Ernährung adipöser kritisch kranker Intensivpatienten unter besonderer Beachtung der Proteindosierung

Zusammenfassung

Die Ernährung adipöser Intensivpatienten ist nach wie vor ein kontrovers diskutiertes Thema. Selbst die neuesten Leitlinien geben widersprüchliche, zum Teil auf unphysiologischen Annahmen basierende Empfehlungen. Wenn auch die meisten ein hypokalorisches Ernährungskonzept mit viel Protein befürworten, so findet sich dennoch keine Übereinstimmung, was das Ausmaß der Energiereduktion und die Proteindosierung betrifft. Wir setzen dem ein einfaches Konzept einer progressiven Hypoalimentation entgegen, das auf einer Definition des Normgewichts beruht, sowie einer Proteinzufuhr, die auf einer Schätzung der Körpermagermasse basiert. Ein Vergleich mit den herkömmlichen Vorgehensweisen belegt den physiologischeren Ansatz dieser neuen Empfehlung.

Abstract

Nutrition for obese critically ill patients is still a controversial discussion. Latest guidelines give contradictory and partially unphysiological recommendations. Even if they agree on a hypocaloric, high protein feeding regimens, there is no agreement on the exact amount of energy and protein that should be provided for the obese patients. We describe a new concept of hypoalimentation which is based on the definition of lean body weight as well as protein dosing which is based on an estimation of the lean body mass. A comparison with traditional recommendation reveals the physiologic advantages of this new approach.

Schlüsselwörter

Adipositas - enterale Ernährung - parenterale Ernährung - Körperzusammensetzung - Körpermagermasse

Keywords

obesity - enteral nutrition - parenteral nutrition - body composition - lean body mass

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