2b9aa3b442d56ba58ee6f46ab2c4bce3 320630.pdf 8c4928b922ea2d8b86560c327b86b15f474f1496 320630.pdf 595f27b74e05b1568848a780e9b2793af19c40e06bea8fa50555d1fdfeb89f50 320630.pdf Title: Nutrition Therapy in Critically Ill Patients with Obesity: An Observational Study Subject: Background: Critically ill patients with obesity (PwO) have anthropometric characteristics that can be associated with different nutritional-metabolic requirements than other critically ill patients. However, recommendations regarding nutrition delivery in PwO are not clearly established among the different published clinical practice guidelines (CPGs). Our main aim was to evaluate the impact of energy and protein intake in critically ill PwO. Methods: A multicenter (n = 37) prospective observational study was performed. Adult patients requiring medical nutrition therapy (MNT) were included, and PwO (BMI 30 Kgm-2) were analyzed. Demographic data, comorbidities, nutritional status, and the average caloric and protein delivery administered in the first 14 days, including complications and outcomes, were recorded in a database. Patients were classified and analyzed based on the adequacy of energy and protein intake according to CPG recommendations. Results: 525 patients were included, of whom 150 (28.6%) had obesity. The energy delivery was considered inadequate (<11 Kcal/Kg/d) in 30.7% (n = 46) and adequate (11 Kcal/Kg/d) in 69.3% (n = 104) of cases. PwO who received adequate energy delivery had greater use of the parenteral route and longer mean hospital stays (28.6 26.1 vs. 39.3 28.1; p = 0.01) but lower ICU mortality (32.6% vs. 16.5%; p = 0.02). Protein delivery was inadequate (<0.8 g/Kg/d) in 63.3% (n = 95), insufficient (0.8–1.2 g/Kg/d) in 31.33% (n = 47), and adequate (1.2 g/Kg/d) in only 5.4% (n = 8) of patients. PwO with inadequate protein delivery—compared with insufficient delivery—had higher use of the parenteral route and lower mortality in the ICU (25.5% vs. 14.9%; p = 0.02). Multivariate analysis revealed that PwO who received adequate energy delivery (hazard ratio [HR]: 0.398; 95% confidence interval [CI]: 0.180–0.882; p = 0.023) had better survival, while patients with insufficient protein delivery (HR: 0.404; CI 95%: 0.171–0.955; p = 0.038) had better survival than those with inadequate delivery. Conclusion: PwO can frequently receive inadequate energy and protein delivery from MNT during an ICU stay, which may impact the short-term mortality of these critically ill patients. It is emerging to develop strategies to optimize MNT delivery in these patients, which may improve their outcomes. NCT Registry: 03634943. Keywords: obesity; medical nutrition therapy; clinical practice guidelines; caloric intake; protein intake; critically ill patients Author: Juan Carlos Lopez-Delgado, Laura Sanchez-Ales, Jose Luis Flordelis-Lasierra, Esther Mor-Marco, M Luisa Bordeje-Laguna, Esther Portugal-Rodriguez, Carol Lorencio-Cardenas, Paula Vera-Artazcoz, Sara Aldunate-Calvo, Beatriz Llorente-Ruiz, Rayden Iglesias-Rodriguez, Diana Monge-Donaire, Juan Francisco Martinez-Carmona, Rosa Gastaldo-Simeón, Lidón Mateu-Campos, Maria Gero-Escapa, Laura Almorin-Gonzalvez, Beatriz Nieto-Martino, Clara Vaquerizo-Alonso, Teodoro Grau-Carmona, Javier Trujillano-Cabello, Lluis Servia-Goixart and the ENPIC Study Group Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed Feb 19 10:08:05 2025 CET ModDate: Wed Feb 19 10:18:23 2025 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 15 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 522272 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- QNALHW+VnURWPalladioL Type 1 Custom yes yes yes 10 0 SCBVAR+URWPalladioL-Roma Type 1 Custom yes yes yes 16 0 GARODU+URWPalladioL-Bold Type 1 Custom yes yes yes 22 0 TKNZES+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 RNKFKU+CMSY10 Type 1 Builtin yes yes yes 53 0 CKCFAH+PalatinoLinotype,Bold CID TrueType Identity-H yes yes yes 72 0 CKCFBH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 78 0 CKCFBI+PalatinoLinotype CID TrueType Identity-H yes yes yes 81 0 CKCFBJ+PalatinoLinotype TrueType WinAnsi yes yes no 87 0 CKCFBL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 90 0 CKCGDG+PalatinoLinotype TrueType MacRoman yes yes no 93 0 CKCICL+Calibri CID TrueType Identity-H yes yes yes 96 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 106 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-10-22 03:52:41 CEST RepresentationInformation: 320630.