Introduction
Guideline | Energy | Protein |
---|---|---|
ESPEN guidelines on nutrition in cancer patients [19] | 25–30 kcal/kg/day | 1–1.5 g/kg/day |
ESPEN guidelines on parenteral nutrition: non-surgical oncology [18] | 20–25 kcal/kg/day (bedridden) or 25–30 kcal/kg/day (ambulatory patients) | 1.2–2.0 g/kg/day |
Methods
Literature sources and searches
Study selection criteria
Screening and extraction
Results
Study and patient characteristics
Publication Authors (year) Study period, Country Setting | N | Age | Females, n (%) | Cancer location, n (%) | Tumour stage, n (%) | Treatment | Baseline PS | Baseline NS |
---|---|---|---|---|---|---|---|---|
Randomised controlled trials | ||||||||
Obling et al. (2019) [33] May 2014 to Nov 2016 Denmark | 47 (22PN vs 25 control) | Median (range) age in years: All patients: 66.9 (41.5–88.2) Non-sHPN group: 65.9 (43.3–88.2) sHPN group: 67.4 (41.5–81.6) | All patients: 17 (36) Non-sHPN group: 10 (40) sHPN group: 7 (32) | Oesophagus: 2 (4) Stomach: 9 (19) Duodenum: 2 (4) Pancreas: 27 (58) Bile duct: 2 (4) Colorectal: 5 (11) | Incurable (locally advanced or metastatic): 47 (100) | 91% received palliative chemotherapy at study inclusion | Unspecified PS scale, all patients, n (%): 0: 6 (13) 1: 25 (53) 2: 16 (34) non-sHPN group, n (%): 0: 5 (20) 1: 13 (52) 2: 7 (28) sHPN group, n (%): 0: 1 (5) 1: 12 (54) 2: 9 (41) | Median (range) BMI: All patients: 21.3 (14.8–35.7) non-sHPN group: 21.3 (15.9–29.6) sHPN group (n = 22): 21.6 (14.8–35.7) WL prior to inclusion, n (%): < 5%: 8 (17) 5–10%: 10 (22) > 10%: 29 (61) |
Prospective observational studies | ||||||||
Bozzetti et al. (2014) [35] Nov 2004 to March 2011 Italy, France, Germany, Poland, Netherlands, Spain, Belgium, Denmark, UK, Canada | 414 | Median (range): 62 years (16–90 years) | 190 (45.9) | Head and neck: 50 (12.1) Stomach: 92 (22.2) Small bowel-biliary: 10 (2.4) Colon-rectum: 84 (20.3) Ovary: 51 (12.3) Pancreas: 46 (11.1) Other: 81 (19.6) | Incurable: 414 (100) Locoregional: 131 (32.2) Metastatic: 105 (25.8) Locoregional and metastatic: 171 (42.0) Not applicable: 8 (NR) | Most recent therapy, n (%): Surgery: 53 (16.9) Radiotherapy: 24 (7.6) Chemotherapy, 1st line: 89 (28.3) Chemotherapy, 2nd line: 71 (22.6) Chemotherapy, 3rd line: 77 (24.5) NA: 100 (NR) | Median (range) KPS: 60 (20–100) (26 patients with missing data) | WL (habitual weight), median (range): 24% (–8 to –56); WL (previous 6 months), median (range): 16% (–44 to –50); BMI, median (range): 19.5 (12.8–30.0) |
Bozzetti et al. (2015) [36] Nov 2004 to March 2011 Italy, France, Germany, Poland, Netherlands, Spain, Belgium, Denmark, UK, Canada | 579 | Median (range): 64 years (16–95 years) | 262 (47.3) | Colon-rectum: 108 (18.7) Head and neck: 67 (11.6) Ovary: 64 (11.1) Pancreas: 76 (13.1) Small bowel-biliary: 13 (2.2) Stomach: 136 (23.5) Other: 115 (19.9) | Incurable: 579 (100) Metastatic: 379 (66.3) Non-metastatic: 193 (33.7) Data missing on presence of metastases: 7 (NR) | NR | Median (range) KPS: 60 (20–100) (26 patients with missing data) | WL (previous 6 months), median (range): 13.8% (–44 to –50); BMI, median (range): 20.0 (12.7–34.2) |
