Considerations in Feeding Obese Patients: A Review of a Classic Article

Thirteen obese patients requiring parenteral nutrition for postoperative complications were studied prospectively to evaluate the efficacy of hypocaloric, high‐protein parenteral feeding. Nonprotein caloric intake averaged 881 kcal/d or 51.5% of the patients' measured resting energy expenditure. Protein averaged 2.13 ± 0.59 g/kg ideal body weight (IBW). Serum albumin and TIBC increased significantly (2.8 ± 0.5 g/dL to 3.2± 0.4 g/dL, p < .01 and 196 ±39 μg/dL to 248 + 49μ g/dL, p < .05, respectively), and subjects lost weight (120.0± 60.0 kg to 109.7 ±32.5 kg, p < .05). Nitrogen balance studies in 8 subjects suggested nitrogen equilibrium or positive balance can be achieved (+2.4 ± 1.9 g/dL). All patients exhibited complete tissue healing of wounds and abscess cavities and closure of fistulae. In obese, protein‐depleted surgical patients, net protein anabolism and clinical efficacy can be achieved with hypocaloric, high‐protein feeding. Abundant endogenous fat stores provide obligatory energy. (Dickerson RN, Rosato, E, Mullen JL. New protein anabolism with hypocaloric parenteral nutrition in obese stressed patients.