Although 25-35 kcal/kg/day has been widely utilized as a caloric target when feeding critically ill patients, there has been a growing body of literature that suggests that permissive underfeeding with lower caloric targets is as effective as higher calorie targets and may decrease morbidity from overfeeding or from other adverse effects of delivering a full nutritional load to a metabolically stressed patient. There have been several recently published randomized trials (EDEN and PERMIT)8-10 in mixed critically ill patients and in surgical patients only 11 that have shown equivalent primary outcomes with hypocaloric (10 kcal/kg/day) feeding versus normocaloric (25-35 kcal/kg/day). However, a meta-analysis suggests improvement in some secondary outcome measures with the hypocaloric approach.12 Currently, a hypocaloric approach is a reasonable alternative in patients with low or intermediate nutritional risk (based on NUTRIC or other scoring system) and no pre-existing malnutrition, and may decrease select complications such as feeding intolerance, diarrhea, and high gastric residual volumes. Further, hypocaloric feeding (10-20 kcal/kg) has also been found to have multiple benefits in patients with pre-existing obesity (BMI>30) by reducing excessive fat stores while simultaneously preserving lean body mass. However, it is critical when using a hypocaloric approach in ANY patient to understand than "hypocaloric" refers to non-protein calories, and that it must always be accompanied by full and adequate protein delivery (typically 1.5 to 2 grams/kg ideal body weight).1,2