Culine et al. (2014) [37] Sept 2009 to March 2010 France | 749 | Mean (SD): 63.0 years (11.4) | 296 (39.5) | Digestive system: 370 (49.9) Oropharyngeal: 148 (20.0) Respiratory system: 109 (14.7) Other sites: 132 (17.8) | Metastatic: 489 (65.3) | Ongoing chemotherapy or/and radiotherapy: 702 (98.3%) | Unspecified performance status scale, n (%): 0–1: 210 (28.2) 2: 354 (47.5) 3–4: 181 (24.3) | Mean body mass (SD): 59.2 (12.3); mean (SD) WL in last 6 months: 15.6% (7.7%); mean (range) BMI: 21.2 (12.7–39.1) |
Cotogni et al. (2017) [38] Oct 2011 to Sept 2013 Italy | 111 | Median (range) age in years: 62 (32–79) | 54 (49) | Stomach: 38 (34) Colon/rectum: 21 (19) Pancreas/biliary system: 20 (18) Oesophagus: 10 (9) Lung: 10 (9) Ovary: 2 (2) Others: 10 (9) | III: 25 (23) IV: 86 (77) Metastatic: 73 (68) | Patients receiving chemotherapy and/or radiation therapy: 72 (65%) Patients receiving no concurrent treatment: 39 (35%) | KPS median (range): 70 (60–80) | Median (range) BMI: 20.7 (13.5–29.5); median (range) WL in 3 months before HPN: 11.7% (0–38.3) |
Cotogni et al. (2018) [39] Oct 2014 to March 2015 Italy | 65 | Median (range) age in years: 64 (33–79) | 32 (49) | Stomach: 26 (40) Pancreas/biliary system: 15 (23) Colon/rectum: 9 (14) Gynaecological: 5 (8) Oesophagus: 3 (4) Other: 7 (11) | III: 16 (25) IV: 49 (75) Metastatic: 46 (71) | Patients were receiving: Chemotherapy: 65/65 (100%) Neoadjuvant chemotherapy: 9/65 Adjuvant chemotherapy: 37/65 Palliative chemotherapy: 19/65 Chemotherapy and radiation therapy together: 10/65 Adjuvant chemotherapy following surgery: 37/65 Neoadjuvant chemotherapy and subsequently underwent surgery: 5/65 Patients that received surgery: 42 (65%) | KPS mean (range): 67.4 (50–90), median: 70.0 | Mean (range) body weight in kg: 57.4 (33.0–100.0), median: 57.0; median (range) WL in 3 months: 10.7 (1.9–27.8); Mean (range) BMI: 21.2 (12.7–39.1), Median: 21.1 |
Cotogni et al. (2020) [40] June 2008 to May 2015 Italy | 761 | Mean (SD): 62.90 (10.28) | 380 (49.9) | Ovary: 47 (6.2) Gastrointestinal: 564 (74.1) Other: 150 (19.7) | II/III: 220 (28.9) IV: 541 (71.1) | Patients receiving chemotherapy, n (%) SPN and chemotherapy: 376 (49.4) TPN and chemotherapy: 99 (13.0) Patients not receiving chemotherapy, n (%) SPN and no chemotherapy: 191 (25.1) TPN and no chemotherapy: 95 (12.5) | KPS, n (%): 50: 102 (13.4) 60: 222 (29.2) 70: 387 (50.9) 80–90: 50 (6.6) | Mean body mass (SD): 58.42 kg (10.92), mean BMI (SD): 21.37 (3.76), WL in 3 months before HPN, n (%): ≤ 10.0%: 233 (30.6); 10.1–15%: 187 (24.6); 15.1–20%: 181 (23.8); > 20%: 160 (21.0) |
Cotogni et al. (2021) [42] June 2008 to May 2015 Italy | 761 | Median (IQR) age in years: 64 (57–70) | 380 (50) | Gastrointestinal: 564 (74) Ovary: 47 (6) Others: 150 (20) | II/III: 220 (29) IV: 541 (71) | 475 patients (62%) received anticancer treatments (CT/ RT) | KPS, n (%): 50: 102 (13) 60: 222 (29) 70: 387 (51) 80–90: 50 (7) | Median (IQR) body mass in kg: 57.3 (50.4–65) Median (IQR) BMI: 21 (18.7–23.4) Median (IQR) % WL in 3 months before HPN: 13.8 (9.3–19.1) |
