Protein and Calorie Requirements Associated With the Presence of Obesity

Dickerson, Roland N.; Patel, Jayshil J.; McClain, Craig J.

doi:10.1177/0884533617691745

Cited by 22 publications

(29 citation statements)

References 54 publications

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“…It was assumed this optimizes protein utilization, minimizing reliance on gluconeogenesis of amino acids and glycerol . The final adequacy criteria required that energy from all sources was ≤100% of EER, to avoid consequences of overfeeding; obese patients received hypocaloric prescription, well below 100% of EER, but with adequate protein to minimize catabolism . Results from analyses considering nutrition adequacy can be found in the supplementary material (Table S1).…”

Section: Methodsmentioning

confidence: 99%

Protein Provision in Critically Ill Adults Requiring Enteral Nutrition: Are Guidelines Being Met?

et al. 2018

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Background In a previous audit, 81% of enteral protein prescriptions failed to meet protein guidelines. To address this, a very high‐protein enteral formula and protein supplements were introduced, and protein prescriptions were adjusted to account for nonnutrition energy sources displacing enteral formula. This follow‐up audit compared protein provision in critically ill adults requiring exclusive enteral nutrition (EN), first, with local and international guidelines, and second, after changes to practice, with the previous audit in the same intensive care unit (ICU). Methods Data were collected from 106 adults consecutively admitted to the ICU of a U.K. tertiary hospital and requiring exclusive EN ≥3 days. Protein targets based on local guidelines (1.25, 1.5, or 2.0 g/kg/d), nutrition prescription, and delivery were recorded for 24 hours between days 1–3, 5–7, 8–10, and 18–20 post‐ICU admission. Results The proportion of day 1–3 protein prescriptions meeting protein targets increased from 19% in 2015 to 69% in 2017 (P < .0005, φ = 0.50). The median percentage of protein target delivered was lower than prescribed (79% vs 103%; (P < .0005; r = 0.53) and EN delivery only met the target of 22% of patients. The proportion of protein prescriptions meeting protein targets was similar for days 1–3 (69%), 5–7 (71%), and 8–10 (68%), but increased slightly by days 18–20 (74%). The proportion of patients for which EN delivery met protein targets increased with the number of days post‐ICU admission (22%, 26%, 37%, and 53% for days 1–3, 5–7, 8–10, and 18–20, respectively). Conclusion The proportion of protein prescriptions meeting guideline targets was higher after changes to practice.

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Section: Methodsmentioning

confidence: 99%

Protein Provision in Critically Ill Adults Requiring Enteral Nutrition: Are Guidelines Being Met?

et al. 2018

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“…He did this in order to distinguish protein‐deficient and energy‐deficient nutrition, ie, permissive underfeeding, from the high‐protein, hypocaloric regimens that Dickerson et al and Choban and Dickerson were investigating in acutely ill obese patients, which they named hypocaloric nutrition. It is mostly because of this work that ASPEN currently suggests hypocaloric (high‐protein, low‐energy) SNS for critically ill obese patients (weak recommendation, low‐quality evidence) …”

Section: Permissive Underfeeding Vs Hypocaloric (High‐protein) Nutritionmentioning

confidence: 99%

“…Despite their plainly different meanings, the 2 terms are often conflated . (Some confusion might have been avoided had Dickerson and colleagues more consistently referred to their regimen as “hypocaloric, high‐protein” nutrition …”

Section: Permissive Underfeeding Vs Hypocaloric (High‐protein) Nutritionmentioning

confidence: 99%

“…It is mostly because of this work 74-77 that ASPEN currently suggests hypocaloric (high-protein, low-energy) SNS for critically ill obese patients (weak recommendation, lowquality evidence). 35,[78][79][80] Figure 1 illustrates the difference between permissive underfeeding (low-protein, low-energy nutrition) and hypocaloric nutrition (high-protein, low-energy nutrition). Despite their plainly different meanings, the 2 terms are often conflated.…”

