Effect of dietitian-guided nutritional support on intensive care units length of stay and nutritional risk in critically Ill patients.

BACKGROUND: Nutritional support is essential for the recovery of critically ill patients in intensive care units (ICUs). However, the clinical impact of dietitian-guided interventions, particularly on ICU length of stay and nutritional risk scores, remains underexplored. This study evaluated the effect of personalized, dietitian-guided nutritional support (DGNS) versus physician-directed care on ICU length of stay and nutritional status. MATERIALS AND METHODS: In this quasi-experimental study conducted at two centers in Tehran between June 2022 and February 2023, adult ICU patients with an expected stay of five days or more received either DGNS or physician-directed care. The primary outcome was ICU length of stay. Secondary outcomes included changes in nutritional risk scores, assessed using the Nutrition Risk Screening (NRS-2002) tool and the Nutrition Risk in Critically Ill (NUTRIC) score. Parametric and nonparametric tests were used to compare the two groups, and multivariable linear regression was performed to adjust for potential confounders. RESULTS: Among 107 patients (52 intervention, 55 control), adjusted analysis showed significantly shorter ICU stay in the intervention group β: -2.53; (95% confidence interval [CI]: -4.66, -0.39); P = 0.021. Nutritional risk scores improved more in the intervention group (median change in NRS-2002: -2.0 [interquartile range (IQR): -3.0 to - 1.0] vs. 0.0 [IQR: -1.0-0.0]; P < 0.001); NUTRIC: -1.0 [IQR: -2.0-0.0] vs. 0.0 [IQR: 0.0-0.0]; P < 0.001). New infections (7.7% vs. 38.2%) and pressure ulcers (3.8% vs. 18.2%) were less frequent in the intervention group (P < 0.05). No difference in 28-day mortality was noted. CONCLUSION: Dietitian-guided personalized nutrition reduced ICU stay and improved nutritional status, emphasizing dietitians' role in ICU care. Further randomized trials are warranted to confirm these findings.