Cotogni et al. (2022) [41] Oct 2012 to Sept 2015 Italy | 215 | Median (IQR) age in years: HPN group (n = 89): 68 (62 − 74) non-HPN group (n = 36): 68 (63–74) | HPN group: 42 (47) non-HPN group: 15 (42) | HPN group: Oesophagus/stomach: 25 (28) Pancreas/biliary system: 21 (24) Colon/rectum: 13 (15) Ovary: 7 (8) Lung: 4 (4) Urinary tract/prostate: 3 (3) Other: 16 (18) Non-HPN group: Oesophagus/stomach: 8 (22) Pancreas/biliary system: 9 (25) Colon/rectum: 2 (6) Ovary: 2 (6) Lung: 3 (8) Urinary tract/prostate: 3 (8) Other: 9 (25) | HPN group (n = 89): II: 3 (3) III: 13 (15) IV: 73 (82) Non-HPN group (n = 36): II: 1 (3) III: 7 (19) IV: 28 (78) | Patients receiving chemotherapy, n (%): HPN group (n = 89): 0 (0) non-HPN group (n = 36): 0 (0) | Median (IQR) KPS: HPN group: 60 (50 − 70) non-HPN group: 60 (60 − 70) ECOG PS: HPN group, n (%) 1: 1 (1) 2: 60 (67) 3: 28 (32) non-HPN group, n (%) 1: 0 (0) 2: 29 (81) 3: 7 (19) | Median (IQR) body weight in kg: HPN group: 57 (50–65) non-HPN group: 58 (51–69) Median (IQR) %WL in 3 months before HPN: HPN group: 10.9 (7.0 − 16.7) non-HPN group: 11.3 (6.5 − 16.0) |
Ma et al. (2021) [43] Oct 2014 to Jan 2019 Taiwan | 50 | Median (range) age in years in PN group: 68 (35–88) | 11 (22) | Gastric: 25 (100) | Locally advanced: 10 (40) Metastatic: 15 (60) | All patients were undergoing salvage CT | ECOG PS in PN group, n (%) 1: 11 (44) 2: 14 (56) | Body mass mean (kg) PN group: 51.66 (10.53) BMI mean PN group: 20.1 (3.6) |
Vashi et al. (2014) [44] April 2009 to March 2014 USA | 52 | Mean 53.2 (9.4) | 31 (59.6) | Pancreas: 14 (26.9) Colorectal: 11 (21.2) Ovarian: 6 (11.5) Appendix: 5 (9.6) Stomach: 4 (7.7) Others: 12 (23.1) | Advanced: 52 (100) | All patients underwent active CT, RT, or hormonal therapy while enrolled in the study | Mean (SD) KPS: 60.1 (10.8) | Body mass mean (SD) kg: 62.2 (14.6) Mean (SD) % WL in 6 months prior to HPN: 16.9 (9.3) Mean WL in 6 months prior to HPN, in kg: 13.2 |
Single arm trial | ||||||||
Pelzer et al. (2010) [34] Jan 2002 to Jan 2004 Germany | 32 | Assumed to be median, (range) in years: 62 (47–75) | 14 (43.8) | Pancreas: 32 (100) | IV inoperable: 32 (10 | NR | NR | Median (range) BMI: 19.7 (14.4–25.9) |
Retrospective observational studies | ||||||||
Goodrose-Flores et al. (2020) [24] 2016 to 2018 Sweden | Total: 124 Standard PN: 104 High-protein PN: 20 | All patients: 63.4 (12.9) Standard PN 63.4 (13.1) High-protein PN 63.4 (12.3) | All patients: 60 (48) Standard PN: 50 (48) High-protein PN: 10 (50) | Standard PN group Gastrointestinal: 41 (39) Pancreatic: 17 (16) Gynaecological: 12 (12) Head–neck: 6 (6) Other: 28 (27) High-protein PN group (n = 20) Gastrointestinal: 9 (45) Pancreatic: 3 (15) Gynaecological: 1 (5) Head–neck: 2 (10) Other: 5 (25) | Advanced/palliative: 124 (100) | Treatment with curative intent: 0 | NR | Standard PN: 65.2 (14.1) High-protein PN: 63.2 (10.1) All patients: 22.7 (4.3) Standard PN: 22.8 (4.6) High-protein PN: 21.9 (3.0) |
