Nutrition Therapy in Critically Ill Patients with Obesity : An Observational Study
López-Delgado, Juan Carlos (Hospital Clínic i Provincial de Barcelona)
Sanchez-Ales, Laura (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Flordelis-Lasierra, José Luis (Hospital 12 de Octubre (Madrid))
Mor-Marco, Esther (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Bordeje, Mª Luisa (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Portugal-Rodriguez, Esther (Hospital Clínico Universitario de Valladolid)
Lorencio-Cardenas, Carol (Hospital Universitari de Girona Doctor Josep Trueta)
Vera-Artazcoz, Paula (Institut de Recerca Sant Pau)
Aldunate-Calvo, Sara (Complejo Hospitalario de Navarra)
Llorente-Ruiz, B. (Hospital Universitario Príncipe de Asturias (Alcalá de Henares, Madrid))
Iglesias-Rodriguez, Rayden (Hospital General de Granollers)
Monge-Donaire, Diana (Hospital Virgen de la Concha (Zamora))
Martínez Carmona, JF. (Hospital Regional Universitario Carlos Haya (Málaga))
Gastaldo-Simeón, Rosa (Hospital de Manacor (Manacor, Illes Balears))
Mateu Campos, ML. (Hospital General Universitario de Castellón)
Gero, Maria (Hospital Universitario de Burgos)
Almorín Gonzálvez, Laura (Hospital Clínic i Provincial de Barcelona)
Nieto-Martino, Beatriz (Hospital Universitario de Fuenlabrada ( Madrid))
Vaquerizo-Alonso, Clara (Hospital Universitario de Fuenlabrada ( Madrid))
Grau-Carmona, Teodoro (Hospital 12 de Octubre (Madrid))
Trujillano-Cabello, Javier (Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré)
Servia-Goixart, Lluis (Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré)
Universitat Autònoma de Barcelona

Date:	2025
Abstract:	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 Kg·m) 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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Caloric intake ; Clinical practice guidelines ; Critically ill patients ; Medical nutrition therapy ; Obesity ; Protein intake
Published in:	Nutrients, Vol. 17 Núm. 4 (february 2025) , p. 732, ISSN 2072-6643

DOI: 10.3390/nu17040732
PMID: 40005060

15 p, 510.0 KB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles