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

Area of Science:

• Critical Care Medicine
• Nutritional Science
• Obesity Medicine

Background:

• Obesity presents unique nutritional-metabolic challenges in critically ill patients.
• Clinical practice guidelines for nutrition delivery in critically ill patients with obesity (PwO) lack clear consensus.
• Understanding energy and protein intake impacts is vital for PwO outcomes.

Purpose of the Study:

• To evaluate the impact of energy and protein intake on critically ill patients with obesity.
• To analyze outcomes related to nutrition delivery adequacy in PwO.
• To identify factors influencing mortality and survival in PwO receiving medical nutrition therapy.

Main Methods:

• A multicenter prospective observational study involving 37 centers.
• Inclusion of adult patients requiring medical nutrition therapy (MNT), with a focus on PwO (BMI ≥ 30 Kg·m^-2).
• Analysis of demographic data, comorbidities, nutritional status, energy and protein delivery (first 14 days), complications, and outcomes, categorized by adequacy according to CPG recommendations.

Main Results:

• 150 of 525 (28.6%) included patients had obesity.
• Adequate energy delivery (≥11 Kcal/Kg/d) was associated with lower ICU mortality (16.5% vs. 32.6%) and longer hospital stays.
• Protein delivery was frequently inadequate (<0.8 g/Kg/d) or insufficient (0.8-1.2 g/Kg/d) in 94.6% of PwO; insufficient delivery was linked to lower ICU mortality compared to inadequate delivery.
• Multivariate analysis indicated adequate energy and insufficient protein delivery were associated with better survival.

Conclusions:

• Critically ill patients with obesity frequently experience inadequate energy and protein delivery during ICU stays.
• Suboptimal medical nutrition therapy in PwO may significantly impact short-term mortality.
• Developing strategies to optimize MNT delivery is essential for improving outcomes in critically ill patients with obesity.