--- title: "Guideline Adherence in Enteral Nutrition Practices in Turkish ICUs: Point-Prevalence Study" id: "bmj-open-20-evaluation-of-guideline-adherence-in-enteral-nutrition-practices-among-icu" canonical_url: "https://medichelpline.com/clinical-feed/bmj-open-20-evaluation-of-guideline-adherence-in-enteral-nutrition-practices-among-icu" content_type: "clinical_feed_article" specialty: "Critical Care" source_name: "BMJ Open" source_url: "http://bmjopen.bmj.com/cgi/content/short/16/9/e120718?rss=1" published_at: "2026-09-02T12:59:18.000Z" evidence_level: "Journal Feed" license: "CC-BY-NC-4.0 / Informational Use" --- # Guideline Adherence in Enteral Nutrition Practices in Turkish ICUs: Point-Prevalence Study ## Provenance & Clinical Metadata - **Canonical URL:** https://medichelpline.com/clinical-feed/bmj-open-20-evaluation-of-guideline-adherence-in-enteral-nutrition-practices-among-icu - **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md) - **Primary Source:** BMJ Open - **Source URL:** [Original Journal Publication](http://bmjopen.bmj.com/cgi/content/short/16/9/e120718?rss=1) - **Published At:** 2026-09-02T12:59:18.000Z - **Evidence Rating:** Journal Feed ## Executive GIST (TL;DR) - This multicentre point-prevalence study assessed adherence to clinical nutrition guidelines for **enteral nutrition** (EN) in six intensive care units in Türkiye using ESPEN, ASPEN and KEPAN–based criteria. - Ninety-eight adult ICU patients who had been in the ICU ≥48 hours and received EN ≥24 hours on one of two specified dates were included. - Median age was 72 years (IQR 59–79); 61.2% were male. - EN was started within 48 hours in 73.5% of patients; 13.3% of delays had no clinical justification. - Median achievement of energy target was 87% (IQR 69.6%–100%); median protein target achievement was 82% (IQR 64.9%–100%). - Only 27.6% of patients met 100% of both energy and protein requirements. - Failure to hit nutritional targets correlated with more comorbidities (p=0.007), higher BMI (p=0.017) and renal dysfunction (p=0.041). - EN continued despite contraindications in 14.3% of patients; those patients had higher APACHE II, SOFA and NUTRIC scores (statistically significant per source). - Overall guideline adherence was reported as high, but the study highlighted gaps in achieving full nutritional targets and in optimizing **prokinetic agents** use. - No interventions were performed; practices were evaluated against guideline-based recommendations without changes to care. ## Clinical Analysis & Structured Key Points Objectives Malnutrition is a significant problem in critically ill patients and is associated with higher mortality, morbidity and healthcare costs. Enteral nutrition (EN), being more physiological than parenteral nutrition, helps reduce complications. This study evaluated how well EN practices in Turkish intensive care units (ICUs) align with current clinical nutrition guidelines. Design and setting This multicentre, prospective, point-prevalence study was carried out in six ICUs in Türkiye. Participants Adult patients (≥18 years) who had stayed in the ICU for at least 48 hours and had received EN for a minimum of 24 hours on either of the two prespecified point-prevalence dates (30 July and 30 August 2025) were eligible. All patients meeting these criteria were included. Interventions No intervention was performed. Existing EN practices were evaluated against guideline-based recommendations. Primary outcome measures EN practices were assessed according to initiation time, type of EN tube, method of EN administration, rate of achieving calorie and protein target, management of conditions requiring EN interruption and use of prokinetic agents. Guideline adherence was evaluated using a protocol based on European Society for Clinical Nutrition and Metabolism (ESPEN), American Society for Parenteral and Enteral Nutrition (ASPEN) and Turkish Society of Clinical Enteral and Parenteral Nutrition (KEPAN) recommendations. Results 98 patients were included; 60 patients (61.2%) were male, and the median age was 72 (IQR 59 - 79) years. EN was initiated within 48 hours in 72 patients (73.5%), while 13 (13.3%) delays lacked clinical justification. The median percentage of administered energy and protein compared with the targets was 87% (IQR 69.6% - 100%) and 82% (IQR 64.9% - 100%), respectively. However, only 27 patients (27.6%) achieved 100% of both energy and protein requirements. Failure to achieve nutritional targets was significantly associated with a higher number of comorbidities (p=0.007), higher body mass index (p=0.017) and renal dysfunction (p=0.041). EN continued despite contraindications in 14 patients (14.3%), who had significantly higher Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Nutrition Risk in Critically Ill (NUTRIC scores (all p Conclusions Among patients receiving EN, overall adherence to guideline recommendations was high. 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