A nutrition strategy for obese ICU patients with special consideration for the reference of protein.

Hypocaloric, high protein feeding regimens have been proposed for feeding obese critically ill patients. However, the exact amount of energy and protein that should be provided to the obese patients with these regimens is still under discussion. Furthermore, the body compartment to be used as a reference for appropriate protein dosing has not yet been determined. While both actual and ideal body weight have been proposed, neither is an accurate reflection of total body protein content in obese individuals. Alternatively, dosing protein based on lean body mass (LBM), which is highly correlated with total body protein, might be the most appropriate method of calculating protein requirements as defined by actual body composition. LBM can be measured or estimated by various methods. We herein discuss a rationale to determine both the energy and protein needs to use in hypocaloric feeding regimens for obese patients based on the use of Standard Body Weight (SBW) and LBM, using previously published body composition data from 1420 healthy volunteers. When applied to the obese population, and compared to current practices, this method results in highly significant differences for both total and gender-specific protein dosing.

The ratio of energy expenditure to nitrogen loss in diverse patient groups--a systematic review.

BACKGROUND & AIMS: The ratio of energy expenditure to nitrogen loss respectively of energy to nitrogen provision (E/N) is considered a valuable tool in the creation of an enteral or parenteral formulation. Specific E/N ratios for parenteral nutrition (PN) have not yet been clearly defined. To determine the range of energy expenditure, nitrogen (protein) losses, and E/N ratios for various patient groups, we performed a systematic review of the literature. METHODS: Medline 1950-2011 was searched for all studies on patients or healthy controls reporting energy expenditure and nitrogen loss at the same time. RESULTS: We identified 53 studies with 91 cohorts which comprised 1107 subjects. Mean TEE ± standard deviation (SD) was 31.2 ± 7.2 kcal/kg BW/day in patients (n = 881) and 35.6 ± 4.3 kcal/kg BW/day in healthy controls (n = 266). Mean total protein loss (TPL) was 1.50 ± 0.57 g/kg BW/day in patients and 0.94 ± 0.24 g/kg BW/day in healthy controls. A non-linear significant correlation was found between TPL and the E/N ratio. CONCLUSION: The E/N ratio is not a constant value but decreases continuously with increasing protein loss. These variations should be considered in the nutritional support of patients.