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. 2018 Jun 4;2018(6):CD007867. doi: 10.1002/14651858.CD007867.pub2

Ahrens 2005.

Methods Study design: prospective, randomized controlled trial.
Study dates: “study dates not available"
Setting: level‐1 trauma centre. Department of Surgery, Detroit Receiving Hospital, Wayne State University, Detroit, Michigan
Country: USA
Participants Inclusion criteria

  1. Surgical patients, ≥ 18 years old, with requirement for parenteral nutrition by a central catheter due to contraindication or intolerance to enteral nutrition


Exclusion criteria

  1. Baseline blood glucose level > 200 mg/dl

  2. Expectation of receiving parenteral nutrition for < 4 days

  3. Severily underweight (< 75% of ideal body weight)

  4. Morbid obesity (> twice their ideal body weight

  5. Currently receiving corticosteroid therapy

  6. Admitting diagnosis of burn

  7. Receiving parenteral nutrition on admission

  8. Not able to provide informed consent


Sample size: calculated sample size of 26 participants to detect an absolute difference in glucose area under the curve of 50 mg hr/dl with 80% power (P = 0.05). 40 participants were randomized: 20 to each group. Only 18 were ICU participants (8 of the low caloric and 10 of the standard group). At baseline both groups were well matched, with exception of lower creatinine clearance in the standard group.
Age (years mean ± SD) group 1: 45.3 ± 17.2; group 2: 53.1 ± 17.9
Sex (male, %) group 1: 75; group 2: 80
Most frequent admitting diagnosis (groups 1 and 2 respectively): pancreatitis 6 & 6, trauma 7 & 3, bowel obstruction 4 & 5.
ICU participants (n). group 1: 8; S group 2: 10
APACHE II score (mean ± SD of participants in ICU). Group 1: 20.1 ± 9.1; Group 2: 18.6 ± 11.1
Mechanical ventilation (n). 8 participants in each group
Baseline nutrition status No major differences between ideal and actual body weight in both groups
Duration of parenteral nutrition (days; median (interquartile range)). group 1 6 (4 to 10); group 2 7 (5 to 10)
Interventions Group 1, low caloric parenteral nutrition (n = 20)

  1. 20 non‐protein calories/kg ideal body weight/day


Group 2, standard parenteral nutrition (n = 20)

  1. 30 non protein calories/kg ideal body weight/day


In both groups, parenteral nutrition was administered by a multiple‐bottle system. Lipids administration was standardized to 1000 kcal 3 times weekly. Proteins administered according the levels of estimated metabolic stress of the disease (mild 1.2 ‐ 1.4; moderate 1.5 ‐ 1.7; or severe 1.8 ‐ 2.2 gr/kg/day)
Outcomes Primary outcomes

  1. Incidence and severity of hyperglycaemia and daily insulin requirements during parenteral nutrition


Incidence of hyperglycaemia was calculated as the number of assessments of glycaemia ≥ 200 mg/dl divided by the total number of assessments
Severity of hyperglycaemia was assessed by measuring the area under the curve
Secondary outcomes

  1. Infectious complications (new‐onset infections according to established criteria)

  2. Hospital charges (charges for hospital room, diagnostic services, medication, nursing services, direct expenses)
Funding sources Not available
Declarations of interest The authors have no financial interests to disclose
Notes Total calories administered/kg (median (interquartile range)) were: 26.6 (26.2 to 27.5) and 37.0 (36.6 to 38.4); the amount of protein administered and the duration of PN therapy were similar. The first author sent the data of continuous outcomes expressed as mean and standard deviation.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Participants were randomly assigned by means of a computer‐generated random‐numbers
Allocation concealment (selection bias) Low risk Central allocation (pharmacist)
Blinding of participants and personnel (performance bias) 
 All outcomes Low risk Clinicians were blinded to which caloric group participants were randomized to, with the exception of the critical care pharmacist who calculated the formula.
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Clinicians were blinded to which caloric group participants were randomized to, with the exception of the critical care pharmacist who calculated the formula.
Incomplete outcome data (attrition bias) 
 All outcomes Low risk All outcomes: outcome data were available for all participants.
Selective reporting (reporting bias) Low risk All outcomes reported
Other bias Low risk No evidence of other bias