Can Hypocaloric, High-Protein Nutrition Support Be Used in Complicated Bariatric Patients to Promote Weight Loss?
Bariatric surgery, an effective treatment for morbid obesity, may result in complications that require nutrition support. Common goals for nutrition support in post-bariatric surgery patients include nutrition repletion, avoiding overfeeding, preserving lean body mass, and promoting wound healing. It is often questioned if continued weight loss can be part of the nutrition goals and if weight loss is safe for patients who become critically ill following bariatric surgery. Recent clinical practice guidelines from both the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and Society of Critical Care Medicine (SCCM) have recommended the use of hypocaloric, high-protein nutrition support in both critically and non-critically ill obese patients. Hypocaloric feedings of 50%-70% of estimated energy requirements based on predictive equations or <14 kcal/kg actual body weight, as well as high-protein feedings of 1.2 g/kg actual weight or 2-2.5 g/kg ideal body weight, are suggested by A.S.P.E.N. in the 2013 clinical guidelines for nutrition support of hospitalized adult patients with obesity. Two small studies in complicated post-bariatric surgery patients requiring nutrition support have shown that the strategy of hypocaloric, high-protein feedings can result in positive outcomes, including positive nitrogen balance, wound healing, weight loss, and successful transition to oral diets. Additional research, including large, randomized studies, is still needed to validate these findings. However, based on a review of available clinical practice guidelines, predictive equations, indirect calorimetry, case studies, and systematic reviews, hypocaloric, high-protein nutrition support appears to at least be equal to eucaloric feedings and may be a useful tool for clinicians to achieve continued weight loss in complicated bariatric surgery patients requiring nutrition support.
['Beebe|Mara Lee|ML|', 'Crowley|Nina|N|']
D000328:Adult D050110:Bariatric Surgery D031204:Caloric Restriction D016638:Critical Illness D004044:Dietary Proteins D006801:Humans D009751:Nutritional Requirements D018529:Nutritional Support D009767:Obesity, Morbid D011183:Postoperative Complications D016896:Treatment Outcome D015431:Weight Loss
nutrition nutritional support bariatric surgery obesity enteral nutrition energy intake nutrition assessment nutrition support practice parenteral nutrition research and diseases