Hypocaloric Enteral Tube Feeding in Critically Ill Obese Patients

Objective: We respectively compared the nutritional and clinical efficacies of eucaloric and hypocaloric enteral feedings in 40 critically ill, obese patients admitted to the trauma or surgical intensive care unit.

Methods: Adult patients, 18 to 69 years old, with weights greater than 125% of ideal body weight, normal renal and hepatic functions, and who received at least 7 d of enteral tube feeding were studied. Patients were stratified according to feeding group: eucaloric feeding (>or=20 kcal/kg of adjusted weight per day; n = 12) or hypocaloric feeding (<20 kcal/kg of adjusted weight per day; n = 28). The goal protein intake for both groups was approximately 2 g/kg of ideal body weight per day. Clinical events and nutrition data were recorded for 4 wk.

Results: Patients were similar according to sex, age, weight, body mass index, Second Acute Physiology and Chronic Health Evaluation score, Trauma score, and Injury Severity Score. The hypocaloric feeding group received significantly fewer calories than the eucaloric group (P<or= 0.05). The hypocaloric group had a shorter stay in the intensive care unit (18.6 +/- 9.9 d versus 28.5 +/- 16.1 d, P < 0.03), decreased duration of antibiotic therapy days (16.6 +/- 11.7 d versus 27.4 +/- 17.3 d, P < 0.03), and a trend toward a decrease in days of mechanical ventilation (15.9 +/- 10.8 d versus 23.7 +/- 16.6 d, P = 0.09). There was no statistically significant difference in nitrogen balance or serum prealbumin response between groups.

Conclusion: These data suggest that hypocaloric enteral nutrition support is as least as effective as eucaloric feeding in critically ill, obese patients.