Obling et al. (2018) [45] Jan 2005 to Dec 2015 Denmark | 80 | Median (CI) age: 63.8 (25.1, 83.6) | 53 (66) | Upper GI cancer: 40 (50) Lower GI cancer: 10 (12) Gynaecological cancer: 22 (28) Other cancer: 8 (10) | Incurable: 80 (100) Metastatic: 71 (89) | NR | NR | Median (range) BMI: All patients: 20.7 (14.1–38.5) |
Ruggeri et al. (2020) [46] July 1990 to July 2019 Italy | 969 | Mean PN group: 64.2 (12.6) | PN group: 305 (48.5) | PN group: GI tract: 319 (62.2) Head-neck: 104 (16.5) Other organs: 114 (18.1) Lung: 20 (3.2) | PN group: Palliative: 666 (100) | NR | KPS in PN group, n (%): 40: 157 (25.0) 50: 276 (43.9) 60: 127 (20.2) 70: 53 (8.4) 80: 16 (2.5) | NR |
Ruggeri et al. (2021) [47] July 1990 to June 2020 Italy | 1,014 | Mean PN group: 64.6 (12.4) | PN group: 222 (49.2) | PN group: Head and neck: 116 (17.4) Oesophagus: 47 (7) Stomach: 153 (23) Pancreas: 65 (9.8) Colon: 128 (19.2) Lung: 21 (3.1) Breast: 16 (2.4) Uterus: 14 (2.1) Ovary: 59 (8.9) Other organs: 47 (7.1) | Advanced, palliative cancer patients in PN group: 629 (100) | Treatment, n (%): CT: 14 (36.8) CT-RT: 1 (2.6) None: 23 (60.5) | Mean (SD) KPS: 62.7 (18.53) | NR |
Santarpia et al. (2006) [48] Jan 1996 to Sept 2003 Italy | 152 | Mean (SD): 57.8 (13.6) | 107 (70.4) | Stomach: 48 (NR) Ovaries: 42 (NR) Colorectum: 30 (NR) Endometrium: 7 (NR) Breast: 6 (NR) Ileum: 5 (NR) Gallbladder: 4 (NR) Pancreas: 3 (NR) Kidney: 2 (NR) Skin: 1 (NR) Prostate: 1 (NR) Abdominal sarcoma: 1 (NR) Unknown: 2 (NR) | Terminal: 152 (100) | NR | KPS ≤ 40: 51.3% KPS ≥ 50: 62 patients | Body mass (kg) (SD): 53.4 (10.9) BMI mean (SD): 20.1 (3.6) Mean (SD) WL in previous 6 months, in kg: 9.5 (4.7) |
Soo et al. (2008) [49] 1999 to 2006 Canada | 38 | Mean SD: 48.76 (13.8) | 27 (71) | Ovarian: 13 (34) Colonic: 6 (15.8) Gastric: 6 (15.8) Peritoneal: 3 (7.9) Unknown: 2 (5.3) Oesophageal: 2 (5.3) Carcinoid: 1 (2.6) Cervical: 1 (2.6) Ampullary: 1 (2.6) GIST: 1 (2.6) Anaplastic large-cell lymphoma: 1 (2.6) Rectal: 1 (2.6) | Advanced: 38 (100) | Treatment, n (%): CT: 14 (36.8) CT-RT: 1 (2.6) None: 23 (60.5) | Mean (SD) KPS: 62.7 (18.53) | NR |
Santarpia et al. (2018) [50] Dates NR Italy | 19 | Mean: 59 (9.0) | 10 (52.6) | Ovary: 8 (NR) Stomach: 4 (NR) Colon-rectum: 3 (NR) Pancreas: 2 (NR) Gallbladder: 1 (NR) | Late-stage incurable: 19 (100) | NR | NR | Mean body mass: 50.5 (8.6) WL in the previous 6 months: in kg: 11.8 ± 4.5 %: 23.5 ± 8.1 |
Overview of PN intervention reported
Publication Authors (year) | PN intervention | Change in body mass | |
---|---|---|---|
Type of PN and duration of PN | Dose planned; dose administered | ||
Randomised controlled trials | |||
Obling et al. (2019) [33] | Type: Supplemental Duration: 17/47 (36%) patients completed 24 weeks of treatment | Dose planned: Energy: 30 kcal/kg/day; protein: 1.5 g/kg/day Dose given: Median energy intake in non-sHPN group: 31.1–40.4 kcal/kg/day, median energy intake in sHPN group: 30.0–40.2 kcal/kg/day Median protein intake in non-sHPN group: 1.10–1.16 g/kg/day Median protein intake in sHPN group: 1.08–1.39 g/kg/day | Median (range) BMI in the non-sHPN group: - Baseline: 21.3 (15.9–29.6) - Visit 2: 21.0 (14.4–29.8) - Visit 3: 19.5 (15.9–29.8) - Visit 4: 22.9 (15.8–31.7) - Visit 5: 22.9 (15.6–31.6) Median (range) BMI in the sHPN group: - Baseline: 21.5 (14.8–35.7) - Visit 2: 22.2 (16.1–36.8) - Visit 3: 22.7 (16.5–38.8) - Visit 4: 23.7 (16.9–34.8) - Visit 5: 23.5 (18.9–31.6 |
