Caloric Deficit Research Articles

Simulasi Reinforcement Learning untuk Kecerdasan Buatan pada Exergame Penurun Berat Badan

The pandemic of Coronavirus Disease 2019 (Covid-19) is still sweeping the globe. This is alarming, and it has a negative impact on physical activity outside the home. Weight gain is one of the issues that has arisen. Artificial intelligence simulation research is proposed for physical activity to help lose weight for it to be something fun with all its limitations. This simulation is going to be included in the game. This study focused on the physical activity carried out based on the results of artificial intelligence calculations to lose weight before being applied to the game. The approach is quantitative. To begin, conduct a literature review to determine the topic, machine learning methods, and calorie calculations for weight loss. Additionally, using reinforcement learning, a model for calculating the need is created for a caloric deficit. The waterfall method is used to model the calculation, which is then simulated in the system. The final stage is model validation, which involves utilizing the functionality correctness in accordance with system requirements. It produces 100 percent correct output based on the list of requirements, according to the tests that have been conducted.

Fibroblast Growth Factor 21 Facilitates the Homeostatic Control of Feeding Behavior.

Fibroblast growth factor 21 (FGF21) is a stress hormone that is released from the liver in response to nutritional and metabolic challenges. In addition to its well-described effects on systemic metabolism, a growing body of literature now supports the notion that FGF21 also acts via the central nervous system to control feeding behavior. Here we review the current understanding of FGF21 as a hormone regulating feeding behavior in rodents, non-human primates, and humans. First, we examine the nutritional contexts that induce FGF21 secretion. Initial reports describing FGF21 as a ‘starvation hormone’ have now been further refined. FGF21 is now better understood as an endocrine mediator of the intracellular stress response to various nutritional manipulations, including excess sugars and alcohol, caloric deficits, a ketogenic diet, and amino acid restriction. We discuss FGF21’s effects on energy intake and macronutrient choice, together with our current understanding of the underlying neural mechanisms. We argue that the behavioral effects of FGF21 function primarily to maintain systemic macronutrient homeostasis, and in particular to maintain an adequate supply of protein and amino acids for use by the cells.

Preserving Muscle Mass during Your Weight Loss Journey

To lose weight, you need to create a calorie deficit by eating fewer calories or increasing the number of calories you burn through physical activity or both. In general, you need to decrease your caloric intake by 500 to 700 calories a day to lose 0.5 to 1 kilogram a week. If you can add some physical activity to your day, you will be able to accomplish your weight-loss goals even faster. It sounds simple; however, it is much more complex than it sounds, because when you lose weight, you usually lose a combination of fat, lean mass, and water. Studies have shown that if you achieve a caloric deficit to lose weight solely by cutting calories, you are probably going to lose a quarter of your weight loss form muscle mass [1].

Sustainable Intensification Practices Reduce Food Deficit for the Best- and Worst-Off Households in Ethiopia and Mozambique

An adequate food supply is widely recognized as a necessary condition for social development as well as a basic human right. Food deficits are especially common among semi-subsistence farming households in eastern and southern Africa and farm productivity is widely regarded as the locus for enhancing household food outcomes. However, knowledge gaps surrounding benefits associated with climate smart, productivity-enhancing technologies require attention. This study evaluates benefits associated with sustainable intensification farm management practices (crop residue retention, minimum tillage, manure application and use of herbicides, pesticides, fertilizer, and improved seeds) for household calorie and protein supplies and demonstrates their scope across households with high-, moderate- and low- likelihoods of calorie and protein deficits. Household-level calorie and protein deficits were estimated from survey data on food production, acquisition and consumption for households in Ethiopia and Mozambique. Multinomial logistic models were used to identify drivers of household food deficit status and logistic model trees established “rules of thumb” to classify households by food deficit status as low, moderate or high likelihood. In Ethiopia, especially wet seasons were associated with a high likelihood of a food deficit while especially dry seasons were associated with a high likelihood of food deficit in Mozambique. The practices associated with sustainable intensification and related technologies substantially enhanced food outcomes in groups with a high- and a low-likelihood of food deficit, and associated benefits were high for the best-off households. Benefits associated with sustainable intensification technologies were not observed for households with a moderate likelihood of a food deficit and some technologies even increased risk. The sustainable intensification practices assessed here were associated with improved food outcomes yet benefits were limited in scope for households of intermediate status. Thus, there is a need to expand the technical options available to reduce food deficit.

