Impact of an individualized hypocaloric, high-protein enteral nutrition protocol on clinical outcomes in critically ill obese Indian patients: A pre-and post-intervention study

Abstract

Background: Current clinical nutrition guidelines for critically ill obese (CIO) patients rely on expert consensus and general ICU data, necessitating research into targeted approaches. This study evaluated the impact of an individualized hypocaloric, high-protein (HypocaloricHP) enteral nutrition (EN) protocol on clinical outcomes in CIO Indian patients. Methods: In this study, 104 mechanically ventilated CIO Indian patients (WHO-Asian Obese BMI classification) receiving EN were divided into the HypocaloricHP (n=52) and pre-implementation (n=52) groups. The HypocaloricHP protocol provided 20-25 calories/kg actual body weight (ABW) for BMI 25-29.9kg/m², 15-20 calories/kg ABW for BMI ≥30kg/m² and 1.5g protein/kg ideal body weight (IBW). The pre-implementation protocol provided 25-30 calories/kg adjusted body weight and 1.2-1.3g protein/kg IBW. Primary endpoints were mechanical ventilation (MV) days, ICU, and hospital length of stay (LOS). Secondary endpoint was in-hospital mortality. Results: The HypocaloricHP group received higher target calories and proteins. HypocaloricHP protocol significantly reduced MV days (6.8±4.3 vs. 9.5±5.4days; p=0.001), ICU LOS (9.7±3.6 vs. 15.5±8days; p=<0.001), and hospital LOS (14.9±6.6 vs. 20.4±10.8days; p=0.008). In-hospital mortality was lower in the HypocaloricHP group (13% vs. 29%; p=0.056). Conclusions: The HypocaloricHP EN protocol improved nutrition delivery and significantly reduced MV days, ICU stay, and hospital stay, with a trend toward lower in-hospital mortality in CIO Indian patients.