---
title: "Micronutrients in Critically Ill Adults: Evidence, Risks, and Moving Toward Precision Nutrition"
id: "pubmed-42681987"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42681987"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42681987/"
doi: "10.1097/MCO.0000000000001253"
published_at: "2026-09-02T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Micronutrients in Critically Ill Adults: Evidence, Risks, and Moving Toward Precision Nutrition
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42681987
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42681987/)
- **DOI:** [10.1097/MCO.0000000000001253](https://doi.org/10.1097%2FMCO.0000000000001253)
- **Published At:** 2026-09-02T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Recent evidence questions routine high-dose single-micronutrient therapy in critically ill adults despite biological plausibility for benefit. - Multiple trials and analyses report no outcome improvement with high-dose **vitamin C** and potential harms in sepsis, COVID-19, severe burns, and post-cardiac arrest patients. - A 2025 meta-analysis found **vitamin D** supplementation was associated with reduced short-term mortality and shorter ICU stay in mechanically ventilated patients. - **Thiamine** may shorten duration of shock but has not demonstrated mortality benefit. - Observational data identify frequent carnitine disturbances during critical illness; both deficiency and excess may relate to worse outcomes. - **Selenium** supplementation continues to show no clear clinical benefit across sepsis phenotypes and high-risk surgical groups. - Emerging mechanistic links connect trace element dysregulation (copper, zinc, iron) to critical illness–acquired weakness via processes including copper-dependent cell death and altered iron and zinc homeostasis. - Advances in biomarkers (for example **hepcidin**, soluble transferrin receptor, ferritin, and selenoprotein P) improve detection of true deficiency and support targeted replacement strategies. - Current recommendation: ensure baseline daily micronutrient requirements are met and limit supplementation to patients with biomarker-confirmed deficiency or high-risk biologic phenotypes. - Future research should prioritize biomarker-guided, individualized, precision-nutrition approaches and validated metabolic profiling to define who may benefit from targeted micronutrient therapy.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Micronutrients in adult critically ill patients: lessons learned and the path toward precision [Christian Stoppe](https://pubmed.ncbi.nlm.nih.gov/?term=Stoppe+C&cauthor_id=42681987)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42681987/#full-view-affiliation-1 "Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42681987/#full-view-affiliation-2 "Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany."), [Kursat Gundogan](https://pubmed.ncbi.nlm.nih.gov/?term=Gundogan+K&cauthor_id=42681987)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42681987/#full-view-affiliation-3 "Division of Medical Intensive Care, Department of Internal Medicine, Erciyes University Faculty of Medicine.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42681987/#full-view-affiliation-4 "Department of Clinical Nutrition, Health Sciences Institute, Erciyes University, Kayseri, Turkey."), [Stefano Marelli](https://pubmed.ncbi.nlm.nih.gov/?term=Marelli+S&cauthor_id=42681987)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42681987/#full-view-affiliation-5 "Neurocritical Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, Milan, Italy.") Affiliations Expand ### Affiliations * 1 Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg. * 2 Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany. * 3 Division of Medical Intensive Care, Department of Internal Medicine, Erciyes University Faculty of Medicine. * 4 Department of Clinical Nutrition, Health Sciences Institute, Erciyes University, Kayseri, Turkey. * 5 Neurocritical Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, Milan, Italy. * PMID: **42681987** * DOI: [ 10.1097/MCO.0000000000001253 ](https://doi.org/10.1097/mco.0000000000001253) Item in Clipboard # Micronutrients in adult critically ill patients: lessons learned and the path toward precision Christian Stoppe et al. Curr Opin Clin Nutr Metab Care. 2026. Show details Display options Display options Format Abstract PubMed PMID Curr Opin Clin Nutr Metab Care Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Curr+Opin+Clin+Nutr+Metab+Care%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Curr+Opin+Clin+Nutr+Metab+Care%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42681987/) . 