Florham Park, New Jersey
A newly published consensus report prepared by a panel of clinical experts, with sponsorship from Nestlé Health Science, reveals that there are opportunities to do more to manage the impact of obesity on the delivery of critical care, particularly in the area of nutrition therapy. With more than 25 percent of ICU patients considered to be obese or severely obese,1 the panel of clinical experts urges hospitals and medical professionals to adapt medical care traditionally designed to meet the needs of average-weight patients to the unique needs of the obese patient population. Patients with obesity, while heterogeneous as a population, are typically predisposed to greater morbidity, higher instances of infection and organ failure, and extended length of stay, all negative clinical outcomes that affect overall recovery.1,2,3
“The lack of consistent standardized nutrition interventions for the critically ill patient with obesity means that some patients may be overfed and others may be underfed or malnourished. Some may never have their nutritional needs assessed. All of these scenarios can present problems with health outcomes and recovery rates,” said Dr Stephen McClave, M.D., professor of Medicine, University of Louisville, and moderator of the consensus panel.
The consensus report, published as a supplement to the September 2011 issue of the Journal of Parenteral and Enteral Nutrition (JPEN), explores multiple issues related to obesity in the critical care setting including the many challenges associated with applying standard nutrition therapy practice to the obese patient population. Areas of concern include assessment of nutritional status and nutrient requirements, as well as delivery of nutrients, including route of delivery, overfeeding of calories, underfeeding of protein and monitoring of feeding tolerance.
“The intent of specialized nutrition support for the critically ill patient with obesity is to provide sufficient nutrients to facilitate clinical recovery, avoid adverse effects relative to the inherent metabolic complications associated with obesity, minimize protein loss, and ultimately achieve net protein anabolism during the recovery phase of the patient’s hospitalization,” says Roland Dickerson, Pharm.D., BCNSP, FACN, FCCP, of the University of Tennessee Health Science Center.
The panel agreed that, of the more than 200 enteral nutrition formulations available at the time of the conference, none adequately met the nutritional needs of the critically ill patient with obesity without manipulation. The panel specifically recommended a high protein, hypocaloric feeding formula to maximize protein synthesis and preserve lean body mass.
“As a leader in providing solutions that meet the nutritional challenges of all patients, Nestlé Health Science has committed to collaborating with these experts to collectively identify the best approach for the critically ill patient with obesity, and focusing our efforts on their valuable insights and recommendations,” said Juan Ochoa, M.D., Medical and Scientific Director for the company’s; HealthCare Nutrition business.
To address this unmet need, Nestlé Health Science has developed a tube feeding formulation, PEPTAMEN® BARIATRIC formula, with a unique protein-to-calorie ratio specifically designed to help meet the protein requirements of the critically ill patient with obesity recommended in the 2009 Critical Care Nutrition Guidelines.4
Additionally, Nestlé Nutrition Institute is sponsoring a continuing medical education activity for physicians, registered dietitians, registered nurses and pharmacists to learn about obesity in the ICU and the new recommendations for the nutritional management of the critically ill patient with obesity. To learn more, visit the Dannemiller website.
Review the full consensus panel report titled Obesity in Critical Care.
Participants in the consensus panel who contributed to this report include Matt Cave, M.D., University of Louisville, Mark DeLegge, M.D., Medical University of South Carolina, John Dibaise, M.D., Mayo Clinic, Roland Dickerson, Pharm.D., University of Tennessee Health Science Center, John Drover, M.D., Queens University Canada, Tom Frazier, M.D., University of Louisville, Ken Fujioka, M.D., Scripps Clinic, Dympna Gallagher, Ed.D., St. Luke’s-Roosevelt Hospital, Ryan Hurt, M.D., Ph.D., Mayo Clinic, Lee Kaplan, M.D., Ph.D., Massachusetts General Hospital, Laszlo Kiraly, M.D., Oregon Health and Science University, Robert Kushner, M.D., Northwestern University, Robert Martindale, M.D., Ph.D., Oregon Health and Science University, Stephen McClave, M.D., University of Louisville, Craig McLain, M.D., University of Louisville, Juan Ochoa, M.D., Nestlé HealthCare Nutrition and University of Pittsburgh and Charles Van Way, M.D., University of Missouri.
About Nestlé Health Science
Nestlé Health Science, through its Nestlé HealthCare Nutrition business, offers nutritional solutions for people with specific dietary needs related to illnesses, disease states or the special challenges of different life stages. Nestlé Health Science, a wholly owned subsidiary of Nestlé S.A., became operational on January 1, 2011 and has worldwide headquarters in Lutry, Switzerland. For more information, visit the Nestlé Health Science website.
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1 Hogue CW Jr, Stearns JD, Colantuoni E, Robinson KA, Stierer T, Mitter N, Pronovost PJ, Needham DM: The impact of obesity on outcomes after critical illness: a meta-analysis. Intensive Care Med. 2009 Jul;35(7):1152-70.
2 Cave MC, Nutrition Clinical Practice 2008:23 16-34.
3 Sakr Y, Intensive Care Medicine 2008:34 1999-2009.
4 This above statement does not constitute an endorsement of PEPTAMEN® BARIATRIC Formulas or any other Nestlé Health Science product formula by SCCM, A.S.P.E.N., or members of the consensus panel.