Choban P S, Burge J C, Scales D, Flancbaum L
Department of Surgery, College of Medicine, The Ohio State University, Columbus 43210, USA.
Am J Clin Nutr. 1997 Sep;66(3):546-50. doi: 10.1093/ajcn/66.3.546.
Nutrition support in obese hospitalized patients is controversial, with some practitioners advocating restricted energy or hypoenergetic feedings when patients are being actively treated for another disease. To eliminate the need for indirect calorimetry, this randomized, double-blind, prospective study was undertaken to determine whether obese hospitalized patients given a hypoenergetic parenteral regimen administered to provide 2 g protein x kg ideal body wt (IBW)(-1) x d(-1), could achieve nitrogen balance comparable with that of control subjects given isonitrogenous normoenergetic formula. Thirty obese hospitalized patients with an average body mass index (BMI; in kg/m2) of 35 were randomly assigned to the hypoenergetic [energy (kJ):nitrogen (g) = 314:1; energy (kcal):nitrogen (g) = 75:1; n = 16] or control [energy (kJ):nitrogen (g) = 628:1; energy (kcal):nitrogen (g) = 150:1; n = 14] formulas. The initial formula volume administered provided 2 g protein x kg IBW(-1) x d(-1). Nitrogen balance was determined on day 0 and weekly. The total daily energy intake [per kg actual body weight (ABW)] was 57 +/- 12 kJ (hypoenergetic) compared with 94 +/- 21 kJ (control), P < 0.001, and the nonprotein energy intake was 36 +/- 10 kJ (hypoenergetic) compared with 73 +/- 17 kJ (control), P < 0.001. Protein intake was the same per ABW, 2.0 +/- 0.2 and 2.0 +/- 0.1 g kg IBW(-1) x d(-1), NS, for the hypoenergetic and control formulas, respectively. Mean net nitrogen balance was not significantly different between the groups, even after patients were subgrouped by illness, nor was the percentage of patients achieving positive nitrogen balance. Duration of treatment averaged 10.5 +/- 2.6 d. Weight change did not differ significantly between groups. These data indicate that patients receiving hypoenergetic feedings providing 2 g protein x kg IBW(-1) x d(-1) achieved nitrogen balance comparable with patients given conventional total parenteral nutrition regimens, even when critically ill.
肥胖住院患者的营养支持存在争议，一些从业者主张在患者因其他疾病接受积极治疗时采用能量限制或低能量喂养。为了无需进行间接测热法，开展了这项随机、双盲、前瞻性研究，以确定给予肥胖住院患者低能量肠外营养方案（提供2 g蛋白质×kg理想体重（IBW）⁻¹×d⁻¹）是否能实现与给予等氮正常能量配方的对照受试者相当的氮平衡。30名平均体重指数（BMI；单位：kg/m²）为35的肥胖住院患者被随机分配至低能量组[能量（kJ）：氮（g）= 314：1；能量（kcal）：氮（g）= 75：1；n = 16]或对照组[能量（kJ）：氮（g）= 628：1；能量（kcal）：氮（g）= 150：1；n = 14]。最初给予的配方奶量提供2 g蛋白质×kg IBW⁻¹×d⁻¹。在第0天和每周测定氮平衡。每日总能量摄入量[每千克实际体重（ABW）]，低能量组为57±12 kJ，对照组为94±21 kJ，P<0.001；非蛋白质能量摄入量，低能量组为36±10 kJ，对照组为73±17 kJ，P<0.001。按每ABW计算的蛋白质摄入量相同，低能量组和对照组分别为2.0±0.2和2.0±0.1 g kg IBW⁻¹×d⁻¹，无显著差异。即使将患者按疾病亚组划分，两组间的平均净氮平衡也无显著差异，实现正氮平衡的患者百分比也无差异。治疗持续时间平均为10.5±2.6天。两组间体重变化无显著差异。这些数据表明，接受提供2 g蛋白质×kg IBW⁻¹×d⁻¹的低能量喂养的患者，即使在危重病时，也能实现与接受传统全肠外营养方案的患者相当 的氮平衡。
