title: The Critical Care Obesity Paradox and Implications for Nutrition Support.
abstract: Obesity is a leading cause of preventable death worldwide. The prevalence of obesity has been increasing and is associated with an increased risk for other co-morbidities. In the critical care setting, nearly one third of patients are obese. Obese critically ill patients pose significant physical and on-physical challenges to providers, including optimization of nutrition therapy. Intuitively, obese patients would have worse critical care-related outcome. On the contrary, emerging data suggests that critically ill obese patients have improved outcomes, and this phenomenon has been coined "the obesity paradox." The purposes of this review will be to outline the historical views and pathophysiology of obesity and epidemiology of obesity, describe the challenges associated with obesity in the intensive care unit setting, review critical care outcomes in the obese, define the obesity-critical care paradox, and identify the challenges and role of nutrition support in the critically ill obese patient.
authors.affiliation: Division of Pulmonary & Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Suite E5200 Pulmonary & Critical Care Medicine, Milwaukee, WI, 53226, USA. jpatel2@mcw.edu.
authors.forename: Jayshil J
authors.initials: JJ
authors.lastname: Patel
authors.affiliation: Department of Surgery, University of Florida, Gainesville, FL, USA.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Rosenthal
authors.affiliation: Division of Trauma Surgery, Department of Surgery, University of Louisville, Louisville, KY, USA.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Miller
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Panna
authors.initials: P
authors.lastname: Codner
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Oregon Health Science University, Portland, OR, USA.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Kiraly
authors.affiliation: Division of General Surgery, Department of Surgery, Oregon Health Science University, Portland, OR, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Martindale
mesh_terms: D015897:Comorbidity; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy; D004750:Enteral Nutrition / Q000379:methods; D006801:Humans; D018529:Nutritional Support / Q000379:methods*; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D010288:Parenteral Nutrition / Q000379:methods
keywords: Critical care; Enteral nutrition; Intensive care; Nutrition; Obesity; Parenteral nutrition; Permissive underfeeding