{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:30:28Z","timestamp":1790353828858,"version":"4.1.0"},"reference-count":63,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Parenter Enteral Nutr"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Protein delivery is currently of interest in critical illness. It is plausible that higher protein delivery, targeting international recommendations, may cause gastrointestinal (GI) dysfunction. We aimed to determine relationships between enteral protein delivery and GI dysfunction in critically ill adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis according to a predetermined protocol (PROSPERO CRD42022345591) encompassing MEDLINE, Embase, EMCARE, CENTRAL, and CINAHL databases (between January 1, 2000, and August 5, 2025) was conducted. Parallel\u2010group randomized trials using an enteral nutrition intervention reporting (1) statistically significant differences in protein delivered and (2) any GI dysfunction\u2013related outcome were included. Data are presented as mean\u2009\u00b1\u2009SD or risk ratio (RR) with 95% CI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 15 studies (5277 patients), mean protein delivery was 1.05\u2009\u00b1\u20090.38 vs 0.47\u2009\u00b1\u20090.23\u2009g\/kg\/day in higher\u2010 vs lower\u2010protein groups, respectively (nine studies), and 66.00\u2009\u00b1\u200923.83 vs 42.70\u2009\u00b1\u200912.99\u2009g\/day (six studies reporting protein delivery as grams per day). The higher\u2010protein group had an increased risk of vomiting (RR, 1.25; 95% CI, 1.11\u20131.42;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0004), with no evidence of heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.58) and no influence on gastric residual volumes (GRVs)\u2009\u2265300\u2009ml (RR, 1.18; 95% CI, 0.69\u20132.00;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.55), prokinetic administration (RR, 1.24; 95% CI, 0.98\u20131.56;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.07), abdominal distension (RR, 0.67; 95% CI, 0.40\u20131.13;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.14), diarrhea (RR, 0.99; 95% CI, 0.81\u20131.20;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.90), or constipation (RR, 1.02; 95% CI, 0.92\u20131.13;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.68). There was no evidence of publication bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher protein delivery is associated with increased rates of vomiting. Several important confounders (feed volume, concurrent energy delivery, supplemental parenteral nutrition) significantly influence this outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jpen.70034","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T06:35:56Z","timestamp":1764052556000},"page":"146-160","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of higher enteral protein delivery on gastrointestinal dysfunction in critical illness: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4396-3598","authenticated-orcid":false,"given":"Anil Bangalore","family":"Gopal","sequence":"first","affiliation":[{"name":"The University of Adelaide Adelaide 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