Section: Permissive Underfeeding Vs Hypocaloric (High-protein) Nutritionmentioning

confidence: 99%

“…81,82 (Some confusion might have been avoided had Dickerson and colleagues more consistently referred to their regimen as "hypocaloric, high-protein" nutrition. 80 ) To cite an example, an otherwise meticulous systematic review and meta-analysis of the clinical benefits of "permissive underfeeding" ignored the protein content of the nutrition regimens, which varied from generous to almost zero. 83…”

Section: Permissive Underfeeding Vs Hypocaloric (High-protein) Nutritionmentioning

confidence: 99%

See 2 more Smart Citations

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

Hoffer

2018

Nut in Clin Prac

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High-protein hypocaloric nutrition, tailored to each patient's muscle mass, protein-catabolic severity, and exogenous energy tolerance, is the most plausible nutrition therapy in protein-catabolic critical illness. Sufficient protein provision could mitigate the rapid muscle atrophy characteristic of this disease while providing urgently needed amino acids to the central protein compartment and sites of tissue injury. The protein dose may range from 1.5 to 2.5 g protein (1.8-3.0 g free amino acids)/kg dry body weight per day. Nutrition should be low in energy (≈70% of energy expenditure or ≈15 kcal/kg dry body weight per day) because efforts to match energy provision to energy expenditure are physiologically irrational, risk toxic energy overfeeding, and have repeatedly failed in large clinical trials to demonstrate clinical benefit. The American Society for Parenteral and Enteral Nutrition currently suggests high-protein hypocaloric nutrition for obese critically ill patients. Short-term high-protein hypocaloric nutrition is physiologically and clinically sensible for most protein-catabolic critically ill patients, whether obese or not.

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Dietary Management of Blood Glucose in Medical Critically Ill Overweight and Obese Patients: An Open‐Label Randomized Trial

Rice

Files

Morris

et al. 2018

J Parenter Enteral Nutr

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Background: Enteral nutrition (EN) increases hyperglycemia due to high carbohydrate concentrations while providing insufficient protein. The study tested whether an EN formula with very high‐protein‐ and low‐carbohydrate‐facilitated glucose control delivered higher protein concentrations within a hypocaloric protocol. Methods: This was a multicenter, randomized, open‐label clinical trial with parallel design in overweight/obese mechanically ventilated critically ill patients prescribed 1.5 g protein/kg ideal body weight/day. Patients received either an experimental very high‐protein (37%) and low‐carbohydrate (29%) or control high‐protein (25%) and conventional‐carbohydrate (45%) EN formula. Results: A prespecified interim analysis was performed after enrollment of 105 patients (52 experimental, 53 control). Protein and energy delivery for controls and experimental groups on days 1–5 were 1.2 ± 0.4 and 1.1 ± 0.3 g/kg ideal body weight/day (P = .83), and 18.2 ± 6.0 and 12.5 ± 3.7 kcals/kg ideal body weight/day (P < .0001), respectively. The combined rate of glucose events outside the range of >110 and ≤150 mg/dL were not different (P = .54, primary endpoint); thereby the trial was terminated. The mean blood glucose for the control and the experimental groups were 138 (−SD 108, +SD 177) and 126 (−SD 99, +SD 160) mg/dL (P = .004), respectively. Mean rate of glucose events >150 mg/dL decreased (Δ = −13%, P = .015), whereas that of 80–110 mg/dL increased (Δ = 14%, P = .0007). Insulin administration decreased 10.9% (95% CI, −22% to 0.1%; P = .048) in the experimental group relative to the controls. Glycemic events ≤80 mg/dL and rescue dextrose use were not different (P = .23 and P = .53). Conclusions: A very high‐protein and low‐carbohydrate EN formula in a hypocaloric protocol reduces hyperglycemic events and insulin requirements while increasing glycemic events between 80–110 mg/dL.

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Protein and Calorie Requirements Associated With the Presence of Obesity

Cited by 22 publications

References 54 publications

Protein Provision in Critically Ill Adults Requiring Enteral Nutrition: Are Guidelines Being Met?

Protein Provision in Critically Ill Adults Requiring Enteral Nutrition: Are Guidelines Being Met?

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

Dietary Management of Blood Glucose in Medical Critically Ill Overweight and Obese Patients: An Open‐Label Randomized Trial

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