (PN + EN). The NMA results showed that according to SUCRA, PN + EN had the highest probability of being the most effective intervention for improving serum albumin values (SUCRA = 84.5%) and reducing infection rates (SUCRA = 83.0%) and mortality rates (SUCRA = 82.7%). PN had the highest probability of reducing the length of hospitalization (SUCRA = 77.9%), while EIN had the highest probability of reducing feeding-related complication rates (SUCRA = 81.0%).

Conclusion

The available evidence suggests that all four models of nutrition support affect the nutritional status and clinical outcomes of critically ill patients in the ICU to varying degrees. However, EN + PN appears to be the most effective approach in improving clinical outcomes and nutrition support in critically ill ICU patients. More high-quality studies are needed to validate these findings.

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Fig. 1
Fig. 2: Quality assessment of included studies.
Fig. 3: Network meta-analysis of clinical outcomes.
Fig. 4: Network meta-analysis of mortality rates in adults and minors.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This study was supported by the Scientific Research Fund of Yunnan Provincial Department of Education (grant number 2024J0847) and the Science and Technology Program of Yunnan Province Science and Technology Department (grant number 202101BA070001-118).

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Authors and Affiliations

  1. School of Nursing, Honghe Health Vocational College, Mengzi, Yunnan, China

    Tingting Shi & Yunmei Chen

  2. Department of Emergency, The First Affiliated Hospital of Dali University, Dali, Yunnan, China

    Ting Li

  3. Department of Nursing, The First Affiliated Hospital of Dali University, Dali, Yunnan, China

    Xiaoling Zhu

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Contributions

Conceptualization: Tingting Shi and Yunmei Chen; methodology: Tingting Shi, Ting Li, and Xiaoling Zhu; formal analysis and investigation: Tingting Shi; writing—original draft preparation: Tingting Shi; writing—review and editing: Tingting Shi, Ting Li; supervision: Yunmei Chen and Xiaoling Zhu; all authors have commented on previous versions of the manuscript. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Yunmei Chen.

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Shi, T., Li, T., Zhu, X. et al. Comparison of the effects of different models of nutrient supply on nutritional status and clinical outcomes in ICU patients: a systematic review and network meta-analysis. Eur J Clin Nutr (2026). https://doi.org/10.1038/s41430-026-01704-7

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