Hypocaloric Nutrition Support Research Articles

Prescribed hypocaloric nutrition support for critically-ill adults.

There are controversies about the amount of calories and the type of nutritional support that should be given to critically-ill people. Several authors advocate the potential benefits of hypocaloric nutrition support, but the evidence is inconclusive. To assess the effects of prescribed hypocaloric nutrition support in comparison with standard nutrition support for critically-ill adults SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, Embase and LILACS (from inception to 20 June 2017) with a specific strategy for each database. We also assessed three websites, conference proceedings and reference lists, and contacted leaders in the field and the pharmaceutical industry for undetected/unpublished studies. There was no restriction by date, language or publication status. We included randomized and quasi-randomized controlled trials comparing hypocaloric nutrition support to normo- or hypercaloric nutrition support or no nutrition support (e.g. fasting) in adults hospitalized in intensive care units (ICUs). We used standard methodological procedures expected by Cochrane. We meta-analysed data for comparisons in which clinical heterogeneity was low. We conducted prespecified subgroup and sensitivity analyses, and post hoc analyses, including meta-regression. Our primary outcomes were: mortality (death occurred during the ICU and hospital stay, or 28- to 30-day all-cause mortality); length of stay (days stayed in the ICU and in the hospital); and Infectious complications. Secondary outcomes included: length of mechanical ventilation. We assessed the quality of evidence with GRADE. We identified 15 trials, with a total of 3129 ICU participants from university-associated hospitals in the USA, Colombia, Saudi Arabia, Canada, Greece, Germany and Iran. There are two ongoing studies. Participants suffered from medical and surgical conditions, with a variety of inclusion criteria. Four studies used parenteral nutrition and nine studies used only enteral nutrition; it was unclear whether the remaining two used parenteral nutrition. Most of them could not achieve the proposed caloric targets, resulting in small differences in the administered calories between intervention and control groups. Most studies were funded by the US government or non-governmental associations, but three studies received funding from industry. Five studies did not specify their funding sources.The included studies suffered from important clinical and statistical heterogeneity. This heterogeneity did not allow us to report pooled estimates of the primary and secondary outcomes, so we have described them narratively.When comparing hypocaloric nutrition support with a control nutrition support, for hospital mortality (9 studies, 1775 participants), the risk ratios ranged from 0.23 to 5.54; for ICU mortality (4 studies, 1291 participants) the risk ratios ranged from 0.81 to 5.54, and for mortality at 30 days (7 studies, 2611 participants) the risk ratios ranged from 0.79 to 3.00. Most of these estimates included the null value. The quality of the evidence was very low due to unclear or high risk of bias, inconsistency and imprecision.Participants who received hypocaloric nutrition support compared to control nutrition support had a range of mean hospital lengths of stay of 15.70 days lower to 10.70 days higher (10 studies, 1677 participants), a range of mean ICU lengths of stay 11.00 days lower to 5.40 days higher (11 studies, 2942 participants) and a range of mean lengths of mechanical ventilation of 13.20 days lower to 8.36 days higher (12 studies, 3000 participants). The quality of the evidence for this outcome was very low due to unclear or high risk of bias in most studies, inconsistency and imprecision.The risk ratios for infectious complications (10 studies, 2804 participants) of each individual study ranged from 0.54 to 2.54. The quality of the evidence for this outcome was very low due to unclear or high risk of bias, inconsistency and imprecisionWe were not able to explain the causes of the observed heterogeneity using subgroup and sensitivity analyses or meta-regression. The included studies had substantial clinical heterogeneity. We found very low-quality evidence about the effects of prescribed hypocaloric nutrition support on mortality in hospital, in the ICU and at 30 days, as well as in length of hospital and ICU stay, infectious complications and the length of mechanical ventilation. For these outcomes there is uncertainty about the effects of prescribed hypocaloric nutrition, since the range of estimates includes both appreciable benefits and harms.Given these limitations, results must be interpreted with caution in the clinical field, considering the unclear balance of the risks and harms of this intervention. Future research addressing the clinical heterogeneity of participants and interventions, study limitations and sample size could clarify the effects of this intervention.

Occurrence of refeeding syndrome in adults started on artificial nutrition support: prospective cohort study

BackgroundRefeeding syndrome is a potentially life-threatening condition characterised by severe intracellular electrolyte shifts, acute circulatory fluid overload and organ failure. The initial symptoms are non-specific but early clinical features are...

Prescribed hypocaloric nutrition support for critically ill adults

Prescribed hypocaloric nutrition support for critically ill adults

Nutrition support in the obese, diabetic patient: the role of hypocaloric feeding

It has previously been thought that meeting estimated caloric needs with nutrition support improves outcomes in critically ill, obese patients with diabetes. Recent data suggests that intentionally failing to match caloric expenditure may actually result in better outcomes than eucaloric feeding. This review will evaluate recent studies exploring the relationship between caloric intake and outcomes in obese patients with underlying insulin resistance or diabetes. Obese patients who receive 33-70% of their estimated caloric needs during critical illness have better clinical outcomes than patients fed eucalorically. The reasons for this are not clear, however, they do not appear to be due to improved glycemic control. It is possible that caloric restriction acts by improving insulin sensitivity in protein and glucose metabolism, reducing the risk of infection without causing severe hypoglycemia. Patients who are unable to achieve goal-feeding rates have poorer clinical outcomes but this is most likely due to severity of illness rather than caloric intake itself. It is better to err on the side of hypocaloric nutrition support in obese, diabetic patients rather than overfeeding. Hypocaloric feeding may result in improved outcomes, however, the optimal duration of hypocaloric nutrition support is not known.

