University of Kentucky HeathCare, Lexington, Kentucky, USA.
Nutr Clin Pract. 2011 Jun;26(3):253-60. doi: 10.1177/0884533611405673.
The provision of nutrition has traditionally been driven by the desire to provide adequate calories. However, over the past decade it has become evident that provision of excess calories can be detrimental to patients' outcomes in both critical care and long-term care settings. This review examines patient populations for whom hypocaloric nutrition can be both appropriate and beneficial. In specific situations, critically ill patients, such as those with obesity, stroke, and spinal cord injury, may have decreased energy requirements. In patients with spinal cord injury, the level of injury significantly correlates with the extent of reduced caloric energy expenditure. Ventilator-dependent patients with amyotrophic lateral sclerosis (ALS) have decreased energy needs; energy expenditure for ALS patients is lower than the predictive equation value. Aging patients will have decreased energy needs relative to a reduction in lean body mass. Patients with cerebral palsy (CP) have significantly lower caloric requirements than anticipated using predictive equations. Patients with CP pose a particular challenge in nutrition assessment. Several studies demonstrate that patients with CP have significantly lower caloric requirements than anticipated using predictive equations; thus, patients with CP benefit from indirect calorimetry. Provision of nutrition for obese patients is briefly addressed, as this is an increasingly important consideration for nutrition support in both the critical care and long-term care settings. When indirect calorimetry is not available, clinicians should remember that most patients will have low resting energy expenditure regardless of functional status and require frequent evaluation during institution of nutrition recommendations to guard against overfeeding and obesity.
营养供给传统上是为了提供足够的热量。然而，在过去的十年中，人们已经明显认识到，提供过多的热量可能对重症监护和长期护理环境中的患者的预后产生不利影响。这篇综述检查了可以适当和有益地提供低热量营养的患者人群。在某些情况下，危重患者，如肥胖、中风和脊髓损伤患者，可能需要减少能量需求。在脊髓损伤患者中，损伤水平与减少的热量能量消耗程度显著相关。患有肌萎缩侧索硬化症（ALS）的需要呼吸机支持的患者的能量需求减少；ALS 患者的能量消耗低于预测方程值。与瘦体重减少相比，老年患者的能量需求会减少。脑瘫（CP）患者的热量需求明显低于预测方程预计的水平。CP 患者的营养评估具有特殊的挑战性。多项研究表明，CP 患者的热量需求明显低于预测方程预计的水平；因此，CP 患者受益于间接测热法。简要讨论了肥胖患者的营养供给问题，因为这在重症监护和长期护理环境中的营养支持中是一个日益重要的考虑因素。当无法进行间接测热法时，临床医生应记住，无论功能状态如何，大多数患者的静息能量消耗都较低，在实施营养建议时需要频繁评估，以防止过度喂养和肥胖。
