Principles and indications of hypocaloric parenteral nutrition

Abstract

Postoperative metabolism is characterized by increased energy demand and nitrogen loss. Whereas autoregulatory mechanisms are able to meet the energy needs by enhanced lipolysis without endogenous problems, nitrogen loss mainly affects functionally and metabolically important proteins. In order to prevent these protein losses during the acute postoperative period, hypocaloric parenteral nutrition is suggested. The concept of hypocaloric nutrition consists of adequate amino acid substitution of 1.2-1.5 g/kg body weight per day and a low-dosed carbohydrate supply not to exceed 150-200 g per day. According to our own experience, this carbohydrate supply is best done with glucose substitutes like polyoles, since these substrates do no greater damage to the endogenous autoregulatory mechanism and give additional support to hepatic gluconeogenesis so that amino acids can be spared. Analyzing a 6-year period of using both hypocaloric and caloric-adequate postoperative parenteral nutrition we believe that hypocaloric nutrition is as beneficial as higher caloric parenteral nutrition, which in its application and monitoring is more expensive and time-consuming.

High‐Protein Hypocaloric Nutrition for Non‐Obese Critically Ill Patients

“…Indeed, in view of the increasingly plausible benefits of generous protein provision, coupled with the well‐documented toxicity of energy overfeeding, it seems unlikely that the large clinical outcome RCTs required to justify a strong treatment recommendation will ever be carried out. In my opinion, and that of others, the evidence supporting ASPEN's suggestion of high‐protein hypocaloric nutrition for critically ill obese patients is not only sound enough to act upon, but should be extrapolated to the great majority of catabolic critically ill patients for whom the consequent trivial diminution of body fat imposes no risk.…”

“…As explained in this review, the totality of existing evidence suggests that this regimen is equally appropriate for nonobese protein-catabolic critically ill patients. High-protein hypocaloric nutrition has long been advocated for nonobese acutely ill patients, [9][10][11][12][13] but only recently has it been taken seriously. [14][15][16][17] We previously reviewed [18][19][20][21][22] and now update the status of this therapy.…”

Hypocaloric Support in the Critically Ill

“…Lo ¨hlein reported in 1986 a similar hypocaloric regimen consisting of a glucose supply not exceeding 150 to 200 g/day and amino acids in doses of 1.2 to 1.5 g/kg/day. This author, from Hannover, Germany, believed that hypocaloric nutrition is as beneficial as higher caloric parenteral nutrition, which in terms of its application and monitoring is more expensive and time-consuming [40].…”

Metabolismo y nutrición del paciente en estado crítico

“…Parece fundamental mantener el paciente con glucemias no mayores de 160-180 mg/dl mediante la disminución en el aporte de glucosa exógena y la administración de insulina en caso necesario. Este régimen, conocido como "soporte hipocalórico", iniciado precursoramente en nuestro servicio 2 y luego aceptado por múltiples autores 4,23,24,26,35 , suministra entre 50 y 70 % del gasto energético basal, y ha sido recomendado también en el paciente obeso 28,102,103 .…”

“…Nuestro servicio fue pionero en el uso de la nutrición parenteral hipocalórica (hipoglúcida) pero hiperproteica en el estado crítico 2 . Desde ya hace varios años diferentes autores la apoyan [23][24][25][26][27][28][29][30] .…”