From the Guidelines
Daily Caloric Requirement for Polymorbid Patients
The daily caloric requirement for a polymorbid patient should be approximately 27 kcal/kg actual body weight/day for older patients (aged ≥65 years) and 30 kcal/kg actual body weight/day for severely underweight patients, considering the patient's individual needs and risk factors, such as refeeding syndrome 1.
Estimating Energy Requirements
- Energy requirements can be estimated using indirect calorimetry (IC), a published prediction equation, or a weight-based formula, although the accuracy of prediction equations in this population is low 1.
- In the absence of IC, total energy expenditure (TEE) for older polymorbid patients can be estimated at approximately 27 kcal/kg actual body weight/day, with resting energy expenditure (REE) estimated at 18-20 kcal/kg actual body weight/day and adjusted for activity or stress factors 1.
- For severely underweight patients, REE can be estimated at 30 kcal/kg actual body weight/day, but this target should be achieved cautiously and slowly due to the high risk of refeeding syndrome 1.
Protein and Micronutrient Targets
- Polymorbid medical inpatients requiring nutritional support should receive 1.1-1.5 g protein/kg body weight per day to prevent body weight loss, reduce complications, and improve functional outcome and quality of life 1.
- In patients with impaired kidney function (eGFR <30 ml/min/1.73m²), a low amount of protein (0.8 g protein/kg body weight/day) should be targeted 1.
- An adequate intake of micronutrients (vitamins and trace elements) should be ensured to meet daily estimated requirements 1.
Considerations for Cholesterol and Fat Targets
- While the provided evidence does not specifically address cholesterol and fat targets, it is essential to consider the patient's individual needs and risk factors, such as cardiovascular disease, when determining their nutritional requirements 1.
- A balanced diet that meets the patient's energy, protein, and micronutrient needs while minimizing excessive cholesterol and fat intake is crucial for optimal nutritional support 1.
From the Research
Daily Caloric Requirements for Polymorbid Patients
The daily caloric requirements for polymorbid patients are not explicitly stated in the provided studies. However, the following points can be considered:
- The Harris-Benedict equation is commonly used to estimate caloric needs, but its accuracy may not be optimal in all patients, particularly acutely ill obese patients 2.
- A patient's caloric intake should be slightly less than calculated needs to avoid the metabolic risks of overfeeding 2.
- The ESPEN guidelines on nutritional support for polymorbid internal medicine patients provide recommendations on energy and protein requirements, but do not specify a daily caloric target 3, 4.
- For critically ill obese patients, a hypo-caloric, high-protein regimen is recommended, with 60-70% of caloric requirements provided to promote steady weight loss and mitigate lean muscle mass loss 5.
Considerations for Cholesterol and Fat Targets
The provided studies do not specifically address cholesterol and fat targets for polymorbid patients. However, the following points can be considered:
- Malnutrition, including protein-calorie malnutrition, can affect patients of any medical discipline and is managed most efficiently by an interdisciplinary and multiprofessional nutrition team 6.
- The provision of adequate nutrition, including protein and calories, is an integral component of supportive care for critically ill patients, including those with obesity 5.
- The optimal route of delivery, target dose, and macronutrient components of nutritional support are still debated, but enteral nutrition is preferred due to its association with maintenance of gut integrity, reduction in bacterial translocation and infection rates, and modulation of systemic immune responses 5.
Key Points to Consider
- Polymorbid patients are at risk of malnutrition, which can contribute to hospital morbidity, mortality, costs, and readmissions 2, 3, 4, 6.
- Early screening for malnutrition risk and individualized nutritional support interventions are essential for improving outcomes in polymorbid patients 2, 3, 4, 6.
- The optimal nutritional strategy for polymorbid patients, including daily caloric requirements and cholesterol and fat targets, requires further research and consideration of individual patient needs 3, 4, 5.