TY - JOUR
T1 - Nutrition support in the obese, diabetic patient
T2 - The role of hypocaloric feeding
AU - Reeds, Dominic N.
PY - 2009/3
Y1 - 2009/3
N2 - Purpose of review 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. Recent findings 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. Summary 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.
AB - Purpose of review 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. Recent findings 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. Summary 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.
KW - Critical illness
KW - Diabetes
KW - Glycemic control
KW - Hypocaloric feeding
KW - Nutrition support
KW - Obesity
KW - Permissive underfeeding
UR - http://www.scopus.com/inward/record.url?scp=64349097055&partnerID=8YFLogxK
U2 - 10.1097/MOG.0b013e32831ef1e4
DO - 10.1097/MOG.0b013e32831ef1e4
M3 - Article
C2 - 19528882
AN - SCOPUS:64349097055
SN - 0267-1379
VL - 25
SP - 151
EP - 154
JO - Current opinion in gastroenterology
JF - Current opinion in gastroenterology
IS - 2
ER -