Tajchman Sharla K, Tucker Anne M, Cardenas-Turanzas Marylou, Nates Joseph L
Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Department of Clinical Sciences and Administration, University of Houston, College of Pharmacy, Houston, Texas, USA.
JPEN J Parenter Enteral Nutr. 2016 Aug;40(6):806-13. doi: 10.1177/0148607115574289. Epub 2015 Mar 9.
Current guidelines from the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine (ASPEN/SCCM) regarding caloric requirements and the provision of nutrition support in critically ill, obese adults may not be suitable for similar patients with cancer. We sought to determine whether the current guidelines accurately estimate the energy requirements, as measured by indirect calorimetry (IC), of critically ill, obese cancer patients.
This was a retrospective validation study of critically ill, obese cancer patients from March 1, 2007, to July 31, 2010. All patients ≥18 years of age with a body mass index (BMI) ≥30 kg/m(2) who underwent IC were included. We compared the measured energy expenditure (MEE) against the upper limit of the recommended guideline (25 kcal/kg of ideal body weight [IBW]) and MEE between medical and surgical patients in the intensive care unit.
Thirty-three patients were included in this study. Mean MEE (28.7 ± 5.2 kcal/kg IBW) was significantly higher than 25 kcal/kg IBW (P < .001), and 78% of patients had nutrition requirements greater than the current guideline recommendations. No significant differences in MEE between medical and surgical patients in the ICU were observed.
Critically ill, obese cancer patients require more calories than the current guidelines recommend, likely due to malignancy-associated metabolic variations. Our results demonstrate the need for IC studies to determine the energy requirements in these patients and for reassessment of the current recommendations.
美国肠外与肠内营养学会及危重病医学会（ASPEN/SCCM）发布的关于危重症肥胖成人热量需求及营养支持供给的现行指南可能不适用于患有癌症的类似患者。我们试图确定现行指南是否能准确估计危重症肥胖癌症患者通过间接测热法（IC）测得的能量需求。
这是一项对2007年3月1日至2010年7月31日期间危重症肥胖癌症患者的回顾性验证研究。纳入所有年龄≥18岁、体重指数（BMI）≥30 kg/m²且接受IC检查的患者。我们将测得的能量消耗（MEE）与推荐指南的上限（理想体重[IBW]的25 kcal/kg）进行比较，并比较了重症监护病房内科和外科患者的MEE。
本研究纳入了33例患者。平均MEE（28.7±5.2 kcal/kg IBW）显著高于25 kcal/kg IBW（P<.001），78%的患者营养需求高于现行指南推荐值。未观察到重症监护病房内科和外科患者的MEE有显著差异。
危重症肥胖癌症患者所需热量比现行指南推荐的更多，可能是由于与恶性肿瘤相关的代谢变化。我们的结果表明需要进行IC研究以确定这些患者的能量需求，并重新评估现行推荐。
