Does Hypocaloric feeding impact the outcome of critically Ill with increased BMI?


Obesity represents a daunting problem for critical care providers, both in the increasing volume of patients with this condition and in the complexity of issues faced. In modern critical care, the paradigm of ‘’therapeutic nutrition” is replacing ‘’traditional support’’ in nutrition and outcome research in obese critically ill patients suggests a link between hypocaloric feeding and mortality. This study aims to investigate the relationship between hypocaloric feeding and early weaning and mortality of critically ill patient with increased BMI.


A prospective observational study was conducted in a multicentric critical care unit (CCU) in a tertiary care hospital from January to December 2014. The sample was limited to patient who remind in CCU at least 3 days on enteral feeding. Data including demographics, body mass index (BMI) >25, baseline nutritional status using subjective global assessment (SGA), severity of illness (ie, Acute Physiology and Chronic Health Evaluation (APACHE II) score), nutrition delivery, and outcomes were recorded. Statistical analysis using fisher’s exact test, chi square test, and Pearson correlation were performed using SPSS 11.0 version.


Out of 136 patients, comprising of 70.5% males and 29.5% females, aged 57.6±14.8 were classified as 53% overweight, 44% obese, and 3% morbidly obese according to BMI. On admission, the mean Glasgow Coma Scale and APACHE II score were 9±4.943, 22±8.46 respectively. Medical diagnostic classification revealed 29% had respiratory failure, 9% renal, 10% cardiac, 10% sepsis, 5% sleep apnea and 37% others. The mean energy and protein delivered was 1223±273 and 50.5±13.42 respectively, derived a positive correlation with average CCU (10.5±7.52) and hospital length of stay (16.9±11.85), which was statistically significant (p < 0.005). Average nutrition delivery had a strong positive correlation with length of mechanical ventilation (p<0.05), stating the impact of hypocaloric feeding on early weaning process.


These data suggest that hypocaloric regimens can be considered specific to obese critically-ill patients, although the complications related to co morbidities in these patients may require other therapeutic possibilities to be considered, with specific nutrients.