In the Critically Ill Obese Should We Tip the Scale With More Protein?

This article explores the optimal nutrition support for critically ill obese patients in the ICU. It discusses the current feeding recommendations, which suggest hypocaloric, high-protein enteral feeding within 24 hours of admission. However, there is ongoing debate regarding the timing of feeding and the definition of "high protein." Studies have shown that early full feeding does not significantly impact mortality in ICU obese patients. Guidelines recommend increasing protein doses to prevent muscle loss, but the ideal protein dose remains uncertain. A small trial revealed that ICU patients may have anabolic resistance, challenging the approach of increasing protein dose. Another trial investigating the impact of protein dose on hospital time to discharge alive did not find significant differences in critically ill patients, including those with a BMI greater than 30 kg/m2. The article presents a post hoc analysis of a study on protein dosing in obese patients, which found that higher protein doses did not improve clinical outcomes in obese patients. However, the study has limitations, such as the use of different methods to determine protein needs and the exclusion of certain patients. The article concludes that current recommendations for nutrition in ICU obese patients should be conservative and based on individual patient factors. [Extracted from the article]