Calorie- and Protein-Deficient Diets Despite Adequate Dietary Diversity among Pregnant Women in a Low-Income Urban Area in Delhi, India.

We interviewed 221 antenatal women in the second or third trimester of pregnancy attending a primary care antenatal clinic at a low-income area in Delhi, India, during 2019-20. The Minimum Dietary Diversity-Women (MDD-W) score for 10 food groups was calculated using the open recall method during a 24-h recall period. The median MDD-W score was 6 (IQR 4-7). Low dietary diversity (MDD-W <5) was observed in 65 (29.4%) participants. Low SES and higher age (≥25 years) were statistically significant predictors of lower dietary diversity, but it was unrelated to parity. Furthermore, protein deficit was observed in 185 (83.7%) and calorie deficit in 210 (95%) participants.

Assessment of anaemia and nutritional status of antenatal women attending a tertiary care hospital.

ABSTRACTAim:The aim of this study was to assess and grade anaemia in antenatal women at a tertiary care hospital.Materials and Methods:This cross-sectional study was conducted on 151 participants over 4 months at All India Institute of Medical Sciences (AIIMS), Rishikesh, a tertiary care hospital in Uttarakhand, India. Extensive work on quantifying daily nutritional intake and requirement was done to estimate antenatal women’s nutritional status suffering from anaemia.Results:The proportion of anaemia among pregnant women was 37.09%, with mean haemoglobin of 11 g/dl, mode and median of 11.3 g/dl with higher and moderate anaemia than mild. It was in direct proportion with the number of abortions, gravid status and trimester of pregnancy. There was a protein deficit of 30–60% in 73.2% of the anaemic patients. Iron tablets were taken regularly by 85.5% of anaemic patients and 87.1% of non-anaemic patients. None of the anaemic patients met their 100% calorie requirement. The least calorie deficit was found to be 14.4%. A calorie deficit of 30–60% was found in 75% of the anaemic patients. Patients with severe anaemia had a calorie deficit of 40–60%.Discussion:Poverty, ignorance and non-availability of resources are the key factors underlying this condition. The lacunae in the delivery chain of beneficence to antenatal women offered by the government need to be looked at. Family planning has a pivotal role in controlling anaemia, as a high frequency of abortions and pregnancies were associated with anaemia.

Use of an electronic volume based feeding protocol to improve nutrition delivery in critical care

Rationale: Nutritional deficits in critically ill patients have been shown to lead to increased morbidity, mortality and length of stay(1). During the intensive care unit (ICU) admission breaks to feed are common; patients are often nil by tube for procedures and investigations(2). Volume based feeding (VBF) has been suggested as a strategy to reduce deficits with nursing staff adjusting feed rates to achieve target feed volume(3). We implemented an electronic VBF protocol to calculate calorie deficits and feed rates.

Effects of Early vs. Late Time-Restricted Eating on Cardiometabolic Health, Inflammation, and Sleep in Overweight and Obese Women: A Study Protocol for the ChronoFast Trial.

Background: Time-restricted eating is a promising dietary strategy for weight loss, glucose and lipid metabolism improvements, and overall well-being. However, human studies demonstrated contradictory results for the restriction of food intake to the beginning (early TRE, eTRE) or to the end of the day (late TRE, lTRE) suggesting that more carefully controlled studies are needed.Objective: The aim of the ChronoFast trial study is to determine whether eTRE or lTRE is a better dietary approach to improve cardiometabolic health upon minimized calorie deficits and nearly stable body weight.Methods: Here, we present the study protocol of the randomized cross-over ChronoFast clinical trial comparing effects of 2 week eTRE (8:00 to 16:00 h) and lTRE (13:00 to 21:00 h) on insulin sensitivity and other glycemic traits, blood lipids, inflammation, and sleep quality in 30 women with overweight or obesity and increased risk of type 2 diabetes. To ensure timely compliance and unchanged dietary composition, and to minimize possible calorie deficits, real-time monitoring of dietary intake and body weight using a smartphone application, and extensive nutritional counseling are performed. Continuous glucose monitoring, oral glucose tolerance test, 24 h activity tracking, questionnaires, and gene expression analysis in adipose tissue and blood monocytes will be used for assessment of study outcomes.Discussion: The trial will determine whether eTRE or lTRE is more effective to improve cardiometabolic health, elucidate underlying mechanisms, and contribute to the development of recommendations for medical practice and the wider population.Clinical Trial Registration: www.ClinicalTrials.gov, Identifier [NCT04351672]

