As obesity among critically ill patients continues to rise, a new report suggests that hospitals modify nutrition management in the intensive care unit to reduce comorbidities and improve outcomes.

"Nutrition Therapy of the Severely Obese, Critically Ill Patient: Summation of Conclusions and Recommendations" — a consensus report from clinical experts in critical care, obesity and research — appears as a supplement to September's Journal of Parenteral and Enteral Nutrition. According to the report, "Hospitalized obese patients suffer greater morbidity with increased infection, hospital and ICU length of stay, organ failure and duration of mechanical ventilation."

Juan Ochoa, M.D., co-author and medical and scientific director at Nestle HealthCare Nutrition, Florham Park, N.J., which sponsored the report, says, "The obesity epidemic has changed clinical practice everywhere and that's especially palpable in the ICU. There's a paucity of information about what to do with these patients from a nutritional point of view."

He contends that standardized nutrition therapy can reduce the risk of infections, as well as length of stay.

Acknowledging the heterogeneity of obese patients, the report recommends "a high-protein, hypocaloric regimen" to reduce fat mass, improve insulin sensitivity and preserve lean body mass.

Lead author Stephen A. McClave, M.D., professor of medicine, University of Louisville, says new guidelines suggest that clinicians add nutrients that better stimulate the immune system, including arginine, glutamine, fish oil, zinc and magnesium.

To assess tolerance and ensure adequacy of therapy, obese ICU patients should be monitored throughout the nutrition regimen, according to the report.

Christine Gerbstadt, M.D., a spokesperson for the American Dietetic Association, Chicago, questions the efficacy of high-protein, hypocaloric diets. She says metabolic demands of a critically ill patient cannot be met by a "protein modified fast."