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Observational Study
. 2025 Feb 19;17(4):732.
doi: 10.3390/nu17040732.

Nutrition Therapy in Critically Ill Patients with Obesity: An Observational Study

Juan Carlos Lopez-Delgado  1 , Laura Sanchez-Ales  2 , Jose Luis Flordelis-Lasierra  3   4 , Esther Mor-Marco  5 , M Luisa Bordeje-Laguna  5 , Esther Portugal-Rodriguez  6 , Carol Lorencio-Cardenas  7 , Paula Vera-Artazcoz  8 , Sara Aldunate-Calvo  9 , Beatriz Llorente-Ruiz  10 , Rayden Iglesias-Rodriguez  11 , Diana Monge-Donaire  12 , Juan Francisco Martinez-Carmona  13 , Rosa Gastaldo-Simeón  14 , Lidón Mateu-Campos  15 , Maria Gero-Escapa  16 , Laura Almorin-Gonzalvez  1 , Beatriz Nieto-Martino  17 , Clara Vaquerizo-Alonso  17 , Teodoro Grau-Carmona  3   4 , Javier Trujillano-Cabello  18   19 , Lluis Servia-Goixart  18   19 , The Enpic Study Group
Affiliations
Observational Study

Nutrition Therapy in Critically Ill Patients with Obesity: An Observational Study

Juan Carlos Lopez-Delgado et al. Nutrients. .

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-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: caloric intake; clinical practice guidelines; critically ill patients; medical nutrition therapy; obesity; protein intake.

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Conflict of interest statement

All the authors declare that they have no conflicts of interest regarding the subject of this manuscript.

Figures

Figure 1
Figure 1
Study flow chart of patients included in the study (A) and BMI groups (B).
See this image and copyright information in PMC

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