Obesity and critical care nutrition: current practice gaps and directions for future research
Abstract Background This review has been developed following a panel discussion with an international group of experts in the care of patients with obesity in the critical care setting and focuses on current best practices in malnutrition screening and assessment, estimation of energy needs for pati...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-022-04148-0 |
| _version_ | 1797827518606082048 |
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| author | Roland N. Dickerson Laura Andromalos J. Christian Brown Maria Isabel T. D. Correia Wanda Pritts Emma J. Ridley Katie N. Robinson Martin D. Rosenthal Arthur R. H. van Zanten |
| author_facet | Roland N. Dickerson Laura Andromalos J. Christian Brown Maria Isabel T. D. Correia Wanda Pritts Emma J. Ridley Katie N. Robinson Martin D. Rosenthal Arthur R. H. van Zanten |
| author_sort | Roland N. Dickerson |
| collection | DOAJ |
| description | Abstract Background This review has been developed following a panel discussion with an international group of experts in the care of patients with obesity in the critical care setting and focuses on current best practices in malnutrition screening and assessment, estimation of energy needs for patients with obesity, the risks and management of sarcopenic obesity, the value of tailored nutrition recommendations, and the emerging role of immunonutrition. Patients admitted to the intensive care unit (ICU) increasingly present with overweight and obesity that require individualized nutrition considerations due to underlying comorbidities, immunological factors such as inflammation, and changes in energy expenditure and other aspects of metabolism. While research continues to accumulate, important knowledge gaps persist in recognizing and managing the complex nutritional needs in ICU patients with obesity. Available malnutrition screening and assessment tools are limited in patients with obesity due to a lack of validation and heterogeneous factors impacting nutrition status in this population. Estimations of energy and protein demands are also complex in patients with obesity and may include estimations based upon ideal, actual, or adjusted body weight. Evidence is still sparse on the role of immunonutrition in patients with obesity, but the presence of inflammation that impacts immune function may suggest a role for these nutrients in hemodynamically stable ICU patients. Educational efforts are needed for all clinicians who care for complex cases of critically ill patients with obesity, with a focus on strategies for optimal nutrition and the consideration of issues such as weight stigma and bias impacting the delivery of care. Conclusions Current nutritional strategies for these patients should be undertaken with a focus on individualized care that considers the whole person, including the possibility of preexisting comorbidities, altered metabolism, and chronic stigma, which may impact the provision of nutritional care. Additional research should focus on the applicability of current guidelines and evidence for nutrition therapy in populations with obesity, especially in the setting of critical illness. |
| first_indexed | 2024-04-09T12:49:36Z |
| format | Article |
| id | doaj.art-8f810c61b162496ba03a1103075d4796 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-09T12:49:36Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-8f810c61b162496ba03a1103075d47962023-05-14T11:18:17ZengBMCCritical Care1364-85352022-09-0126111410.1186/s13054-022-04148-0Obesity and critical care nutrition: current practice gaps and directions for future researchRoland N. Dickerson0Laura Andromalos1J. Christian Brown2Maria Isabel T. D. Correia3Wanda Pritts4Emma J. Ridley5Katie N. Robinson6Martin D. Rosenthal7Arthur R. H. van Zanten8Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science CenterClinical Nutrition ManagerDigestive Disease and Surgery Institute, Cleveland ClinicDepartment of Surgery, Federal University of Minas GeraisPlacenta-Linda HospitalAustralian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash UniversityScientific and Medical Affairs, Abbott NutritionAcute Care Surgery Team, University of Florida College of MedicineChair, Department of Intensive Care Medicine & Research, Gelderse Vallei HospitalAbstract Background This review has been developed following a panel discussion with an international group of experts in the care of patients with obesity in the critical care setting and focuses on current best practices in malnutrition screening and assessment, estimation of energy needs for patients with obesity, the risks and management of sarcopenic obesity, the value of tailored nutrition recommendations, and the emerging role of immunonutrition. Patients admitted to the intensive care unit (ICU) increasingly present with overweight and obesity that require individualized nutrition considerations due to underlying comorbidities, immunological factors such as inflammation, and changes in energy expenditure and other aspects of metabolism. While research continues to accumulate, important knowledge gaps persist in recognizing and managing the complex nutritional needs in ICU patients with obesity. Available malnutrition screening and assessment tools are limited in patients with obesity due to a lack of validation and heterogeneous factors impacting nutrition status in this population. Estimations of energy and protein demands are also complex in patients with obesity and may include estimations based upon ideal, actual, or adjusted body weight. Evidence is still sparse on the role of immunonutrition in patients with obesity, but the presence of inflammation that impacts immune function may suggest a role for these nutrients in hemodynamically stable ICU patients. Educational efforts are needed for all clinicians who care for complex cases of critically ill patients with obesity, with a focus on strategies for optimal nutrition and the consideration of issues such as weight stigma and bias impacting the delivery of care. Conclusions Current nutritional strategies for these patients should be undertaken with a focus on individualized care that considers the whole person, including the possibility of preexisting comorbidities, altered metabolism, and chronic stigma, which may impact the provision of nutritional care. Additional research should focus on the applicability of current guidelines and evidence for nutrition therapy in populations with obesity, especially in the setting of critical illness.https://doi.org/10.1186/s13054-022-04148-0MalnutritionObesityCritical illnessNutrition assessmentNutritional requirementsNutrition therapy |
| spellingShingle | Roland N. Dickerson Laura Andromalos J. Christian Brown Maria Isabel T. D. Correia Wanda Pritts Emma J. Ridley Katie N. Robinson Martin D. Rosenthal Arthur R. H. van Zanten Obesity and critical care nutrition: current practice gaps and directions for future research Critical Care Malnutrition Obesity Critical illness Nutrition assessment Nutritional requirements Nutrition therapy |
| title | Obesity and critical care nutrition: current practice gaps and directions for future research |
| title_full | Obesity and critical care nutrition: current practice gaps and directions for future research |
| title_fullStr | Obesity and critical care nutrition: current practice gaps and directions for future research |
| title_full_unstemmed | Obesity and critical care nutrition: current practice gaps and directions for future research |
| title_short | Obesity and critical care nutrition: current practice gaps and directions for future research |
| title_sort | obesity and critical care nutrition current practice gaps and directions for future research |
| topic | Malnutrition Obesity Critical illness Nutrition assessment Nutritional requirements Nutrition therapy |
| url | https://doi.org/10.1186/s13054-022-04148-0 |
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