Prospective observational studies | |||
Bozzetti et al. (2014) [35] | Type: Total Duration: Median (range): 2 months (1–126) (n = 139) | Dose planned: Energy: at least 25 kcal/kg/day, protein: 1 g amino acid/kg/day Dose given: NR | NR |
Bozzetti et al. (2015) [36] | Type: Total Duration: NR | Dose planned: Energy: at least 25 kcal/kg/d, protein: 1 g amino acid/kg/day Dose given: NR | NR |
Culine et al. (2014) [37] | Type: Total and supplemental Duration: NR | Dose planned: NR Dose given: Energy, mean (SD): 26 (0.4) kcal/kg/day; protein, mean (SD): 1.15 (0.02) g/kg/day | Weight in kg, mean (SD): - Baseline: 59.6 (12.5) - Day 28: 61.1 (12.5) - p < 0.001 BMI, mean (SD): - Baseline: 20.9 (4.0) - Day 28: 21.4 (3.9) - p < 0.001 |
Cotogni et al. (2017) [38] | Type: Supplemental Duration: Median (range) duration of PN in days: 137 (21–576) | Dose planned: Energy for bedridden patients: 20–25 kcal/kg/day, energy for ambulatory patients: 25–30 kcal/kg/day, protein: 1–1.5 g/kg/day Dose given: NR | NR |
Cotogni et al. (2018) [39] | Type: Total and supplemental Duration: NR | Dose planned: Energy: 25–30 kcal/kg/day, protein: 1–1.5 g/kg/day Dose given: NR | Mean (range), median - Baseline: 57.4 (33.0–100.0), 57.0 - 60 days: 58.9 (37.7–96.0), 57.0 - 90 days: 59.7 (37.5–95.0), 60.0 - p < 0.01 |
Cotogni et al. (2020) [40] | Type: Total and supplemental Duration: NR | Dose planned: Energy: 25–30 kcal/kg/day, protein: 1–1.5 g/kg/day Dose given: NR | NR |
Cotogni et al. (2021) [42] | Type: Total and supplemental Duration: Median (IQR) duration in days: 203 (101–296) | Dose planned: Energy: 25–30 kcal/kg/day, protein: 1–1.5 g/kg/day Dose given: NR | NR |
Cotogni et al. (2022) [41] | Type: Total and supplemental Duration: NR | Dose planned: Energy: 25–30 kcal/kg/day, protein: 1–1.5 g/kg/day Dose given: NR | NR |
Ma et al. (2021) [43] | Type: Supplemental Duration: Median (range) duration in days: 135 (16–569) | Dose planned: Energy: 910–1,800 kcal/day; protein: 33–60 g/day Dose given: NR | Mean (SD) body weight in PN group, in kg: - Baseline (n = 25): 51.66 (10.53) - Change from baseline at 0.5 months (n = 22): –1.14 (4.14), p = 0.212 - Change from baseline at 1 month (n = 19): 4.13 (25.54), p = 0.490 - Change from baseline at 2 months (n = 12): 1.93 (5.24), p = 0.227 - Change from baseline at 3 months (n = 7): 3.34 (4.72), p = 0.110 Mean (SD) BMI in PN group: - Baseline (n = 25): 20.1 (3.6) - Change from baseline at 0.5 months (n = 22): –0.4 (1.7), p = 0.285 - Change from baseline at 1 month (n = 19): –0.4 (2.0), p = 0.422 - Change from baseline at 2 months (n = 12): 0.9 (2.4), p = 0.248 - Change from baseline at 3 months (n = 7): 1.3 (1.8), p = 0.105 |