2026 Sep 2. doi: 10.1097/MCO.0000000000001253. Online ahead of print. ### Authors [Christian Stoppe](https://pubmed.ncbi.nlm.nih.gov/?term=Stoppe+C&cauthor_id=42681987)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42681987/#short-view-affiliation-1 "Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42681987/#short-view-affiliation-2 "Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany."), [Kursat Gundogan](https://pubmed.ncbi.nlm.nih.gov/?term=Gundogan+K&cauthor_id=42681987)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42681987/#short-view-affiliation-3 "Division of Medical Intensive Care, Department of Internal Medicine, Erciyes University Faculty of Medicine.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42681987/#short-view-affiliation-4 "Department of Clinical Nutrition, Health Sciences Institute, Erciyes University, Kayseri, Turkey."), [Stefano Marelli](https://pubmed.ncbi.nlm.nih.gov/?term=Marelli+S&cauthor_id=42681987)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42681987/#short-view-affiliation-5 "Neurocritical Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, Milan, Italy.") ### Affiliations * 1 Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg. * 2 Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany. * 3 Division of Medical Intensive Care, Department of Internal Medicine, Erciyes University Faculty of Medicine. * 4 Department of Clinical Nutrition, Health Sciences Institute, Erciyes University, Kayseri, Turkey. * 5 Neurocritical Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, Milan, Italy. * PMID: **42681987** * DOI: [ 10.1097/MCO.0000000000001253 ](https://doi.org/10.1097/mco.0000000000001253) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Purpose of review:** Despite strong biological plausibility, empiric high-dose micronutrient supplementation has failed to improve outcomes in critically ill patients. This review synthesizes evidence from the past 18 months and outlines the necessary transition toward biomarker-guided precision nutrition. **Recent findings:** Recent evidence has further challenged routine high-dose micronutrient therapy. High-dose intravenous vitamin C failed to improve outcomes and was associated with potential harm in patients with sepsis, COVID-19, severe burns, and post-cardiac arrest syndrome. In contrast, a 2025 meta-analysis reported reduced short-term mortality and shorter ICU stay with vitamin D supplementation in patients on mechanical ventilation. Thiamine may shorten the duration of shock without affecting mortality. Observational studies suggest that carnitine deficiency is common during critical illness, and both deficiency and excess may be associated with adverse outcomes in critically ill patients. Selenium supplementation continues to show no clinical benefits in multiple sepsis phenotypes and high-risk surgical populations. Novel evidence also links trace element dysregulation to critical illness-acquired weakness, implicating copper-dependent cuproptosis, zinc homeostasis, and iron metabolism in the pathogenesis of muscle dysfunction. Advances in biomarkers (e.g. hepcidin, soluble transferrin receptor, ferritin, and selenoprotein P) are enabling more accurate identification of true deficiency states and targeted replacement strategies. **Summary:** Current evidence does not support routine high-dose single-micronutrient therapy in critically ill patients and suggests potential harm with pharmacological doses of vitamin C. Clinicians should ensure that daily baseline requirements are met and reserve supplementation only for patients with biomarker-confirmed deficiency or biologically defined high-risk phenotypes. Future research should prioritize precision nutritional approaches based on validated biomarkers and individualized metabolic profiling. **Keywords:** critical illness; micronutrients; oxidative stress; personalized medicine; trace elements; vitamins. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## References 1. 1. Berger MM, Shenkin A, Dizdar OS, et al. ESPEN practical short micronutrient guidelines. Clin Nutr 2024; 43:825–857. 2. 1. de Man AME, Stoppe C, Koekkoek K, et al. ESICM/FREM MN group. What do we know about micronutrients in critically ill patients? A narrative review. JPEN J Parenter Enteral Nutr 2025; 49:33–58. 3. 1. Lamontagne F, Masse MH, Menard J, et al. LOVIT Investigators and the Canadian Critical Care Trials Group. Intravenous vitamin C in adults with sepsis in the intensive care unit. N Engl J Med 2022; 386:2387–2398. 4. 1. Müller MM, Pinto R, Lamontagne F, et al. Lessening Organ Dysfunction With Vitamin C (LOVIT) Investigators. Vitamin C does not affect platelet counts in patients with sepsis: a post hoc analysis of the lessening organ dysfunction with vitamin C randomized trial. Crit Care Explor 2025; 7:e1310. 5. 1. Rynne J, Mosavie M, Masse MH, et al. Sepsis subtypes and differential treatment response to vitamin C: a biological sub-study of the LOVIT trial. Intensive Care Med 2025; 51:82–93. 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