This review has been developed following a panel discussion with an international group of experts in the care of patients with obesity in the critical care setting and focuses on current best practices in malnutrition screening and assessment, estimation of energy needs for patients with obesity, the risks and management of sarcopenic obesity, the value of tailored nutrition recommendations, and the emerging role of immunonutrition. Patients admitted to the intensive care unit (ICU) increasingly present with overweight and obesity that require individualized nutrition considerations due to underlying comorbidities, immunological factors such as inflammation, and changes in energy expenditure and other aspects of metabolism. While research continues to accumulate, important knowledge gaps persist in recognizing and managing the complex nutritional needs in ICU patients with obesity. Available malnutrition screening and assessment tools are limited in patients with obesity due to a lack of validation and heterogeneous factors impacting nutrition status in this population. Estimations of energy and protein demands are also complex in patients with obesity and may include estimations based upon ideal, actual, or adjusted body weight. Evidence is still sparse on the role of immunonutrition in patients with obesity, but the presence of inflammation that impacts immune function may suggest a role for these nutrients in hemodynamically stable ICU patients. Educational efforts are needed for all clinicians who care for complex cases of critically ill patients with obesity, with a focus on strategies for optimal nutrition and the consideration of issues such as weight stigma and bias impacting the delivery of care. Current nutritional strategies for these patients should be undertaken with a focus on individualized care that considers the whole person, including the possibility of preexisting comorbidities, altered metabolism, and chronic stigma, which may impact the provision of nutritional care. Additional research should focus on the applicability of current guidelines and evidence for nutrition therapy in populations with obesity, especially in the setting of critical illness.

中文翻译：

---

肥胖和重症监护营养：当前的实践差距和未来研究的方向

这篇综述是在与重症监护环境下肥胖患者护理的国际专家组进行小组讨论后制定的，重点关注当前营养不良筛查和评估的最佳实践、肥胖患者能量需求的估计、风险和管理肌肉减少性肥胖，量身定制的营养建议的价值，以及免疫营养的新兴作用。入住重症监护病房 (ICU) 的患者越来越多地出现超重和肥胖，由于潜在的合并症、炎症等免疫因素以及能量消耗和新陈代谢的其他方面的变化，需要考虑个体化的营养。在研究不断积累的同时，在识别和管理 ICU 肥胖患者的复杂营养需求方面，仍然存在重要的知识缺口。由于缺乏验证和影响该人群营养状况的异质因素，可用的营养不良筛查和评估工具在肥胖患者中是有限的。对肥胖患者的能量和蛋白质需求的估计也很复杂，可能包括基于理想、实际或调整体重的估计。关于免疫营养在肥胖患者中的作用的证据仍然很少，但影响免疫功能的炎症的存在可能表明这些营养在血液动力学稳定的 ICU 患者中发挥作用。需要对所有照顾肥胖重症患者复杂病例的临床医生进行教育工作，重点是最佳营养策略，并考虑影响护理提供的体重耻辱和偏见等问题。目前针对这些患者的营养策略应侧重于考虑整个人的个体化护理，包括可能会影响营养护理提供的既往合并症、代谢改变和慢性耻辱的可能性。其他研究应侧重于当前营养治疗指南和证据在肥胖人群中的适用性，尤其是在危重疾病的情况下。包括先前存在的合并症、新陈代谢改变和慢性耻辱的可能性，这可能会影响营养护理的提供。其他研究应侧重于当前营养治疗指南和证据在肥胖人群中的适用性，尤其是在危重疾病的情况下。包括先前存在的合并症、新陈代谢改变和慢性耻辱的可能性，这可能会影响营养护理的提供。其他研究应侧重于当前营养治疗指南和证据在肥胖人群中的适用性，尤其是在危重疾病的情况下。