Year: 2026
Type: article
Abstract: A Systematic Review and Meta-analysis." 1 The investigation of individualized nutritional strategies in critically ill populations addresses an important and clinically relevant question, particularly given emerging evidence that pre-existing nutritional status influences patient outcomes.2 We believe the manuscript would benefit from a consideration of the following methodological observations.First, the definition of "personalized parenteral nutrition (PPN)" used in the review appears to be broad and heterogeneous.The included studies encompassed fundamentally different interventions, such as early vs delayed parenteral nutrition, caloric target optimization, omega-3-enriched lipid emulsions, and standard PN adjustments.These interventions differ in their physiological and mechanistic effects.We suggest that future syntheses might benefit from either a narrower and more homogeneous exposure definition or, alternatively, explicitly stratified subgroup analyses that respect underlying mechanistic differences.This approach may enhance the interpretability and clinical applicability of the pooled estimates.Second, the application of diagnostic accuracy frameworksincluding receiver operating characteristic (ROC) curves, summary ROC (SROC) analysis, and QUADAS-2 assessment-represents a methodological choice that warrants clarification.These tools are designed for diagnostic test evaluation and are not usually employed for therapeutic intervention studies.3 While systematic reviewers must sometimes adapt tools pragmatically, explicit acknowledgment of this departure from conventional practice and its potential implications for interpretation would strengthen the methodological transparency.Consideration of interventionspecific appraisal frameworks (such as RoB 2 for randomized trials or ROBINS-I for non-randomized designs) may be more aligned with the review's research questions.Third, the meta-analysis reported a statistically significant increase in mortality associated with PPN (OR: 1.24, 95% CI: 1.10-1.39)despite substantial heterogeneity (I² = 81%).Mortality outcomes were pooled across studies with differing study designs, populations, interventions, and at different time points without adequate adjustment or subgroup exploration.Under such circumstances, thorough subgroup exploration and sensitivity analyses-or, where heterogeneity cannot be adequately explained, consideration of a narrative synthesis alongside Orcid
Authors: Anirban Bhattacharjee, Gargi Pal, Riddhi Kundu
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7130664940