Calorie and protein delivery in critically ill surgical and non-surgical patients receiving enteral nutrition therapy

ABSTRACT Providing enteral nutritional therapy to critically ill patients is a challenge, especially during the first days after starting intensive care. These challenges appear to be greater in critically ill surgical patients. Objectives: Describe and compare enteral nutrition practices in critically ill surgical and non-surgical patients. Methods: We conducted a prospective cohort study of surgical and non-surgical patients receiving exclusive enteral nutritional therapy. The values for calorie and protein delivery during the first week after admission to the intensive care unit were recorded. Results: 103 patients were enrolled (54.4% male, mean age: 63.9 years, 26.2% surgical). The median time of initiation of enteral nutritional therapy was the third day in non-surgical and the fourth day in surgical patients. Surgical patients had a lower calorie and protein delivery than non-surgical patients on the second to fourth days after admission. At the end of the first week, 20.2% of the patients had not received any diet, and there was no significant difference in nutrient delivery between the groups. Of the surgical and non-surgical patients, 42.9% and 39.3% were receiving ≥20 kcal/kg/day, and 28.6% and 34.4% were receiving ≥1.2 g/kg of protein per day, respectively. Conclusion: There was a delay in starting patients on enteral nutritional therapy and calorie and protein delivery was low, especially among surgical patients. By the end of the first week, calorie and protein delivery was similar in both groups.

RESUMEN Proporcionar terapia nutricional enteral a pacientes críticos es un desafío, especialmente durante los primeros días después de comenzar los cuidados intensivos. Estos desafíos parecen ser mayores en pacientes quirúrgicos críticos. El propósito del estudio fue describir y comparar las prácticas de nutrición enteral en pacientes críticos quirúrgicos y no quirúrgicos. Se realizó un estudio de cohorte prospectivo de pacientes quirúrgicos y no quirúrgicos que recibieron terapia nutricional enteral exclusiva. Se registraron los datos de entrega de calorías y proteínas durante la primera semana después de la admisión a la unidad de cuidados intensivos. Se estudiaron 103 pacientes (54,4% hombres, edad media: 63,9 años, 26,2% quirúrgicos). La mediana de tiempo de inicio de la terapia nutricional enteral fue el tercer día en pacientes no quirúrgicos y el cuarto día en pacientes quirúrgicos. Los pacientes quirúrgicos tuvieron una entrega de calorías y proteínas más baja que los pacientes no quirúrgicos en el segundo a cuarto día después del ingreso. Al final de la primera semana, el 20,2% de los pacientes no habían recibido ningún aporte nutricional, y no hubo diferencias significativas en el suministro de nutrientes entre los grupos. De los pacientes quirúrgicos y no quirúrgicos, 42,9% y 39,3% estaban recibiendo ≥20 kcal/kg/día, y 28,6% y 34,4% estaban recibiendo ≥1,2 g/kg de proteína por día, respectivamente. Conclusiones: Hubo un retraso en el inicio de los pacientes en terapia nutricional enteral y la entrega de calorías y proteínas fue baja, especialmente entre los pacientes quirúrgicos. Al final de la primera semana, la entrega de calorías y proteínas fue similar en ambos grupos.

Comparison of Activity Factor, Predicted Resting Metabolic Rate, and Intakes of Energy and Nutrients Between Athletic and Non-Athletic High School Students

This study compared activity factor, predicted resting metabolic rate (RMR), and nutrient intakes between athletic and non-athletic high school students in Gangwon-do. Fifty soccer players (30 males and 20 females; mean ages 16.7+/-1.0 years and 16.4+/-1.1 years, respectively) and 50 non-athletic (30 males and 20 females; mean ages 17.5+/-0.4 years and 16.4+/-1.1 years respectively) high school students were included. Anthropometric measurements included: weight and height, triceps skinfold, mid-arm circumference, and body fat. Prediction equations consisted of those from the Harris-Benedict, FAO/WHO/UNU, IMNA, Cunningham, Mifflin et al., and Owen et al. A one-day activity diary was collected by interview, and the 24-hour recall method was used to analyze nutrient intakes of subjects. The activity factors of the male and female athletic groups (2.23 and 2.16, respectively) were significantly higher than those (1.52 and 1.46, respectively) of the non-athletic group. There was only a significant difference in RMR by use of the Cunningham's equation between two groups. For the males, almost all nutrient intakes of the athletic group (except carbohydrate, iron, vitamin B1, B6, and niacin) of athletic group were significantly higher than those of the non-athletic group. The female athletic group showed significantly higher nutrient intakes with the exception of most vitamins. These results suggest that assessments of energy balance between energy intake and energy expenditure by employing RMR and activity factors would be useful to prevent and treat obesity in high school athletes. In addition, the Cunningham's equation would be appropriate for predicting their energy needs.

Comparison of Activity Factor, Predicted Resting Metabolic Rate, and Intakes of Energy and Nutrients Between Athletic and Non-Athletic High School Students

This study compared activity factor, predicted resting metabolic rate (RMR), and nutrient intakes between athletic and non-athletic high school students in Gangwon-do. Fifty soccer players (30 males and 20 females; mean ages 16.7+/-1.0 years and 16.4+/-1.1 years, respectively) and 50 non-athletic (30 males and 20 females; mean ages 17.5+/-0.4 years and 16.4+/-1.1 years respectively) high school students were included. Anthropometric measurements included: weight and height, triceps skinfold, mid-arm circumference, and body fat. Prediction equations consisted of those from the Harris-Benedict, FAO/WHO/UNU, IMNA, Cunningham, Mifflin et al., and Owen et al. A one-day activity diary was collected by interview, and the 24-hour recall method was used to analyze nutrient intakes of subjects. The activity factors of the male and female athletic groups (2.23 and 2.16, respectively) were significantly higher than those (1.52 and 1.46, respectively) of the non-athletic group. There was only a significant difference in RMR by use of the Cunningham's equation between two groups. For the males, almost all nutrient intakes of the athletic group (except carbohydrate, iron, vitamin B1, B6, and niacin) of athletic group were significantly higher than those of the non-athletic group. The female athletic group showed significantly higher nutrient intakes with the exception of most vitamins. These results suggest that assessments of energy balance between energy intake and energy expenditure by employing RMR and activity factors would be useful to prevent and treat obesity in high school athletes. In addition, the Cunningham's equation would be appropriate for predicting their energy needs.