title: Nutrition delivery for obese ICU patients: delivery issues, lack of guidelines, and missed opportunities.
abstract: The most appropriate enteral formula for the severely obese population has yet to be determined. The obese patient in the intensive care unit (ICU) creates numerous difficulties for managing care, one being the ability to deliver appropriate and timely nutrition. Access for nutrition therapy, either enteral or parenteral, can also create a challenge. Currently, no specific guidelines are available on a national or international scale to address the issues of how and when to feed the obese patient in the ICU. A bias against feeding these patients exists, secondary to the perception that an enormous quantity of calories is stored in adipose tissue. Making a specialty enteral formula for obesity from existing commercial formulas and other modular nutrient components is not practical, secondary to difficulty with solubility issues, dilution of the formula, and safety concerns. Using today's concepts and current metabolic data, a formula could be produced that would address many of the specific metabolic derangements noted in obesity. This formula should have a high-protein, low-carbohydrate content with at least a portion of the lipid source coming from fish oil. Specific nutrients that may be beneficial in obesity include arginine, glutamine, leucine, L-carnitine, lipoic acid, S-adenosylmethionine, and betaine. Certain trace minerals such as magnesium, zinc, and selenium may also be of value in the obese population. The concept of a specific bariatric formulation for the ICU setting is theoretically sound, is scientifically based, and could be delivered to patients safely.
authors: Department of Surgery, Oregon Health and Sciences University, Portland, OR 97239, USA. martindr@ohsu.edu
authors: Robert G
authors: RG
authors: Martindale
authors: Mark
authors: M
authors: DeLegge
authors: Stephen
authors: S
authors: McClave
authors: Craig
authors: C
authors: Monroe
authors: Vance
authors: V
authors: Smith
authors: Laszlo
authors: L
authors: Kiraly
mesh_terms: D000596:Amino Acids / Q000032:analysis; D049088:Bariatrics; D003422:Critical Care; D004040:Dietary Carbohydrates / Q000032:analysis; D004041:Dietary Fats / Q000032:analysis; D004044:Dietary Proteins / Q000032:analysis; D002149:Energy Intake; D005395:Fish Oils / Q000032:analysis; D005526:Food, Formulated / Q000032:analysis; D017408:Guidelines as Topic; D006801:Humans; D007362:Intensive Care Units; D009751:Nutritional Requirements; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods* / Q000592:standards*; D009765:Obesity / Q000178:diet therapy*; D004364:Pharmaceutical Preparations / Q000592:standards; D014131:Trace Elements / Q000032:analysis
chemical_list: D000596:Amino Acids; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D005395:Fish Oils; D004364:Pharmaceutical Preparations; D014131:Trace Elements