Nutrition Therapy in Critically Ill Patients with Obesity: An Observational Study

被引：0

作者：

Lopez-Delgado, Juan Carlos ^{[1
]}

Sanchez-Ales, Laura ^{[2
]}

Flordelis-Lasierra, Jose Luis ^{[3
,4
]}

Mor-Marco, Esther ^{[5
]}

Bordeje-Laguna, M. Luisa ^{[5
]}

Portugal-Rodriguez, Esther ^{[6
]}

Lorencio-Cardenas, Carol ^{[7
]}

Vera-Artazcoz, Paula ^{[8
]}

Aldunate-Calvo, Sara ^{[9
]}

Llorente-Ruiz, Beatriz ^{[10
]}

Iglesias-Rodriguez, Rayden ^{[11
]}

Monge-Donaire, Diana ^{[12
]}

Martinez-Carmona, Juan Francisco ^{[13
]}

Gastaldo-Simeon, Rosa ^{[14
]}

Mateu-Campos, Lidon ^{[15
]}

Gero-Escapa, Maria ^{[16
]}

Almorin-Gonzalvez, Laura ^{[1
]}

Nieto-Martino, Beatriz ^{[17
]}

Vaquerizo-Alonso, Clara ^{[17
]}

Grau-Carmona, Teodoro ^{[3
,4
]}

Trujillano-Cabello, Javier ^{[18
,19
,20
]}

Servia-Goixart, Lluis ^{[18
,19
,20
]}

ENPIC Study Grp

机构：

[1] Hosp Clin Barcelona, Clin Inst Internal Med & Dermatol ICMiD, Area Vigilancia Intens, C Villarroel 170, Barcelona 08036, Spain

[2] Hosp Terrassa, Intens Care Dept, C Torrebon S-N, Terrassa 08227, Spain

[3] Hosp Univ 12 Octubre, Intens Care Dept, Ave Cordoba S-N, Madrid 28041, Spain

[4] Hosp 12 Octubre, Inst Invest Sanitaria I 12, Res Inst, Ave Cordoba S-N, Madrid 28041, Spain

[5] Hosp Badalona Germans Trias & Pujol, Intens Care Dept, Carretera Canyet S-N, Badalona 08916, Spain

[6] Hosp Clin Univ Valladolid, Intens Care Dept, Ave Ramon y Cajal 3, Valladolid 47003, Spain

[7] Hosp Univ Josep Trueta, Intens Care Dept, Ave Franca S-N, Girona 17007, Spain

[8] Hosp Santa Creu & Sant Pau, Intens Care Dept, C St Quinti 89, Barcelona 08041, Spain

[9] Complejo Hosp Navarra, Intens Care Dept, C Irunlarrea E, Pamplona 31008, Spain

[10] Hosp Univ Principe Asturias, Intens Care Dept, Ave Principal Univ S-N, Alcala De Henares 28805, Spain

[11] Hosp Gen Granollers, Intens Care Dept, C Francesc Ribas S-N, Granollers 08402, Spain

[12] Hosp Virgen de la Concha, Intens Care Dept, Ave Requejo 35, Zamora 49022, Spain

[13] Hosp Reg Univ Carlos Haya, Intens Care Dept, Ave Carlos Haya 84, Malaga 29010, Spain

[14] Hosp Manacor, Intens Care Dept, Carretera Manacor Alcudia S-N, Manacor 07500, Spain

[15] Hosp Gen Univ Castellon, Intens Care Dept, Avda Benicassim 128, Castellon de La Plana 12004, Spain

[16] Hosp Univ Burgos, Intens Care Dept, Ave Islas Baleares 3, Burgos 09006, Spain

[17] Hosp Univ Fuenlabrada, Intens Care Dept, Cam Molino 2, Fuenlabrada 28942, Spain

[18] Hosp Arnau Vilanova, Intens Care Dept, Ave Alcalde Rovira Roure 80, Lleida 25198, Spain

[19] IRBLLeida Inst Recerca Biomed Lleida Fundacio Dr P, Ave Alcalde Rovira Roure 80, Lleida 25198, Spain

[20] Dr Pifarre Fdn, Lleida Biomed Res Inst, Ave Alcalde Rovira Roure 80, Lleida 25198, Spain

来源：

NUTRIENTS | 2025年 / 17卷 / 04期

关键词：

obesity; medical nutrition therapy; clinical practice guidelines; caloric intake; protein intake; critically ill patients; RESTING ENERGY-EXPENDITURE; INDIRECT CALORIMETRY; CARE; GUIDELINES; SUPPORT;

D O I：

10.3390/nu17040732

中图分类号：

R15 [营养卫生、食品卫生]; TS201 [基础科学];

学科分类号：

100403 ;

摘要：

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<middle dot>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.

引用

页数：15

共 36 条

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