Metabolic support challenges with obesity during critical illness

Dickerson, Roland N.

doi:10.1016/j.nut.2018.05.008

Cited by 21 publications

(4 citation statements)

References 70 publications

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“…Recently studies demonstrated that hypocaloric high-protein NT is safe to obese critically ill, including sarcopenic obese [6,11,21,25]. A subset analysis of pre-morbid obese critically ill found that individuals with hypocaloric vs normocaloric NT, but with similar protein intake, had no statistical difference in relation to ICU and hospital time, mortality and infection rates [26].…”

Section: Discussionmentioning

confidence: 99%

Nitrogen balance in mechanically ventilated obese patients

et al. 2021

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Objective This study aimed to evaluate if the protein intake recommendations for obese critically ill requiring mechanical ventilation are sufficient to promote a positive or neutral nitrogen balance. Methods Cross-sectional study that included 25 obese, ≥18 years old, undergoing mechanical ventilation and who were target to receive high-protein enteral nutrition therapy (2.0-2.5g/kg ideal body weight). Clinical, nutritional and biochemical variables were analyzed. Nitrogen balance was performed when patient was receiving full enteral nutrition therapy and was classified: positive when intake was greater than excretion; negative when excretion was greater than intake; neutral when both were equal. Results The characteristics of patients evaluated were 64.1±9.4 years old, clinical treatment 88%, body mass index 36.5±5.1kg/m2, nitrogen balance 0.3g/day (-5.3 to 4.8g/day), protein intake 2.1g/day (2.0-2.3g/kg) ideal body weight. Of individuals analyzed, 52% showed positive or neutral nitrogen balance with median of 4.23g/day 2.41 to 6.40g/day) in comparison to negative group with median of -5.27g/day (-10.38 to -3.86g/day). Adults had higher ratio of negative nitrogen balance (57.1%) than elderly (44.4%), with protein intake of 2.0 versus 2.1g/day, respectively. No correlation was found between nitrogen balance and variables assessed. Conclusion High-protein enteral nutrition therapy contributed to positive or neutral nitrogen balance for approximately half of obese ventilated individuals. With similar protein intake, elderly showed a higher proportion of positive or neutral nitrogen balance. Nitrogen balance can be influenced by various factors, so further studies are required to identify different protein needs in obese critically.

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Section: Discussionmentioning

confidence: 99%

Nitrogen balance in mechanically ventilated obese patients

et al. 2021

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“…The unique and complex care needs of obese patients (BMI ≥ 30 kg/m 2 ) are amplified when they become critically ill and include a greater risk of insulin resistance and loss of lean muscle mass, and wide variations in macronutrient metabolism, which makes nutrition management complex [4,68]. There is currently very limited, low-quality evidence to inform nutrition provision in the critically ill obese patient, and as a result, the latest clinical guidelines provide inconsistent recommendations regarding energy and protein targets (Table 1).…”

Section: Obesementioning

confidence: 99%

Nutrition therapy in critical illness: a review of the literature for clinicians

et al. 2020

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Nutrition therapy during critical illness has been a focus of recent research, with a rapid increase in publications accompanied by two updated international clinical guidelines. However, the translation of evidence into practice is challenging due to the continually evolving, often conflicting trial findings and guideline recommendations. This narrative review aims to provide a comprehensive synthesis and interpretation of the adult critical care nutrition literature, with a particular focus on continuing practice gaps and areas with new data, to assist clinicians in making practical, yet evidence-based decisions regarding nutrition management during the different stages of critical illness.

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“…Thus, the older patient is at risk for developing muscle erosion with concurrent obesity 22 . The ability to detect muscle atrophy for those with concurrent obesity is challenging, as it is difficult to ascertain via traditional physical assessment methods 23 . Impaired mobility and a sedentary lifestyle with limited physical activity prior to hospitalization or a prolonged illness or hospitalization may imply an impetus for the presence of muscle atrophy for hospitalized older patients 24 …”

Section: Development Of Muscle Atrophy With Obesity During Agingmentioning

confidence: 99%

“…34 The older patient with obesity is also at greater risk for nonalcoholic fatty liver disease and hepatic steatosis due to skeletal muscle insulin resistance 27 and especially older patients with hypertension, hyperlipidemia, and diabetes. 34 Hyperlipidemia, particularly hypertriglyceridemia, occurs more often in patients with obesity 23 and is prevalent in older individuals. 27 Therefore, avoidance of energy overfeeding is imperative, particularly for the older patient with obesity-related comorbidities.…”

Section: Consequences Of Obesity and Aging That Compound Nutrition Therapymentioning

confidence: 99%

Protein Requirements during Hypocaloric Nutrition for the Older Patient With Critical Illness and Obesity: An Approach to Clinical Practice

Dickerson

2020

Nut in Clin Prac

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Current guidelines recommend a hypocaloric, high protein nutrition regimen for patients with obesity and critical illness. The impact of advancing age presents with unique challenges in which a greater protein intake is required to overcome the anabolic resistance associated with aging in the face of presumed decreased renal function. The primary objective of this review is to provide an overview of the impact of obesity and advancing age on protein requirements for patients with critical illness and review the scientific evidence supporting the rationale for hypocaloric, high protein nutrition for this subpopulation, as well as provide some practical suggestions for their clinical management.

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Metabolic support challenges with obesity during critical illness

Cited by 21 publications

References 70 publications

Nitrogen balance in mechanically ventilated obese patients

Nitrogen balance in mechanically ventilated obese patients

Nutrition therapy in critical illness: a review of the literature for clinicians

Protein Requirements during Hypocaloric Nutrition for the Older Patient With Critical Illness and Obesity: An Approach to Clinical Practice

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