The impact of nutritional counseling on thyroid disorders in head and neck cancer patients after (chemo)radiotherapy: results from a\xa0prospective interventional trial

ObjectiveTo analyze the impact of nutritional counseling on the development of hypothyroidism after (chemo)radiotherapy in head and neck cancer patients to propose a new normal tissue complication probability (NTCP) model.Materials and methodsAt baseline, at the end of (chemo)radiotherapy, and during follow-up, thyroid-stimulating hormone (TSH) with free thyroxin (fT3 and fT4), nutritional status, and nutrient intake were prospectively analyzed in 46 out of 220 screened patients. Patients received (chemo)radiotherapy within an intervention (individual nutritional counseling every 2 weeks during therapy) and a control group (no nutritional counseling).ResultsOverall median follow-up was 16.5 [IQR: 12; 22] months. Fourteen patients (30.4%) presented with hypothyroidism after 13.5 [8.8; 17] months. During (chemo)radiotherapy, nutritional status worsened in the entire cohort: body mass index (p < 0.001) and fat-free mass index (p < 0.001) decreased, calorie deficit (p = 0.02) increased, and the baseline protein intake dropped (p = 0.028). The baseline selenium intake (p = 0.002) increased until the end of therapy. Application of the NTCP models by Rønjom, Cella, and Boomsma et al. resulted in good performance of all three models, with an AUC ranging from 0.76 to 0.78. Our newly developed NTCP model was based on baseline TSH and baseline ferritin. Model performance was good, receiving an AUC of 0.76 (95% CI: 0.61–0.87), with a sensitivity of 57.1% and specificity of 96.9% calculated for a Youden index of 0.73 (p = 0.004; area = 0.5).ConclusionBaseline TSH and ferritin act as independent predictors for radiotherapy-associated hypothyroidism. The exclusion of such laboratory chemistry parameters in future NTCP models may result in poor model performance.

Mixed Infant Feeding Is Not Associated With Increased Risk of Decelerated Growth Among WIC-Participating Children in Southern California.

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition assistance to half of infants born in the United States. The nationally representative WIC Infants and Toddler Feeding Practices Study-2 (ITFPS-2) reported a caloric deficit at 7 months among infants receiving WIC mixed feeding packages, suggesting these infants may be at risk for growth deceleration/faltering.Methods: Longitudinal administrative data collected prospectively from WIC participants in Southern California between 2010 and 2019 were used (n = 16,255). Infant lengths and weights were used to calculate weight-for-length (WLZ), weight-for-age (WAZ) and length-for-age (LAZ) z-scores at different time points. Growth deceleration/faltering was determined at 9, 12, 18, and 24 months by the change in z-score from the last measurement taken ≤ 6 months of age. Infant feeding was categorized by the food package (breastfeeding, mixed feeding, and formula feeding) infants received from WIC at 7 months. Poisson regression models were used to evaluate the association between WIC infant package at 7 months and deceleration/faltering at 9, 12, 18, and 24 months.Results: The proportion of infants displaying decelerated/faltering growth was low for all infant food package groups. Receiving the WIC mixed feeding package at 7 months of age was not associated with WLZ, WAZ, and LAZ deceleration/faltering growth.Conclusions: Growth deceleration/faltering rates were very low among WIC participating children in Southern California, highlighting the critical role of nutrition assistance in supporting adequate growth in early childhood.

Effectiveness of a lifestyle weight-loss intervention targeting inactive former elite athletes: the Champ4Life randomised controlled trial

ObjectivesMany athletes struggle in managing the end of their career, often gaining weight and adopting unhealthy lifestyles. Lifestyle programmes targeting former athletes who have gained substantial fat mass (FM) postsports...

Study of the Effects of Sleep Apnea Syndrome on the Paraclinical Parameters of Balance Exploration

Aim: To evaluate the impact of Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) on posturographic parameters. Objective: The primary objective was to evaluate whether the mean gain of the Visually Vestibulo-Ocular Reflex VVOR), the parameter most likely to be modified in case of central damage, decreased in patients diagnosed with OSAHS. The secondary objective was to verify if the other parameters of videonystagmography and posturography varied according to the presence or not of OSAHS. Materials and Methods: Retrospective analysis of posturographic parameters of patients previously tested by polygraphy (whether or not they had OSAHS). Results: In the 66 patients included, the mean VVOR gains did not differ significantly between the "no OSAHS" vs. "OSAHS" groups (respectively 0.88 vs. 0.71, p = 0.1224). None of the other parameters measured, such as the mean caloric deficits, the mean weights of vestibular, visual and somesthetic afferents measured by posturography, the mean gains of the vestibulo-ocular reflex, and the frequency of falls on the posturograph, had a statistically different distribution according to the presence or absence of OSAHS. Conclusion: We did not show any significant difference in posturographic parameters according to the presence or absence of OSAHS, in particular the absence of vestibular and/or central involvement.