Hypocaloric Feeding of the Critically Ill

During critical illness, the stress response causes accelerated gluconeogenesis and lipolysis, leading to hyperglycemia and elevated serum triglyceride levels. The traditional nutrition support strategy of meeting or exceeding calorie requirements may compound the metabolic alterations of the stress response. Hypocaloric nutrition support has the potential to provide nutrition support without exacerbating the stress response. Studies have shown hypocaloric nutrition support to be safe and to achieve nitrogen balance comparable with traditional regimens. Benefits shown include improved glycemic control, decreased intensive care unit (ICU) length of stay (LOS), and decreased ventilator days and infection rate; however, not all studies have produced identical results. Providing adequate dietary protein has emerged as an important factor in efficacy of the hypocaloric regimen. Although it is inconclusive, currently available research suggests that a nutrition support goal of 10-20 kcal/kg of ideal or adjusted weight and 1.5-2 g/kg ideal weight of protein may be beneficial during the acute stress response. Well-designed, randomized, controlled studies with adequate sample size that evaluate relevant clinical outcomes such as mortality, ICU LOS, and infection while controlling for factors such as glycemic control, severity of illness, incorporation of calories from all sources, in addition to feeding regimens, are needed to definitively determine the effects of hypocaloric nutrition support.

Study on Effect and Nursing of Combining Human Growth Hormone with Hypocaloric Nutrition Support to Treat Patients with Postoperative MOF

目的 探讨生长激素合并低热量肠外营养对多器官衰竭患者的影响和护理措施.方法60例术后多器官衰竭患者分为对照组(30例)和实验组(30例),术后48h至16d为观察时期,2组患者术后治疗和营养支持方案相同.实验组术后48 h开始加用rhGH(8 U/d)皮下注射,连续14 d.监测所有患者治疗前后营养指标和营养耐受性指标,同时记录胰岛素应用情况、并发症及临床结果.结果在营养指标及氮平衡方面,2组有显著性差异,在耐受性指标方面,实验组血糖明显升高,与对照组比较,有显著性差异;对照组并发症发生率及病种高于实验组.结论低热量TPN与rhGH联合应用,能够迅速有效纠正多器官衰竭患者的营养代谢障碍,提高血浆蛋白含量,降低并发症的发生率和病死率,改善危重患者预后。

Current Literature: Hypocaloric Parenteral Nutrition Support in Elderly Obese Patients

Hypocaloric nutrition support has been successfully used to achieve positive nitrogen balance in obese patients. However, advanced age is associated with changes in substrate metabolism. To evaluate the efficacy of this practice in elderly patients, we retrospectively reviewed 30 obese patients requiring parenteral nutrition support. Total caloric requirements (TCR) were calculated on the basis of the Harris‐Benedict equation. Patients were given a minimum of 1.5 g/kg/day protein, 75% of TCR when current body weight was >120 and ≤150% of ideal body weight (IBW), and 60% of TCR if current body weight was >150% of IBW. The patients were divided into two groups: group I (N = 18) patients were age <60 and group II (N = 12) patients were ≤60 years of age. Only one of the group I patients (143.2 ± 25.7% IBW, received 18.2 ± 3.7 keal/kg/day and 1.6 ± 0.4 g/kg/day protein), but five of the group II patients (141.3 ± 14.4% IBW, received 18.3 ± 2.6 keal/kg/day and 1.7 ± 0.3 g/kg/day protein), had negative nitrogen balance (p = .025). Apparently, elderly obese patients have limited capacity to mobilize their fat stores as energy sources and may continue to undergo protein catabolism with hypocaloric high‐protein nutrition support. Therefore this form of nutrition support should be used with caution in elderly obese patients. (Am Surg 66:394–400, 2000)

Nutrition Support for the Obese Patient

Abstract The severely obese represent an extremely challenging group of patients. Their body size and associated comorbidities complicate even routine medical care. These management difficulties spill over into nutrition support. As with any patient population, when the severely obese develop conditions such as critical illness and have an interruption in nutritional intake, they deserve aggressive nutrition intervention. However, standard enteral and parenteral approaches may be harmful. Most of the potential adverse effects can be attributed to the concentrated glucose infusion that represents a major calorie source of conventional feeding. To minimize the negative impact of nutrition support, a novel feeding approach, a protein‐sparing, hypocaloric regimen, is presented. This technique preserves protein stores while avoiding glucose‐related complications by intentionally restricting energy administration, in particular, glucose. Although there are relatively few investigations of this nutritional regimen in the literature, those that do exist confirm its safety and suggest a benefit for the patient. This article will review the issues pertaining to standard feeding approaches in the severely obese and the theoretical benefits of hypocaloric nutrition support. It will also review the published studies that used this method.

Nutrition Support of Obese Hospitalized Patients

Obesity is a chronic disease that affects 33% of the adult population and 30% to 40% of the hospitalized adult population. Obesity can be defined with the use of percent of ideal body weight, but because of a number of problems associated with this method, body mass index has become the accepted measure. Nutrition assessment and selection of route of nutrition support are similar in the obese and normal weight patient. A variety of methods for estimating energy and protein needs in the obese patient are available but become increasingly unreliable as the degree of obesity increases. Measuring energy needs becomes appropriate as obesity becomes more severe. A strategy that uses hypocaloric nutrition support in the obese hospitalized patient is reviewed.