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Initiation of nutritional support is delayed in critically ill obese patients: a multicenter cohort study
Anne-Laure Borel1, Carole Schwebel1, Benjamin Planquette1
1From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT).
Background:
A high catabolic rate characterizes the acute phase of critical illness. Guidelines recommend an early nutritional support, regardless of the previous nutritional status.
Objective:
We aimed to assess whether the nutritional status of patients, which was defined by the body mass index (BMI) at admission in an intensive care unit (ICU), affected the time of nutritional support initiation.
Design:
We conducted a cohort study that reported a retrospective analysis of a multicenter ICU database (OUTCOMEREA) by using data prospectively entered from January 1997 to October 2012. Patients who needed orotracheal intubation within the first 72 h and >3 d were included.
Results:
Data from 3257 ICU stays were analyzed. The delay before feeding was different according to BMI groups (P = 0.035). The delay was longer in obese patients [BMI (in kg/m²) ≥30; n = 663] than in other patients with either low weight (BMI <20; n = 501), normal weight (BMI ≥20 and <25; n = 1135), or overweight (BMI ≥25 and <30; n = 958). The association between nutritional status and a delay in nutrition initiation was independent of potential confounding factors such as age, sex, and diabetes or other chronic diseases. In comparison with normal weight, the adjusted RR (95% CI) associated with a delayed nutrition initiation was 0.92 (0.86, 0.98) for patients with low weight, 1.00 (0.94, 1.05) for overweight patients, and 1.06 (1.00, 1.12) for obese patients (P = 0.004).
Conclusions:
The initiation of nutritional support was delayed in obese ICU patients. Randomized controlled trials that address consequences of early compared with delayed beginnings of nutritional support in critically ill obese patients are needed.
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