Abstract
ABSTRACT Objective This study aimed to evaluate if the protein intake recommendations for obese critically ill requiring mechanical ventilation are sufficient to promote a positive or neutral nitrogen balance. Methods Cross-sectional study that included 25 obese, ≥18 years old, undergoing mechanical ventilation and who were target to receive high-protein enteral nutrition therapy (2.0-2.5g/kg ideal body weight). Clinical, nutritional and biochemical variables were analyzed. Nitrogen balance was performed when patient was receiving full enteral nutrition therapy and was classified: positive when intake was greater than excretion; negative when excretion was greater than intake; neutral when both were equal. Results The characteristics of patients evaluated were 64.1±9.4 years old, clinical treatment 88%, body mass index 36.5±5.1kg/m2, nitrogen balance 0.3g/day (-5.3 to 4.8g/day), protein intake 2.1g/day (2.0-2.3g/kg) ideal body weight. Of individuals analyzed, 52% showed positive or neutral nitrogen balance with median of 4.23g/day 2.41 to 6.40g/day) in comparison to negative group with median of -5.27g/day (-10.38 to -3.86g/day). Adults had higher ratio of negative nitrogen balance (57.1%) than elderly (44.4%), with protein intake of 2.0 versus 2.1g/day, respectively. No correlation was found between nitrogen balance and variables assessed. Conclusion High-protein enteral nutrition therapy contributed to positive or neutral nitrogen balance for approximately half of obese ventilated individuals. With similar protein intake, elderly showed a higher proportion of positive or neutral nitrogen balance. Nitrogen balance can be influenced by various factors, so further studies are required to identify different protein needs in obese critically.
Highlights
In the critical care setting, obesity can contribute to exacerbate ventilatory, cardiovascular, renal and endocrine dysfunctions and pharmacokinetic and pharmacodynamic alterations, leading to an increased metabolic and inflammatory state [1,2,3,4]
No correlation was found between nitrogen balance and variables assessed
Nitrogen balance can be influenced by various factors, so further studies are required to identify different protein needs in obese critically
Summary
In the critical care setting, obesity can contribute to exacerbate ventilatory, cardiovascular, renal and endocrine dysfunctions and pharmacokinetic and pharmacodynamic alterations, leading to an increased metabolic and inflammatory state [1,2,3,4]. Due to these metabolic alterations added to physical inactivity, muscle protein synthesis is decreased and muscle mass can be utilized as an energy substrate for gluconeogenesis, leading to excessive proteolysis, a condition associated with higher mortality [3,4,5,6].
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