103 PROTEIN AND ENERGY INTAKE DURING ICU-RECOVERY 6 Evidence on dietary intake and nutritional care in the post-ICU hospitalisation phase and beyond is largely lacking. In recent cohort study, energy and protein deficits were reported in ICU-patients admitted with a traumatic brain injury.31 Another nested cohort showed patients did not meet estimated or measured energy and protein requirements in the general ward after ICU-discharge, where an oral diet was the most common mode of nutritional therapy.32 Our study adds to the sparse body of post-ICU data, demonstrating that in a significant proportion of ICU-patients, achieving nutritional adequacy is limited. During the recovery phase, a large proportion of patients in our study participated in rehabilitation activities, but only a small group consulted a dietician or SLT, or used dietary supplements. Nevertheless, the use of dietary supplementation significantly increased protein and energy intake during follow-up and therefore increased nutritional intake. The use of dietary supplementation was associated with swallowing difficulties and taste issues that remained present up to 12-months after discharge in some patients. However, the presence of these barriers was not associated with a higher number of visits to either a dietician nor a SLT. These findings suggest there is a gap between the number of patients in need of nutritional guidance post-ICU and those actually receiving help. More intensive nutritional support, with additional supplementary feeding in the recovery phase, may therefore help patients in reaching dietary targets when eating is difficult. This study is the first study investigating protein and energy intake in the ICU and during recovery using an intensive follow-up format. The personalised approach applied in this study enabled to minimise loss to follow-up, despite several restricting measures due to the ongoing COVID-19 pandemic. The highest proportion of loss to follow-up in the recovery phase was 35% (Supplemental table 1) for assessment at 3-months post-ICU, which coincided with the first wave of COVID-19 in the Netherlands. However, this proportion is lower than what was reported in our previously conducted retrospective study which used data collected at the standard care outpatient clinic.2 There are some limitations to this study. Firstly, due to its small-scaled setup, generalisation of the results should be done with caution. Also, we did not collect data on dietary intake during the post-ICU hospitalisation period. Information on dietary intake before ICU-admission was lacking, as we were unable to collect these in the acute care setting. Finally, it is generally known that qualitative assessment methods of nutritional intake, like the 24-h dietary recall method, are prone to under and overreporting,33 which may have affected the post-ICU intake results.
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