Division Endocrinology, Diabetes and Bone Disease.
Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Curr Opin Clin Nutr Metab Care. 2020 Mar;23(2):116-120. doi: 10.1097/MCO.0000000000000636.
As the obesity epidemic continues, there is a greater proportion of patients with overweight, obesity, and other forms of adiposity-based chronic disease that require intensive care. Nutrition therapy in the ICU is a vital part of critical care but can be challenging in this setting because of the increased risk of stress hyperglycemia and adverse impact of obesity- and diabetes-related complications.
Current guidelines favor early nutritional therapy with a hypocaloric, high-protein diet in patients with overweight/obesity. More aggressive protein intake may be useful in those with greater severity of overweight/obesity with an upper limit of 3 g/kg ideal body weight per day. Although there is no specific recommendation, choosing enteral formulas with higher fat content and slower digesting carbohydrates may assist with glucose control. Supplementation with immunonutrients is recommended, given their known benefits in obesity and in reducing inflammation, but must be done in an individualized manner.
Aggressive nutritional therapy is crucial in patients with overweight/obesity to support ongoing metabolic demands. Although a hypocaloric high-protein feeding strategy is a starting point, nutritional therapy should be approached in an individualized manner taking into account age, weight and BMI, basal metabolism, nutrition status, complications, and comorbidities.
随着肥胖症的流行，越来越多超重、肥胖和其他形式的肥胖相关慢性病患者需要重症监护。重症监护中的营养治疗是重症监护的重要组成部分，但在这种情况下可能具有挑战性，因为应激性高血糖的风险增加，肥胖和糖尿病相关并发症的不良影响。
目前的指南赞成超重/肥胖患者早期采用低热量、高蛋白饮食的营养治疗。对于超重/肥胖程度更严重的患者，更积极的蛋白质摄入可能有用，每天最高可达 3g/kg 理想体重。尽管没有具体的建议，但选择脂肪含量较高、消化较慢的碳水化合物的肠内配方可能有助于控制血糖。鉴于免疫营养素在肥胖症和减少炎症方面的已知益处，建议进行补充，但必须以个体化的方式进行。
超重/肥胖患者需要积极的营养治疗以支持持续的代谢需求。虽然低热量高蛋白喂养策略是一个起点，但应根据年龄、体重和 BMI、基础代谢、营养状况、并发症和合并症以个体化的方式进行营养治疗。