Vashi et al. (2014) [44] | Type: Total and supplemental Duration: Mean (SD) (range) duration in months: 3.4 (2.5) (0.4–11.7) | Dose planned: Energy: 25–30 kcal/kg for BMI < 30; 22–25 kcal/kg for BMI ≥ 30; protein: 1.5–2 for BMI < 30; 2–2.5 for BMI ≥ 30 Dose given: Mean (SD) PN energy delivery in patients with < 3 months follow-up (n = 37) in kcal/kg/day: 23.4 (5.2); Mean (SD) PN energy delivery in patients with ≥ 3 months follow-up (n = 15) in kcal//day: 20.8 (3.9); protein < 3 months follow-up 1.5 g/kg/day & ≥ 3 months follow-up 1.3 g/kg/day | Mean (SD) body weight in kg amongst patients with 1 month of follow-up data (n = 39): - Baseline: 61.5 (13.4) - Month 1: 63.1 (12.7) - p = 0.03 |
Single arm trial | |||
Pelzer et al. (2010) [34] | Type: Supplemental Duration: Median (range) duration in weeks: 18 (8–35) | Dose planned: Protein: 1.2–1.5 g/kg/day Dose given: NR | Median (range) BMI: - Before PN: 19.7 (14.4–25.9) - After PN: 20.5 (15.4–25.0) |
Retrospective observational studies | |||
Goodrose-Flores et al. (2020) [24] | Type: Unclear Duration: Median duration of PN across all patients: 2 months | Dose planned: NR Dose given: Mean (SD) energy intake in kcal g/kg/day: • Standard PN (n = 104): 19.7 (4.7), High-protein PN (n = 20): 21.4 (5.1) Protein: Mean (SD) protein intake in g/kg/day: • Standard PN (n = 104): 0.77 (0.19) • High-protein PN (n = 20): 1.15 (0.26) | Mean (SD) body weight in kg in standard PN group (n = 104): - Before PN: 65.2 (14.1) - After PN: 65.5 (13.1) - % change from baseline: 0.12 (5.3) Mean (SD) BMI in standard PN group (n = 104): - Before PN: 22.8 (4.6) - After PN: 22.9 (4.4) |
Obling et al. (2018) [45] | Type: Supplemental Duration: Median (range) duration in days: all patients (n = 80): 364.9 (6–2,006) | Dose planned: Energy: 30 kcal/kg/day, protein: 1.2 g/kg/day Dose given: Median (range) actual protein intake: all patients: 0.87 (0.43–1.92) | NR |
Ruggeri et al. (2020) [46] | Type: Unclear Duration: NR | Dose planned: NR Dose given: Energy, mean (SD): 32 (8) kcal/kg/day, protein, mean (SD): 1.4 (0.4) g/kg/day | NR |
Ruggeri et al. (2021) [47] | Type: Total and supplemental Duration: NR | Dose planned: NR Dose given: Energy, mean (SD): 31 (9) kcal/day, protein, mean (SD): 1.3 (0.4) | Mean (SD) change in BMI after 1 month of treatment: - TPN: 0.04 (0.25) - SPN: 0.21 (0.23) |
Santarpia et al. (2006) [48] | Type: Total Duration: NR | Dose planned: Energy: 20–30 kcal/kg/day, protein: 1–1.5 g/kg/day Dose given: NR | Mean (SD) weight in kg amongst the 64 patients that survived longer than 60 days: - Baseline: 51.7 (10.3) - After 1 month: 53.2 (10.3) - p = 0.0001 Mean (SD) BMI amongst the 64 patients that survived longer than 60 days: - Baseline: 19.6 (3.1) - After 1 month: 20.1 (3.1) - p = 0.0001 |
Soo et al. (2008) [49] | Type: Total Duration: NR | Dose planned: Energy: 25 kcal/kg, protein: 1 g/kg/day Dose given: NR | NR |
Santarpia et al. (2018) [50] | Type: Total Duration: NR | Dose planned: NR Dose given: Energy: 30 kcal/kg/day, protein: 1.34 g/kg/day | NR |