Al-Dorzi Hasan M, Stapleton Renee D, Arabi Yaseen M
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
Pulmonary and Critical Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.
Curr Opin Clin Nutr Metab Care. 2022 Mar 1;25(2):99-109. doi: 10.1097/MCO.0000000000000803.
During critical illness, several neuroendocrine, inflammatory, immune, adipokine, and gastrointestinal tract hormone pathways are activated; some of which are more intensified among obese compared with nonobese patients. Nutrition support may mitigate some of these effects. Nutrition priorities in obese critically ill patients include screening for nutritional risk, estimation of energy and protein requirement, and provision of macronutrients and micronutrients.
Estimation of energy requirement in obese critically ill patients is challenging because of variations in body composition among obese patients and absence of reliable predictive equations for energy expenditure. Whereas hypocaloric nutrition with high protein has been advocated in obese critically ill patients, supporting data are scarce. Recent studies did not show differences in outcomes between hypocaloric and eucaloric nutrition, except for better glycemic control. Sarcopenia is common among obese patients, and the provision of increased protein intake has been suggested to mitigate catabolic changes especially after the acute phase of critical illness. However, high-quality data on high protein intake in these patients are lacking. Micronutrient deficiencies among obese critically ill patients are common but the role of their routine supplementation requires further study.
An individualized approach for nutritional support may be needed for obese critically ill patients but high-quality evidence is lacking. Future studies should focus on nutrition priorities in this population, with efficient and adequately powered studies.
在危重病期间，几种神经内分泌、炎症、免疫、脂肪因子和胃肠道激素途径被激活；与非肥胖患者相比，其中一些途径在肥胖患者中更为强烈。营养支持可能会减轻其中一些影响。肥胖危重病患者的营养重点包括营养风险筛查、能量和蛋白质需求评估以及宏量营养素和微量营养素的供应。
由于肥胖患者身体组成的差异以及缺乏可靠的能量消耗预测方程，评估肥胖危重病患者的能量需求具有挑战性。虽然有人主张在肥胖危重病患者中采用高蛋白低热量营养，但支持数据很少。除了血糖控制更好外，最近的研究并未显示低热量营养和正常热量营养在结局上有差异。肌肉减少症在肥胖患者中很常见，有人建议增加蛋白质摄入量以减轻分解代谢变化，尤其是在危重病急性期之后。然而，这些患者高蛋白摄入的高质量数据尚缺乏。肥胖危重病患者中微量营养素缺乏很常见，但其常规补充的作用需要进一步研究。
肥胖危重病患者可能需要个体化的营养支持方法，但缺乏高质量证据。未来的研究应聚焦于该人群的营养重点，开展高效且有足够样本量的研究。