Sodium intake and high blood pressure among adults on caloric deficit: a multi-year cross-sectional analysis of the U.S. population, 2007-2018.

Small studies have shown reduced sodium-sensitivity of blood pressure in obese adolescents on a caloric deficit. We aimed to explore the association between mean daily sodium intake and prevalent hypertension among a nationally representative sample of U.S. adults on a calorie deficit. We used a design-based regression model to explore the association between sodium intake and prevalent hypertension. We also conducted sensitivity analyses using multiple imputation chained equations and propensity score matching. We also measured the effect of a binary exposure derived from the widely recommended threshold of 2.3 grams of sodium intake per day. Among 5756 individuals, we did not detect any significant association between increased sodium and the odds of hypertension (OR: 0.97; 95% CI: 0.90; 1.05). All our sensitivity analyses are consistent with our main findings. People on a calorie deficit-a component of healthy weight loss-without malnutrition saw no benefit in reduced sodium intake to lower blood pressure. These results highlight the need to explore new population-specific strategies for sodium intake reduction, including new dietary prescription approaches to improve dietary adherence and reduce the risk associated with sodium-deficient diets.

The association of macronutrient deficit with functional status at discharge from the intensive care unit: a retrospective study from a single-center critical illness registry.

Nutrition is often thought to influence outcomes in critically ill patients. However, the relationship between macronutrient delivery and functional status is not well characterized. Our goal was to investigate whether caloric or protein deficit over the course of critical illness is associated with functional status at the time of intensive care unit (ICU) discharge. We performed a retrospective analysis of surgical ICU patients at a teaching hospital in Boston, MA. To investigate the association of caloric or protein deficit with Functional Status Score for the ICU (FSS-ICU), we constructed linear regression models, controlling for age, sex, race, body mass index, Nutritional Risk in the Critically Ill score, and ICU length of stay. We then dichotomized caloric as well as protein deficit, and performed logistic regressions to investigate their association with functional status, controlling for the same variables. Linear regression models (n = 976) demonstrated a caloric deficit of 238 kcal (237.88; 95%CI 75.13-400.63) or a protein deficit of 14 g (14.23; 95%CI 4.46-24.00) was associated with each unit decrement in FSS-ICU. Logistic regression models demonstrated a 6% likelihood (1.06; 95%CI 1.01-1.14) of caloric deficit ≥6000 vs. <6000 kcal and an 8% likelihood (1.08; 95%CI 1.01-1.15) of protein deficit ≥300 vs. <300 g with each unit decrement in FSS-ICU. In our cohort of patients, macronutrient deficit over the course of critical illness was associated with worse functional status at discharge. Future studies are needed to determine whether optimized macronutrient delivery can improve outcomes in ICU survivors.

The Intestinal Microbiome Predicts Weight Loss on a Calorie-Restricted Diet and Is Associated With Improved Hepatic Steatosis.

Background: The microbiome has been shown in pre-clinical and epidemiological studies to be important in both the development and treatment of obesity and metabolic associated fatty liver disease (MAFLD). However, few studies have examined the role of the microbiome in the clinical response to calorie restriction. To explore this area, we performed a prospective study examining the association of the intestinal microbiome with weight loss and change in hepatic steatosis on a calorie-restricted diet.Methods: A prospective dietary intervention study of 80 overweight and obese participants was performed at the Greater West Los Angeles Veterans Affair Hospital. Patients were placed on a macronutrient standardized diet for 16 weeks, including 14 weeks of calorie restriction (500 calorie deficit). Body composition analysis by impedance, plasma lipid measurements, and ultrasound elastography to measure hepatic steatosis were performed at baseline and week 16. Intestinal microbiome composition was assessed using 16S rRNA gene sequencing. A per protocol analysis was performed on all subjects completing the trial (n = 46).Results: Study completers showed significant reduction in weight, body mass index, total cholesterol, low density lipoprotein, and triglyceride. Subjects who lost at least 5% of their body weight had significantly greater reduction in serum triglyceride and hepatic steatosis than those with <5% body weight loss. Enterococcus and Klebsiella were reduced at the end of the trial while Coprococcus and Collinsella were increased. There were also significant baseline microbiome differences between patients who had at least 5% weight loss as compared to those that did not. Lachnoclostridium was positively associated with hepatic steatosis and Actinomyces was positively associated with hepatic steatosis and weight. Baseline microbiome profiles were able to predict which patients lost at least 5% of their body weight with an AUROC of 0.80.Conclusion: Calorie restriction alters the intestinal microbiome and improves hepatic steatosis in those who experience significant weight loss. Baseline microbiome differences predict weight loss on a calorie–restricted diet and are associated with improvement in hepatic steatosis, suggesting a role of the gut microbiome in mediating the clinical response to calorie restriction.

