Hypocaloric feeding of obese patients in the intensive care unit

Purpose of review Given the increased awareness of the detrimental complications of overfeeding, particularly hyperglycemia, the safety and efficacy of specialized nutritional support for the critically ill obese patient is of major concern. The intent of this review is to provide the scientific foundation, supporting and conflicting literature, for the implementation of hypocaloric, high-protein specialized nutritional support for acutely ill, hospitalized patients with obesity. Recent findings Similar anabolic equivalencies can be achieved with hypocaloric, high-protein nutritional support compared with a more traditional higher calorie, lower protein regimen. The provision of additional calories worsens hyperglycemia, results in a further accumulation of fat mass, and increases the potential for overfeeding without significant net protein anabolism gain. Summary The current literature indicates that hypocaloric, high-protein enteral or parenteral nutrition is promising as the standard of practice for the metabolic support of the critically ill obese patient. The achievement of net protein anabolism and the avoidance of overfeeding complications are the primary goals, with fat weight loss a welcome secondary benefit.