Compared with standard calorie and protein targets, early calorie and protein restriction did not decrease mortality but was associated with faster recovery and fewer complications.

Of 3,044 patients randomly assigned between July 5, 2018, and 8 Dec 8, 2020, eight withdrew consent to participation.

By day 90, 628 (41·3%) of 1,521 patients in the low group and 648 (42·8%) of 1,515 patients in the standard group had died.

Median time to readiness for ICU discharge was 8·0 days (IQR 5·0–14·0) in the low group and 9·0 days (5·0–17·0) in the standard group.

Proportions of patients with secondary infections did not differ between the groups.

The low group had lower proportions of patients with vomiting, diarrhoea, bowel ischaemia, and liver dysfunction.

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