Assessment of Distorted Nutrition-Related Beliefs and Behaviors of Students Enrolled in an Introductory Nutrition Course

Abstract Objectives Most students entering an introductory nutrition course have previously held beliefs about food. They have been eating their whole lives and have been bombarded with media portraying both sound and flawed science. Drawing from psychology, the cognitive model describes how distorted beliefs can give rise to distorted behaviors. Distorted beliefs can be rooted in fantasia, or the certainty that something is understood that truly is not. Applying this to nutrition, fantasia and associated distorted beliefs may negatively impact eating behavior. The objectives of this study are to 1) assess the nutrition-related knowledge, beliefs, and behaviors of students taking an introductory nutrition course, 2) evaluate the effectiveness of pre- and post-unit assignments designed to help students evaluate and correct their own areas of fantasia. Methods Nutrition in Everyday Life is an introductory nutrition course (n = 25). In 2020, pre- and post- unit reflective assignments were integrated into the course. Using the cognitive model, these assignments aimed to help students evaluate and correct distorted beliefs rooted in fantasia. Mixed methods, including a pre/post-test, were used to evaluate the effectiveness of the assignments. Mann-Whitey U tests were used to compare quantitative data. Results Prior to the course, students’ average pre-test score was a 66%. The most commonly held distorted beliefs included, “If people eat less and exercise more, they will always lose weight,” and “Low-fat and diet foods are always healthier alternatives to full-fat products.” Students reported that these beliefs had influenced them to “avoid carbohydrates and fat” and to “eat in a calorie deficit and exercise a lot.” Students’ average post-test scores significantly increased (P = 0.001), indicating that students were better able to identify distorted beliefs. Students reported that correcting their distorted beliefs may impact their behaviors, such as “wanting to alter diets to include more healthier carbs and fats.” Conclusions The incorporation of pre- and post-unit reflective assignments into an introductory nutrition course can be an effective way to teach students to critically evaluate their own previously held beliefs, which may lead to positive changes in nutrition-related behaviors. Funding Sources College at Oneonta Foundation; SUNY Oneonta Alumni Association.

Wild Bornean orangutans experience muscle catabolism during episodes of fruit scarcity

Pronounced temporal and spatial variation in the availability of food resources can produce energetic deficits in organisms. Fruit-dependent Bornean orangutans face extreme variation in fruit availability and experience negative energy and protein balance during episodes of fruit scarcity. We evaluate the possibility that orangutans of different sexes and ages catabolize muscle tissue when the availability of fruit is low. We assess variation in muscle mass by examining the relationship between urinary creatinine and specific gravity and use the residuals as a non-invasive measure of estimated lean body mass (ELBM). Despite orangutans having a suite of adaptations to buffer them from fruit scarcity and associated caloric deficits, ELBM was lower during low fruit periods in all age-sex classes. As predicted, adult male orangutans had higher ELBM than adult females and immatures. Contrary to expectation, flanged and unflanged males did not differ significantly in ELBM. These findings highlight the precarity of orangutan health in the face of rapid environmental change and add to a growing body of evidence that orangutans are characterized by unique metabolic traits shaped by their unpredictable forest environment.

