Hypocaloric, High‐Protein Nutrition Therapy in Older vs Younger Critically Ill Patients With Obesity

Dickerson, Roland N.; Medling, Theresa L.; Smith, Ashley C.; Maish, George O.; Croce, Martin A.; Minard, Gayle; Brown, Rex O.

doi:10.1177/0148607112466894

Cited by 59 publications

(94 citation statements)

References 37 publications

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“…Infusing protein at a dose of 2–2.5 g/kg ideal body weight per day should approximate protein requirements, preserve nitrogen balance, and allow for adequate wound healing. Nitrogen balance was similar with these levels regardless of whether energy intake was hypocaloric or eucaloric 269 , 465 , 467 . Use of BMI and ideal body weight is recommended for these calculations, while use of adjusted body weight should be avoided.…”

Section: Q Obesity In Critical Illnessmentioning

confidence: 82%

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

McClave

Taylor

Martindale

et al. 2016

J Parenter Enteral Nutr

2,551

1,248

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Section: Q Obesity In Critical Illnessmentioning

confidence: 82%

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

McClave

Taylor

Martindale

et al. 2016

J Parenter Enteral Nutr

2,551

1,248

View full text Add to dashboard Cite

“…Four comparative studies [59][60][61][62] and 2 case series 63,64 examined the use of hypocaloric, high protein nutrition therapy for hospitalized patients with obesity. The hypocaloric, high protein diets contained average intakes ranging from 90 g to 140 g of protein and 900 kcals to 1300 kcals daily (Table 4).…”

Section: Accuracymentioning

confidence: 99%

“…Data to support this recommendation are in Table 3, where protein intake of 1.2 g/kg actual body weight (2 g/kg ideal body weight) daily was given to patients in 5 observational studies [59][60][61][62]64 with hypocaloric or eucaloric energy intake. An additional study compared protein requirements based on nitrogen balance studies separately for ICU and non-ICU patients.…”

Section: Daily Nutrient Deliverymentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

Choban

Dickerson

Malone

et al. 2013

J Parenter Enteral Nutr

134

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Background: Due to the high prevalence of obesity in adults, nutrition support clinicians are encountering greater numbers of obese patients who require nutrition support during hospitalization. The purpose of this clinical guideline is to serve as a framework for the nutrition support care of adult patients with obesity. Method: A systematic review of the best available evidence to answer a series of questions regarding management of nutrition support in patients with obesity was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation working group. A consensus process, that includes consideration of the strength of the evidence together with the risks and benefits to the patient, was used to develop the clinical guideline recommendations prior to multiple levels of external and internal review and approval by the A.S.P.E.N. Board of Directors. Questions: (1) Do clinical outcomes vary across levels of obesity in critically ill or hospitalized non−intensive care unit (ICU) patients? (2) How should energy requirements be determined in obese critically ill or hospitalized non‐ICU patients? (3) Are clinical outcomes improved with hypocaloric, high protein diets in hospitalized patients? (4) In obese patients who have had a malabsorptive or restrictive surgical procedure, what micronutrients should be evaluated?

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“…The interaction between calories and protein upon nitrogen balance and body composition, in conjunction with vigilance in avoiding overfeeding complications, serves as the basis for the use of hypocaloric, high‐protein nutrition therapy for the hospitalized patient with obesity. Table 1 summarizes the current literature of 6 comparative studies and 2 case series totaling 226 hospitalized, surgical, and trauma obese patients receiving hypocaloric, high‐protein nutrition support therapy 12 , 33 – 39 . Mean protein intakes ranged from 1.5 g/kg ideal body weight (IBW)/d to 2.2 g/kg IBW/d for all patients with caloric intakes ranging from 18–25 kcal/kg IBW/d and 30–42 kcal/kg IBW/d for those receiving hypocaloric vs eucaloric feeding, respectively.…”

Section: Evidence For the Use Of Hypocaloric High‐protein Nutrition Tmentioning

confidence: 99%

Protein and Calorie Requirements Associated With the Presence of Obesity

2017

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Obesity compounds the metabolic response to critical illness and increases the risk for overfeeding complications due to its comorbidities. Hypocaloric, high-protein nutrition therapy affords the hospitalized patient with obesity the opportunity to achieve net protein anabolism with a reduced risk of overfeeding complications. The intent of this review is to provide the theoretical framework for development of a hypocaloric high-protein regimen, scientific evidence to support this mode of therapy, and unique considerations for its use in specialized subpopulations. Macronutrient goals and practical suggestions for patient monitoring are given.

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Hypocaloric, High‐Protein Nutrition Therapy in Older vs Younger Critically Ill Patients With Obesity

Abstract: Older critically ill trauma patients exhibited an equivalent net protein response as younger patients during hypocaloric, high-protein nutrition therapy. Older patients are at greater risk for developing azotemia. Close monitoring is warranted.

Cited by 59 publications

References 37 publications

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

A.S.P.E.N. Clinical Guidelines

Protein and Calorie Requirements Associated With the Presence of Obesity

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