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The management of short-term intestinal failure in obese patients*

Published online by Cambridge University Press:  07 March 2007

Jeremy Powell-Tuck
Jeremy Powell-Tuck*
Affiliation:
St Bartholomew's and the Royal London Hospital Medical College, Queen Mary University of London, Turner Street, London E1 2AD, UK
*
Corresponding author: Professor Jeremy Powell-Tuck, fax +44 020 7375 2103, email [email protected]
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Abstract

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The prevalence of obesity in the general population is high and it is inevitable that artificial feeding will be needed from time to time in the obese patient, particularly in the critical care setting. Against a background of generous endogenous stores of energy as adipose tissue and the ability of obese individuals to survive starvation longer than non-obese individuals, emphasis is placed on preserving lean body mass and optimizing physiological function. Insulin resistance is typical of the obese individual and is exacerbated by stress; overfeeding is dangerous, particularly if it results in hyperglycaemia. Refeeding syndrome also has to be avoided. Weight may be difficult to measure and lean body mass difficult to assess. Calculation of energy requirements is therefore problematic in practice in the obese individual and there is substantial evidence from controlled clinical trials of the safety of feeding at or below resting energy expenditure. If this approach is taken it is wise to provide a more generous than normal protein intake and to beware of patients with a very high baseline urinary N excretion.

Keywords

ObesityNutritional supportIntestinal failureCritical illness
Type
BAPEN Symposium 1: Malnutrition in obesity
Information
Proceedings of the Nutrition Society , Volume 64 , Issue 2 , May 2005 , pp. 263 - 267
Copyright
Copyright © The Nutrition Society 2005

Footnotes

*

Others papers presented at this meeting have been published in Proceedings of the Nutrition Society (2004), 63.

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