Caloric and nutrient restriction to augment chemotherapy efficacy for acute lymphoblastic leukemia: the IDEAL trial

Being overweight or obese (OW/OB) during B-cell acute lymphoblastic leukemia (B-ALL) induction is associated with chemoresistance as quantified by minimal residual disease (MRD). We hypothesized that caloric and nutrient restriction from diet/exercise could lessen gains in fat mass (FM) and reduce postinduction MRD. The Improving Diet and Exercise in ALL (IDEAL) trial enrolled patients 10 to 21 years old, newly diagnosed with B-ALL (n = 40), in comparison with a recent historical control (n = 80). Designed to achieve caloric deficits ≥20% during induction, reduce fat intake/glycemic load, and increase activity, IDEAL's end points were FM gain (primary), MRD ≥0.01%, and adherence/feasibility. Integrated biology explored biomarkers of OW/OB physiology. IDEAL intervention did not significantly reduce median FM change from baseline overall (+5.1% [interquartile range [IQR], 15.8] vs +10.7% [IQR, 16.0]; P = .13), but stratified analysis showed benefit in those OW/OB (+1.5% [IQR, 6.6] vs +9.7% [IQR, 11.1]; P = .02). After accounting for prognostic factors, IDEAL intervention significantly reduced MRD risk (odds ratio, 0.30; 95% confidence interval, 0.09-0.92; P = .02). The trial exceeded its adherence (≥75% of overall diet) and feasibility (≥80% completed visits) thresholds. Integrated biology found the IDEAL intervention increased circulating adiponectin and reduced insulin resistance. The IDEAL intervention was feasible, decreased fat gain in those OW/OB, and reduced MRD. This is the first study in any hematologic malignancy to demonstrate potential benefit from caloric restriction via diet/exercise to augment chemotherapy efficacy and improve disease response. A prospective, randomized trial is warranted for validation. These trials were registered at www.clinicaltrials.gov as #NCT02708108 (IDEAL trial) and #NCT01317940 (historical control).

A prospective pilot study of the energy balance profiles in acute non-severe burn patients

BackgroundMajor burn patients have been shown to exhibit a hyper-metabolic state of activity which can persist for up to two years after burn. The relationship between total body surface area (TBSA) and resting metabolic rate (RMR) has been investigated in larger burns (≥20% TBSA), however not in non-severe burns (≤15% TBSA). The primary aim of this observational study was to examine the association between the acute effects of burns <15% TBSA with RMR in patients using indirect calorimetry, as well as any potential covariates. The secondary aim was to determine 24-h energy balance. MethodsThe study included data from 39 participants (82% male), all admitted to the State Adult Burn Unit at Fiona Stanley Hospital. Each patient was recruited upon admission and RMR data was collected on day four (± one day) after burn. ResultsThe pooled data bivariate correlation showed a significant relationship between RMR and TBSA (r=0.435, p=0.009). A stronger relationship was also found between RMR and TBSA in males (r=0.634, p=0.001). Patients recorded a caloric deficit of 116kcal/day. ConclusionThis study demonstrated that a moderately strong linear association exists between RMR and TBSA in males for burns of ≤15% TBSA. The energy balance data indicated that supplementation of calorific intake for non-severe burns suggests careful consideration.

Early caloric deficit is associated with a higher risk of death in invasive ventilated COVID-19 patients

Background & aimsThe aim of this study was to evaluate the nutritional support management in mechanically ventilated coronavirus disease 2019 (COVID-19) patients and explore the association between early caloric deficit and mortality, taking possible confounders (i.e. obesity) into consideration.MethodsThis was a prospective study carried out during the first pandemic wave in the intensive care units (ICUs) of two referral University Hospitals in Lombardy, Italy.Two hundred twenty-two consecutive mechanically ventilated COVID-19 patients were evaluated during the ICU stay. In addition to major demographic and clinical data, we recorded information on the route and amount of nutritional support provided on a daily basis.ResultsAmong patients still in the ICUs and alive on day 4 (N = 198), 129 (65.2%) and 72 (36.4%) reached a satisfactory caloric and protein intake, respectively, mainly by enteral route.In multivariable analysis, a satisfactory caloric intake on day 4 was associated with lower mortality (HR = 0.46 [95%CI, 0.42–0.50], P < 0.001). Mild obesity (body mass index [BMI] ≥30 and < 35 kg/m2) was associated with higher mortality (HR = 1.99 [95%CI, 1.07–3.68], P = 0.029), while patients with moderate-severe obesity (BMI≥35 kg/m2) were less likely to be weaned from invasive mechanical ventilation (HR = 0.71 [95%CI, 0.62–0.82], P < 0.001).ConclusionsThis study confirmed the negative prognostic and clinical role of obesity in mechanically ventilated COVID-19 patients and suggested that early caloric deficit may independently contribute to worsen survival in this patients’ population. Therefore, any effort should be made to implement an adequate timely nutritional support in all COVID-19 patients during the ICU stay.