Clinical practice guidelines (CPGs) for the nutrition management of adult patients who are critically ill present divergences on recommendations regarding the nutrition care process (NCP), which bring difficulties in their application. We aimed to compare the recommendations from these CPGs and present a synthesis of them for each step of the NCP in intensive care unit (ICU) settings.
Systematic review of CPGs on nutrition care in ICU, searched in six databases up to January 2022. We have extracted data about CPGs, steps of the NCP, and quality of evidence for each recommendation. We compiled the recommendations from each CPG for each step of the NCP and calculated the relative frequency of agreement between them.
Ten CPGs were reviewed, and 9 made recommendations for energy requirement, time to start, and route for nutrition support; however, only 3 presented recommendations on nutrition monitoring. The relative frequency of agreement between the recommendations of the CPGs ranges from 11% to 100%. The highest agreement was for the determination of energy requirements by indirect calorimetry and the provision of high protein for patients who are obese (100%). The lowest agreement among the CPGs was for considering either enteral nutrition or parenteral nutrition (PN) as an acceptable route (11%) and when to start PN (16.7%). Most recommendations were based on expert consensus.
There is a wide divergence on the recommendations to NCP of patients who are critically ill. This systematic review summarizes recommendations to evidence-based practice in ICU settings to facilitate the daily decisions of professionals.

This 12-month prospective randomized cluster trial of 20 dietitians in India compared usual care (UC) and evidence-based nutrition practice guideline (EBNPG) care for patients with type 2 diabetes mellitus. Baseline, 6-month, and 12-month data from 238 patients were analyzed. EBNPG implementation was evaluated using the Ottawa Model for Knowledge Transfer. EBNPG and UC groups achieved significant hemoglobin A1C improvements. EBNPG-treated participants were significantly more likely to meet low-density lipoprotein, high-density lipoprotein, and triglyceride goals at 6 or 12 months. Dietitian dropout, implementation barriers, and undetermined EBNPG intervention fidelity are limitations. Future research should assess barriers/supports and degree of EBNPG use.

Chronic kidney disease is classified in stages 1 to 5 by the National Kidney Foundation\'s Kidney Disease Outcomes Quality Initiative depending on the level of renal function by glomerular filtration rate and, more recently, using further categorization depending on the level of glomerular filtration rate and albuminuria by the Kidney Disease Improving Global Outcomes initiative. Registered dietitian nutritionists can be reimbursed for medical nutrition therapy in chronic kidney disease stages 3 to 4 for specific clients under Center for Medicare and Medicaid Services coverage. This predialysis medical nutrition therapy counseling has been shown to both potentially delay progression to stage 5 (renal replacement therapy) and decrease first-year mortality after initiation of hemodialysis. The Joint Standards Task Force of the American Dietetic Association (now the Academy of Nutrition and Dietetics), the Renal Nutrition Dietetic Practice Group, and the National Kidney Foundation Council on Renal Nutrition collaboratively published 2009 Standards of Practice and Standards of Professional Performance for generalist, specialty, and advanced practice registered dietitian nutritionists in nephrology care. The purpose of this article is to provide an update on current recommendations for screening, diagnosis, and treatment of adults with chronic kidney disease for application in clinical practice for the generalist registered dietitian nutritionist using the evidence-based library of the Academy of Nutrition and Dietetics, published clinical practice guidelines (ie, National Kidney Foundation Council on Renal Nutrition, Renal Nutrition Dietetic Practice Group, Kidney Disease Outcomes Quality Initiative, and Kidney Disease Improving Global Outcomes), the Nutrition Care Process model, and peer-reviewed literature.