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-10-21 12:52:18 CEST Size: 522272 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 298 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Design and Setting Destination: subsection.2.1 Item: Title: Data Collection and Study Endpoints Destination: subsection.2.2 Item: Title: Statistical Analysis Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: Study Population Destination: subsection.3.1 Item: Title: Population Characteristics of Patients with Obesity Compared with Other BMI Subgroups Destination: subsection.3.2 Item: Title: Nutrition Delivery and Outcomes in Patients with Obesity Compared with Other BMI Subgroups Destination: subsection.3.3 Item: Title: Assessment of Nutrition Therapy in Patients with Obesity: Energy Delivery Destination: subsection.3.4 Item: Title: Assessment of Nutrition Therapy in Patients with Obesity: Protein Delivery Destination: subsection.3.5 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: Appendix A Destination: appendix.A. Item: Title: References Destination: appendix.B. Info: Title: Nutrition Therapy in Critically Ill Patients with Obesity: An Observational Study Author: Juan Carlos Lopez-Delgado, Laura Sanchez-Ales, Jose Luis Flordelis-Lasierra, Esther Mor-Marco, M Luisa Bordeje-Laguna, Esther Portugal-Rodriguez, Carol Lorencio-Cardenas, Paula Vera-Artazcoz, Sara Aldunate-Calvo, Beatriz Llorente-Ruiz, Rayden Iglesias-Rodriguez, Diana Monge-Donaire, Juan Francisco Martinez-Carmona, Rosa Gastaldo-Simeón, Lidón Mateu-Campos, Maria Gero-Escapa, Laura Almorin-Gonzalvez, Beatriz Nieto-Martino, Clara Vaquerizo-Alonso, Teodoro Grau-Carmona, Javier Trujillano-Cabello, Lluis Servia-Goixart and the ENPIC Study Group Subject: Background: Critically ill patients with obesity (PwO) have anthropometric characteristics that can be associated with different nutritional-metabolic requirements than other critically ill patients. However, recommendations regarding nutrition delivery in PwO are not clearly established among the different published clinical practice guidelines (CPGs). Our main aim was to evaluate the impact of energy and protein intake in critically ill PwO. Methods: A multicenter (n = 37) prospective observational study was performed. Adult patients requiring medical nutrition therapy (MNT) were included, and PwO (BMI 30 Kgm-2) were analyzed. Demographic data, comorbidities, nutritional status, and the average caloric and protein delivery administered in the first 14 days, including complications and outcomes, were recorded in a database. Patients were classified and analyzed based on the adequacy of energy and protein intake according to CPG recommendations. Results: 525 patients were included, of whom 150 (28.6%) had obesity. The energy delivery was considered inadequate (<11 Kcal/Kg/d) in 30.7% (n = 46) and adequate (11 Kcal/Kg/d) in 69.3% (n = 104) of cases. PwO who received adequate energy delivery had greater use of the parenteral route and longer mean hospital stays (28.6 26.1 vs. 39.3 28.1; p = 0.01) but lower ICU mortality (32.6% vs. 16.5%; p = 0.02). Protein delivery was inadequate (<0.8 g/Kg/d) in 63.3% (n = 95), insufficient (0.8 1.2 g/Kg/d) in 31.33% (n = 47), and adequate (1.2 g/Kg/d) in only 5.4% (n = 8) of patients. PwO with inadequate protein delivery compared with insufficient delivery had higher use of the parenteral route and lower mortality in the ICU (25.5% vs. 14.9%; p = 0.02). Multivariate analysis revealed that PwO who received adequate energy delivery (hazard ratio [HR]: 0.398; 95% confidence interval [CI]: 0.180 0.882; p = 0.023) had better survival, while patients with insufficient protein delivery (HR: 0.404; CI 95%: 0.171 0.955; p = 0.038) had better survival than those with inadequate delivery. Conclusion: PwO can frequently receive inadequate energy and protein delivery from MNT during an ICU stay, which may impact the short-term mortality of these critically ill patients. It is emerging to develop strategies to optimize MNT delivery in these patients, which may improve their outcomes. NCT Registry: 03634943. 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