Nutritional practices and impact of feeding adequacy on clinical outcomes in Chinese respiratory intensive care units patients: a prospective observational study (ORIENT study)
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background The current status of nutritional support for patients in Respiratory ICU across mainland China remains inadequately characterized. This multi-center study, conducted in RICUs, was designed to investigate nutritional practices in this specific patient population, focusing on initiation timing, energy/protein adequacy, and associations with clinical outcomes. Methods A prospective, observational study enrolled 1,026 patients (ICU stay >48 h) across 68 Chinese RICUs. We analyzed EN initiation rates (24 h/48 h), caloric/protein intake adequacy during the first 7 days, and outcomes via multivariable Cox regression. Results EN initiation occurred in 36.8% (24 h) and 43.4% (48 h) of patients. Excluding patients who could take oral food, the proportion of patients who started EN within 24 and 48 h increased to 86.9 and 95.3%. Among 499 EN-fed patients, 26.1% developed EN complications. Caloric analysis ( n = 317) identified three trajectories: underfeeding (<70% targets, 32.5%), adequate feeding (70–110, 43.2%), and overfeeding (>110, 24.3%). Overfeeding independently predicted higher non-social infections and significantly increased mortality risk in patients >50 years (HR = 1.83, 95% CI 1.02–3.28; p = 0.04). Mean protein intake was 0.9 g/kg/day, with no 28-day mortality benefit at higher thresholds (≥1.2 g/kg: p = 0.31; ≥1.3 g/kg: p = 0.42). Conclusion This multicenter study demonstrates optimal early EN initiation rates in Chinese RICUs. Energy overfeeding was associated with increased mortality risk only in patients >50 years and non-social infections risk, whereas protein adequacy showed no outcome associations. Protocolized EN delivery balancing adequacy and overfeeding risks is urgently needed in RICUs. Clinical trial registration Identifier, NCT04958447.
Source: Frontiers in Nutrition
Authors: Xu Huang, Yafei Wang, Shuang Geng, Ying Liang, Fan Gao, Tiantian Wang, Huagen Zhang, Jie Fang, Chu Wang, Xiu Gu, Jingping Yang, Zhenshun Cheng, Chun Liu, Wei Lei, Xingang Hu, Hong Luo, Huaihai Fan, Yunhui Zhang, Guoqiang Li, Qingguo Di, Lihua Xing, Yuanyuan Li, Jin Tong, Lin Chen, Wei Sun, Liang Chen, Shengyu Wang, Shaojun Li, Jianhua Liu, Hao Qin, Xiaohua Qiu, Zhuang Ma, Yanxia Li, Hongbin Zhao, Rongzhang Liang, Li Wang, Peng Gao, Linli Sang, Dan Li, Pengguo Hou, Xiuwei Zhang, Dongsheng Wang, Ling Zheng, Feng Hua, Jing Jiang, Xiaoyan Li, Qingrong Nie, Hongwen Zhao, Chuncai Huang, Yingqun Ji, Hong Yu, Liqiang Song, Ju Jin, Ning Li, Weisheng Qian, Jingwu Zeng, Liang Chen, Juan Sun, Wei He, Shuhong Guan, Shukun Chai, Siming Hu, Guanhua Li, Junjie Li, Hongying Jiang, Xuefeng Zhong, Jiashu Li, Jing Zhao, Wei Du, Jiegen Zhang, Zhiliang Liu, Arthur van Zanten, Ye Tian, Ying Cai, Qingyuan Zhan
Institutions: Chinese Academy of Medical Sciences & Peking Union Medical College, China-Japan Friendship Hospital, Central Hospital of Wuhan, Huazhong University of Science and Technology, Peking University Third Hospital, Fu Wai Hospital, Meizhou City People's Hospital, Kunming Medical University, First Affiliated Hospital of Kunming Medical University, Fourth Affiliated Hospital of China Medical University, Zhongnan Hospital of Wuhan University, Third Xiangya Hospital, First Affiliated Hospital of Soochow University, Henan Provincial People's Hospital, Second Xiangya Hospital of Central South University, Taian City Central Hospital, First People's Hospital of Yunnan Province, Tianjin Chest Hospital, Chinese People's Armed Police Force, Cangzhou Central Hospital, First Affiliated Hospital of Zhengzhou University, Central South University, Dalian Medical University, First Affiliated Hospital of Dalian Medical University, Xiangya Hospital Central South University, Second Affiliated Hospital of Chongqing Medical University, Huaian First People’s Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Nanjing Medical University, Fuyang Second People's Hospital, Xi'an Medical University, First Affiliated Hospital of Xi'an Jiaotong University, First Hospital of Xi'an, Xi'an Jiaotong University, Hebei North University, Second Military Medical University, Nanjing Drum Tower Hospital, Nanjing University, First Hospital of China Medical University, Fujian Medical University, First Affiliated Hospital of Fujian Medical University, Nanjing First Hospital, Jilin University, Second Affiliated Hospital of Jilin University, Northern Jiangsu People's Hospital, First Hospital of Jilin University, Nanjing Jiangning Hospital, University of Science and Technology of China, Anhui Medical University, Second Affiliated Hospital of Anhui Medical University, Huzhou Central Hospital, Qingdao University, Yuhuangding Hospital, Second Hospital of Tianjin Medical University, Tongji University, Shanghai East Hospital, Guizhou Provincial People's Hospital, Air Force Medical University, Zhejiang University, Yangtze University, First Affiliated Hospital of Anhui Medical University, Central Hospital Affiliated to Shenyang Medical College, The First People's Hospital of Changzhou, Suzhou Municipal Hospital, Shanghai Jiao Tong University, Ruijin Hospital, The First People’s Hospital of Lianyungang, Capital Medical University, Beijing Hospital, Hebei Medical University, Second Hospital of Hebei Medical University, Ziekenhuis Gelderse Vallei, Wageningen University & Research
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7124838201