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Article analysis:

The article titled "Early vs delayed enteral nutrition or parenteral nutrition in hospitalized patients: An umbrella review of systematic reviews and meta-analyses of randomized trials" provides a comprehensive summary of existing evidence on the effect of early enteral nutrition (EEN) compared with other approaches, including delayed enteral nutrition (DEN), parenteral nutrition (PN), and oral feeding (OF) on clinical outcomes in hospitalized patients. The authors conducted a systematic search up to December 2021, in MEDLINE (via PubMed), Scopus, and Institute for Scientific Information Web of Science. They included systematic reviews with meta-analyses (SRMAs) of randomized trials investigating EEN compared with DEN, PN, or OF for any clinical outcomes in hospitalized patients.

The article is well-structured and provides a clear overview of the research question, methodology, results, and conclusions. The authors used appropriate tools to assess the methodological quality of the systematic reviews and their included trial. They also rated the certainty of the evidence using the “Grading of Recommendations Assessment, Development, and Evaluation” (GRADE) approach.

However, there are some potential biases and limitations that need to be considered when interpreting the results. Firstly, the authors only included SRMAs that investigated EEN compared with DEN, PN or OF for any clinical outcomes in hospitalized patients. This means that they may have missed relevant studies that investigated other interventions or populations. Secondly, while they used appropriate tools to assess the methodological quality of the systematic reviews and their included trial, they did not provide a detailed description of how they assessed each item on these tools. This makes it difficult to evaluate whether their assessments were accurate or biased.

Thirdly, while they rated the certainty of evidence using GRADE approach, they did not provide a detailed explanation for why they downgraded or upgraded certain outcomes. This makes it difficult to understand how confident we can be in their conclusions. Fourthly, the authors did not explore potential sources of heterogeneity between studies, which could have influenced the results. For example, they did not investigate whether the effect of EEN varied depending on the type of patient or clinical setting.

Finally, while the article provides a comprehensive summary of existing evidence on the effect of EEN compared with other approaches, it does not provide a balanced discussion of potential risks or limitations associated with EEN. For example, they did not discuss potential adverse effects such as diarrhea or aspiration pneumonia that can occur with early feeding in critically ill patients.

In conclusion, while the article provides a useful summary of existing evidence on the effect of EEN compared with other approaches in hospitalized patients, there are some potential biases and limitations that need to be considered when interpreting the results. Further research is needed to explore potential sources of heterogeneity and to investigate potential risks or limitations associated with EEN.