Nutrition support in obese hospitalized patients is controversial, with some practitioners advocating restricted energy or hypoenergetic feedings when patients are being actively treated for another disease. To eliminate the need for indirect calorimetry, this randomized, double-blind, prospective study was undertaken to determine whether obese hospitalized patients given a hypoenergetic parenteral regimen administered to provide 2 g protein x kg ideal body wt (IBW)(-1) x d(-1), could achieve nitrogen balance comparable with that of control subjects given isonitrogenous normoenergetic formula. Thirty obese hospitalized patients with an average body mass index (BMI; in kg/m2) of 35 were randomly assigned to the hypoenergetic [energy (kJ):nitrogen (g) = 314:1; energy (kcal):nitrogen (g) = 75:1; n = 16] or control [energy (kJ):nitrogen (g) = 628:1; energy (kcal):nitrogen (g) = 150:1; n = 14] formulas. The initial formula volume administered provided 2 g protein x kg IBW(-1) x d(-1). Nitrogen balance was determined on day 0 and weekly. The total daily energy intake [per kg actual body weight (ABW)] was 57 +/- 12 kJ (hypoenergetic) compared with 94 +/- 21 kJ (control), P < 0.001, and the nonprotein energy intake was 36 +/- 10 kJ (hypoenergetic) compared with 73 +/- 17 kJ (control), P < 0.001. Protein intake was the same per ABW, 2.0 +/- 0.2 and 2.0 +/- 0.1 g kg IBW(-1) x d(-1), NS, for the hypoenergetic and control formulas, respectively. Mean net nitrogen balance was not significantly different between the groups, even after patients were subgrouped by illness, nor was the percentage of patients achieving positive nitrogen balance. Duration of treatment averaged 10.5 +/- 2.6 d. Weight change did not differ significantly between groups. These data indicate that patients receiving hypoenergetic feedings providing 2 g protein x kg IBW(-1) x d(-1) achieved nitrogen balance comparable with patients given conventional total parenteral nutrition regimens, even when critically ill.

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These data do not support previous findings showing a strong correlation between REE determined by the Fick method and other prediction equations and indirect calorimetry. In critically ill patients receiving TPN, indirect calorimetry, if available, remains the most appropriate clinical tool for accurate measurement of REE.

Obesity is a major health problem in the United States today. Traditionally, management of obese hospitalized patients has not differed from that of normal-weight patients, with calorie and protein needs based on current body weight and weight loss postponed until the acute illness has subsided. This study was undertaken to determine whether obese hospitalized patients (> 130% ideal body weight) requiring total parenteral nutrition and given hypocaloric (HC) feedings with adequate protein intake could achieve nitrogen balance comparable with that of controls (C) given isonitrogenous normocaloric formulas. Sixteen obese patients (HC = 9, C = 7) were randomized to either HC (50% resting metabolic energy expenditure, plus protein; calories:nitrogen = 75:1) or C (100% resting metabolic energy expenditure, plus protein; calories:nitrogen = 150:1) formulas. Resting metabolic energy expenditure was determined by indirect calorimetry on day 0 and weekly, and nitrogen balance was determined daily. The two groups were similar in Harris-Benedict predicted energy expenditure and metabolic energy expenditure, initial and final serum albumin, total iron-binding capacity, and weight loss. Total daily calorie and nonprotein calorie intake per kilogram body weight were 14 +/- 4.1 (HC) vs 25 +/- 4 (C) and 7 +/- 1.9 (HC) vs 20 +/- 3 (C), respectively. Protein intake was 1.23 +/- 0.4 (HC) vs 1.31 +/- 0.2 (C) g/kg per day. Initial respiratory quotients were similar and consistent with fasting (HC = 0.7 +/- 0.09 vs C = 0.66 +/- 0.09); final respiratory quotients in C patients reflected mixed fuel use (C = 0.82 +/- 0.11 vs HC = 0.7 +/- 0.12).(ABSTRACT TRUNCATED AT 250 WORDS)