A nutrition strategy for obese ICU patients with special consideration for the reference of protein

Hypocaloric, high protein feeding regimens have been proposed for feeding obese critically ill patients. However, the exact amount of energy and protein that should be provided to the obese patients with these regimens is still under discussion. Furthermore, the body compartment to be used as a reference for appropriate protein dosing has not yet been determined. While both actual and ideal body weight have been proposed, neither is an accurate reflection of total body protein content in obese individuals. Alternatively, dosing protein based on lean body mass (LBM), which is highly correlated with total body protein, might be the most appropriate method of calculating protein requirements as defined by actual body composition. LBM can be measured or estimated by various methods. We herein discuss a rationale to determine both the energy and protein needs to use in hypocaloric feeding regimens for obese patients based on the use of Standard Body Weight (SBW) and LBM, using previously published body composition data from 1420 healthy volunteers. When applied to the obese population, and compared to current practices, this method results in highly significant differences for both total and gender-specific protein dosing.