Obesity and critical care nutrition: current practice gaps and directions for future research

Abstract

Background This review has been developed following a panel discussion with an international group of experts in the care of patients with obesity in the critical care setting and focuses on current best practices in malnutrition screening and assessment, estimation of energy needs for patients with obesity, the risks and management of sarcopenic obesity, the value of tailored nutrition recommendations, and the emerging role of immunonutrition. Patients admitted to the intensive care unit (ICU) increasingly present with overweight and obesity that require individualized nutrition considerations due to underlying comorbidities, immunological factors such as inflammation, and changes in energy expenditure and other aspects of metabolism. While research continues to accumulate, important knowledge gaps persist in recognizing and managing the complex nutritional needs in ICU patients with obesity. Available malnutrition screening and assessment tools are limited in patients with obesity due to a lack of validation and heterogeneous factors impacting nutrition status in this population. Estimations of energy and protein demands are also complex in patients with obesity and may include estimations based upon ideal, actual, or adjusted body weight. Evidence is still sparse on the role of immunonutrition in patients with obesity, but the presence of inflammation that impacts immune function may suggest a role for these nutrients in hemodynamically stable ICU patients. Educational efforts are needed for all clinicians who care for complex cases of critically ill patients with obesity, with a focus on strategies for optimal nutrition and the consideration of issues such as weight stigma and bias impacting the delivery of care. Conclusions Current nutritional strategies for these patients should be undertaken with a focus on individualized care that considers the whole person, including the possibility of preexisting comorbidities, altered metabolism, and chronic stigma, which may impact the provision of nutritional care. Additional research should focus on the applicability of current guidelines and evidence for nutrition therapy in populations with obesity, especially in the setting of critical illness.

Exploring Overnutrition, Overweight, and Obesity in the Hospital Setting—A Point Prevalence Study

“…In addition, patients who have obesity are more likely to be admitted to the Intensive Care Unit post-trauma [ 17 ]. In the critical care setting, the provision of adequate nutrition support to patients who have severe obesity is challenging [ 42 ], and patients who have obesity appear to have lower mortality but an increased risk of complications in several organ systems [ 18 ]. Obesity is also an independent risk factor for hospital readmission following surgery, such as total joint arthroplasty [ 43 ], cardiac surgery [ 41 ], and exacerbation of chronic health conditions [ 38 , 44 ], including mental health conditions [ 45 ].…”

Nutritional Support and Prevention of Complications in Treatment Contribute to Improved Prognosis in Pediatric Diffuse Intrinsic Pontine Glioma Patients

“…Due to the di culty of swallowing and decreased appetite caused by tumor compression, patients often face the problem of insu cient nutritional intake in the early stage. In addition to the decrease in oral intake, tumor-related cachexia, decreased digestive ability, decreased gastrointestinal function, increased catabolism, and side effects of radiotherapy and chemotherapy all exacerbate the decline in the patient's nutritional status 12,13 .…”

Nutritional management during critical illness in those with previous obesity surgery

“…Other authors advocate higher doses as 2–2.5 g/kg/day of ideal body weight, but there have been no studies assessing the benefits of such high doses in this specific population [22]. A recent retrospective analysis of mechanically ventilated adult critically ill patients, not considering overweight and obesity, showed that those individuals with low skeletal muscle area and density who received early increased intake of proteins had lower mortality.…”