The Japanese Critical Care Nutrition Guideline 2024

JSICM · 2025 · Japan

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Authors: Kensuke Nakamura, Ryo Yamamoto, Naoki Higashibeppu et al.
Title: The Japanese Critical Care Nutrition Guideline 2024
Journal: Journal of Intensive Care, 2025
DOI: 10.1186/s40560-025-00785-z
Licence: CC BY 4.0
Changes: Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC11927338

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Recommendations

Verbatim, with grade of recommendation or strength of consensus where given.

Terms in guidelines

Answer: We suggest providing nutrition therapy using nutrition protocols to critically ill patients.GRADE 2B: certainty of evidence = “moderate”
Answer: We suggest administering enteral nutrition rather than parenteral nutrition in critically ill patientsGRADE 2C: certainty of evidence = “low”
Answer: We suggest against intentionally reducing energy intake below energy expenditure in the acute phase of critical illnessGRADE 2B: certainty of evidence = “moderate”
Answer: We suggest administering higher protein doses above the standard (> 1.2 g/kg/day) in critically ill patientsGRADE 2D: certainty of evidence = “very low”
Answer: We recommend initiating enteral nutrition within 48 h following the start of treatment in critically ill patientsGRADE 1B: certainty of evidence = “moderate”
Answer: We suggest against administering enteral nutrition in critically ill patients with hemodynamic instabilityGRADE 2D: certainty of evidence = “very low”
Answer: We suggest against initiating supplemental parenteral nutrition in critically ill patients receiving insufficient amounts of enteral nutritionGRADE 2A: certainty of evidence = “high”
Answer: We suggest using post-pyloric feeding rather than gastric feeding for enteral nutrition in critically ill patientsGRADE 2D: certainty of evidence = “very low”
Answer: We suggest continuous feeding rather than intermittent feeding for gastric enteral nutrition in critically ill patientsGRADE 2D: certainty of evidence = “very low”
Answer: We suggest administering omega-3 fatty acid-enriched enteral nutrition to critically ill patientsGRADE 2C: certainty of evidence = “low”
Answer: We suggest against administering glutamine-enhanced enteral nutrition in critically ill patients receiving enteral nutritionGRADE 2D: certainty of evidence = “very low”
Answer: We suggest against administering enteral nutrition with oligomeric or elemental formulas intended as a source of nitrogen in critically ill patientsGRADE 2D, certainty of evidence = “very low”
Answer: We suggest against administering arginine-enhanced enteral nutrition in critically ill patients receiving enteral nutritionGRADE 2D: certainty of evidence = “very low”
Answer: We suggest against administering high-fat, low-carbohydrate enteral nutrition for critically ill patientsGRADE 2C: certainty of evidence = “low”
Answer: We suggest against administering intravenous lipid emulsions to critically ill patients receiving parenteral nutritionGRADE 2D, certainty of evidence = “very low”
Answer: We recommend administering prebiotics to critically ill patientsGRADE 1B: certainty of evidence = “moderate”
Answer: We suggest administering probiotics to critically ill patientsGRADE 2C: certainty of evidence = “low”
Answer: We recommend administering synbiotics to critically ill patientsGRADE 1C: certainty of evidence = “low”
Answer: We suggest using indirect calorimetry for estimating energy expenditure (EE) in critically ill patientsGRADE 2B: certainty of evidence = “moderate”
Answer: We suggest against giving higher than standard protein doses (> 2.0 g/kg/day) to critically ill pediatric patientsGRADE 2D: certainty of evidence = “very low”
Answer: We suggest initiating enteral feeding within 48 h of starting treatment for critically ill pediatric patientsGrade 2D, certainty of evidence = “very low”
Answer: We suggest against using post-pyloric feeding rather than gastric feeding for enteral nutrition of critically ill pediatric patientsGRADE 2D: certainty of evidence = “very low”
Answer: We suggest using bolus feeding rather than continuous feeding in critically ill pediatric patients undergoing gastric feedingGRADE 2C, certainty of evidence = “low”
Answer: We suggest administering of energy/protein-dense formulas (0.9 to 1.0 kcal/mL) to critically ill pediatric patientsGrade 2D, certainty of evidence = “very low”

Abstract

Nutrition therapy is important in the management of critically ill patients and is continuously evolving as new evidence emerges. The Japanese Critical Care Nutrition Guideline 2024 (JCCNG 2024) is specific to Japan and is the latest set of clinical practice guidelines for nutrition therapy in critical care that was revised from JCCNG 2016 by the Japanese Society of Intensive Care Medicine. An English version of these guidelines was created based on the contents of the original Japanese version. These guidelines were developed to help health care providers understand and provide nutrition therapy that will improve the outcomes of children and adults admitted to intensive care units or requiring intensive care, regardless of the disease. The intended users of these guidelines are all healthcare professionals involved in intensive care, including those who are not familiar with nutrition therapy. JCCNG 2024 consists of 37 clinical questions and 24 recommendations, covering immunomodulation therapy, nutrition therapy for special conditions, and nutrition therapy for children. These guidelines were developed in accordance with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system by experts from various healthcare professionals related to nutrition therapy and/or critical care. All GRADE-based recommendations, good practice statements (GPS), future research questions, and answers to background questions were finalized by consensus using the modified Delphi method. Strong recommendations for adults include early enteral nutrition (EN) within 48 h and the provision of pre/synbiotics. Weak recommendations for adults include the use of a nutrition protocol, EN rather than parenteral nutrition, the provision of higher protein doses, post-pyloric EN, continuous EN, omega-3 fatty acid-enriched EN, the provision of probiotics, and indirect calorimetry use. Weak recommendations for children include early EN within 48 h, bolus EN, and energy/protein-dense EN formulas. A nutritional assessment is recommended by GPS for both adults and children. JCCNG 2024 will be disseminated through educational activities mainly by the JCCNG Committee at various scientific meetings and seminars. Since studies on nutritional treatment for critically ill patients are being reported worldwide, these guidelines will be revised in 4 to 6 years. We hope that these guidelines will be used in clinical practice for critically ill patients and in future research.

Supplementary Information: The online version contains supplementary material available at 10.1186/s40560-025-00785-z.

Contents of the original publication

The section headings of the original.

Introduction
Methods
Basic philosophy and overview
Methodology for the development of clinical practice guidelines
Terms in guidelines

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