Nutrients, Vol. 17, Pages 732: Nutrition Therapy in Critically Ill Patients with Obesity: An Observational Study
Nutrients doi: 10.3390/nu17040732
Authors:
Juan Carlos Lopez-Delgado
Laura Sanchez-Ales
Jose Luis Flordelis-Lasierra
Esther Mor-Marco
M Luisa Bordeje-Laguna
Esther Portugal-Rodriguez
Carol Lorencio-Cardenas
Paula Vera-Artazcoz
Sara Aldunate-Calvo
Beatriz Llorente-Ruiz
Rayden Iglesias-Rodriguez
Diana Monge-Donaire
Juan Francisco Martinez-Carmona
Rosa Gastaldo-Simeón
Lidón Mateu-Campos
Maria Gero-Escapa
Laura Almorin-Gonzalvez
Beatriz Nieto-Martino
Clara Vaquerizo-Alonso
Teodoro Grau-Carmona
Javier Trujillano-Cabello
Lluis Servia-Goixart
the ENPIC Study Group the ENPIC Study Group
Background: Critically ill patients with obesity (PwO) have anthropometric characteristics that can be associated with different nutritional-metabolic requirements than other critically ill patients. However, recommendations regarding nutrition delivery in PwO are not clearly established among the different published clinical practice guidelines (CPGs). Our main aim was to evaluate the impact of energy and protein intake in critically ill PwO. Methods: A multicenter (n = 37) prospective observational study was performed. Adult patients requiring medical nutrition therapy (MNT) were included, and PwO (BMI ≥ 30 Kg·m−2) were analyzed. Demographic data, comorbidities, nutritional status, and the average caloric and protein delivery administered in the first 14 days, including complications and outcomes, were recorded in a database. Patients were classified and analyzed based on the adequacy of energy and protein intake according to CPG recommendations. Results: 525 patients were included, of whom 150 (28.6%) had obesity. The energy delivery was considered inadequate (<11 Kcal/Kg/d) in 30.7% (n = 46) and adequate (≥11 Kcal/Kg/d) in 69.3% (n = 104) of cases. PwO who received adequate energy delivery had greater use of the parenteral route and longer mean hospital stays (28.6 ± 26.1 vs. 39.3 ± 28.1; p = 0.01) but lower ICU mortality (32.6% vs. 16.5%; p = 0.02). Protein delivery was inadequate (<0.8 g/Kg/d) in 63.3% (n = 95), insufficient (0.8–1.2 g/Kg/d) in 31.33% (n = 47), and adequate (≥1.2 g/Kg/d) in only 5.4% (n = 8) of patients. PwO with inadequate protein delivery—compared with insufficient delivery—had higher use of the parenteral route and lower mortality in the ICU (25.5% vs. 14.9%; p = 0.02). Multivariate analysis revealed that PwO who received adequate energy delivery (hazard ratio [HR]: 0.398; 95% confidence interval [CI]: 0.180–0.882; p = 0.023) had better survival, while patients with insufficient protein delivery (HR: 0.404; CI 95%: 0.171–0.955; p = 0.038) had better survival than those with inadequate delivery. Conclusion: PwO can frequently receive inadequate energy and protein delivery from MNT during an ICU stay, which may impact the short-term mortality of these critically ill patients. It is emerging to develop strategies to optimize MNT delivery in these patients, which may improve their outcomes. NCT Registry: 03634943.
Background: Critically ill patients with obesity (PwO) have anthropometric characteristics that can be associated with different nutritional-metabolic requirements than other critically ill patients. However, recommendations regarding nutrition delivery in PwO are not clearly established among the different published clinical practice guidelines (CPGs). Our main aim was to evaluate the impact of energy and protein intake in critically ill PwO. Methods: A multicenter (n = 37) prospective observational study was performed. Adult patients requiring medical nutrition therapy (MNT) were included, and PwO (BMI ≥ 30 Kg·m−2) were analyzed. Demographic data, comorbidities, nutritional status, and the average caloric and protein delivery administered in the first 14 days, including complications and outcomes, were recorded in a database. Patients were classified and analyzed based on the adequacy of energy and protein intake according to CPG recommendations. Results: 525 patients were included, of whom 150 (28.6%) had obesity. The energy delivery was considered inadequate (<11 Kcal/Kg/d) in 30.7% (n = 46) and adequate (≥11 Kcal/Kg/d) in 69.3% (n = 104) of cases. PwO who received adequate energy delivery had greater use of the parenteral route and longer mean hospital stays (28.6 ± 26.1 vs. 39.3 ± 28.1; p = 0.01) but lower ICU mortality (32.6% vs. 16.5%; p = 0.02). Protein delivery was inadequate (<0.8 g/Kg/d) in 63.3% (n = 95), insufficient (0.8–1.2 g/Kg/d) in 31.33% (n = 47), and adequate (≥1.2 g/Kg/d) in only 5.4% (n = 8) of patients. PwO with inadequate protein delivery—compared with insufficient delivery—had higher use of the parenteral route and lower mortality in the ICU (25.5% vs. 14.9%; p = 0.02). Multivariate analysis revealed that PwO who received adequate energy delivery (hazard ratio [HR]: 0.398; 95% confidence interval [CI]: 0.180–0.882; p = 0.023) had better survival, while patients with insufficient protein delivery (HR: 0.404; CI 95%: 0.171–0.955; p = 0.038) had better survival than those with inadequate delivery. Conclusion: PwO can frequently receive inadequate energy and protein delivery from MNT during an ICU stay, which may impact the short-term mortality of these critically ill patients. It is emerging to develop strategies to optimize MNT delivery in these patients, which may improve their outcomes. NCT Registry: 03634943. Read More