---
title: "Individualized energy and protein prescription for critically ill patients with obesity"
id: "pubmed-42663498"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42663498"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42663498/"
doi: "10.1002/ncp.70174"
published_at: "2026-08-28T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Individualized energy and protein prescription for critically ill patients with obesity
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42663498
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42663498/)
- **DOI:** [10.1002/ncp.70174](https://doi.org/10.1002%2Fncp.70174)
- **Published At:** 2026-08-28T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The prevalence of **obesity** has risen, making nutritional management of critically ill patients with obesity a routine issue in intensive care rather than a niche concern. - Current and historical critical care nutrition guidelines for patients with obesity are largely based on expert opinion, show substantial divergence, and sometimes contradict one another. - No existing guideline recommendation for this population has been evaluated in a clinical trial, according to the source. - Most guideline algorithms determine energy and protein targets by using some form of body weight; this leads to a sex-based disparity in protein dose per **fat free mass (FFM)** because men and women with the same body weight typically have different FFM. - The authors propose using a **standardized body weight (SBW22)** to calculate **energy** delivery and using measured **FFM** as the reference for **protein** dosing to avoid sex and BMI-related inequities. - When **FFM** cannot be measured, the authors describe an estimation method derived from measurements in 1,420 healthy human subjects (details of the estimation method and equations were reported in the article). - Energy prescription based on **SBW22** will produce progressively lower calories per kg of actual body weight as BMI increases, resulting in hypoalimentation by calories/kg but aligning with the intended energy target across BMI. - Protein dosing based on **FFM** maintains comparable absolute protein delivery across a wide BMI range and between sexes, avoiding the under- or over-dosing that occurs when protein is prescribed per total body weight. - The authors characterize their combined approach as simple and physiological and recommend that it be tested in a clinical trial to validate safety and efficacy. - Keywords emphasized by the authors include critically ill, energy target, fat free mass, lean body mass, nutrition, obesity, and protein target.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # A proposal for individualized administration of energy and protein in the critically ill with obesity [K Georg Kreymann](https://pubmed.ncbi.nlm.nih.gov/?term=Kreymann+KG&cauthor_id=42663498)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42663498/#full-view-affiliation-1 "Department of Intensive Care Medicine, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany."), [Geraldine de Heer](https://pubmed.ncbi.nlm.nih.gov/?term=Heer+G&cauthor_id=42663498)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42663498/#full-view-affiliation-1 "Department of Intensive Care Medicine, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany."), [Arved Weimann](https://pubmed.ncbi.nlm.nih.gov/?term=Weimann+A&cauthor_id=42663498)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663498/#full-view-affiliation-2 "Department of General, Visceral and Oncological Surgery, Clinical Nutrition Unit, St. George Hospital, Leipzig, Germany.") Affiliations Expand ### Affiliations * 1 Department of Intensive Care Medicine, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany. * 2 Department of General, Visceral and Oncological Surgery, Clinical Nutrition Unit, St. George Hospital, Leipzig, Germany. * PMID: **42663498** * DOI: [ 10.1002/ncp.70174 ](https://doi.org/10.1002/ncp.70174) Item in Clipboard # A proposal for individualized administration of energy and protein in the critically ill with obesity K Georg Kreymann et al. Nutr Clin Pract. 2026. Show details Display options Display options Format Abstract PubMed PMID Nutr Clin Pract Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Nutr+Clin+Pract%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Nutr+Clin+Pract%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42663498/) . 2026 Aug 28. doi: 10.1002/ncp.70174. Online ahead of print. ### Authors [K Georg Kreymann](https://pubmed.ncbi.nlm.nih.gov/?term=Kreymann+KG&cauthor_id=42663498)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42663498/#short-view-affiliation-1 "Department of Intensive Care Medicine, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany."), [Geraldine de Heer](https://pubmed.ncbi.nlm.nih.gov/?term=Heer+G&cauthor_id=42663498)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42663498/#short-view-affiliation-1 "Department of Intensive Care Medicine, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany."), [Arved Weimann](https://pubmed.ncbi.nlm.nih.gov/?term=Weimann+A&cauthor_id=42663498)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663498/#short-view-affiliation-2 "Department of General, Visceral and Oncological Surgery, Clinical Nutrition Unit, St. George Hospital, Leipzig, Germany.") ### Affiliations * 1 Department of Intensive Care Medicine, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany. * 2 Department of General, Visceral and Oncological Surgery, Clinical Nutrition Unit, St. George Hospital, Leipzig, Germany. * PMID: **42663498** * DOI: [ 10.1002/ncp.70174 ](https://doi.org/10.1002/ncp.70174) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract The increasing prevalence of obesity has transformed intensive care and nutritional therapy of patients with obesity from a specialized problem to standard care. The dilemma in providing nutrition to critically ill patients with obesity is that current and historical nutritional guideline recommendations are based on expert opinion, are divergent, and are sometimes contradictory. None has been evaluated in a clinical trial. All but one are based on body weight, which results in a sex difference in the protein dose per fat free mass (FFM). We propose a standardized body weight (SBW22) to determine energy delivery, but to measure FFM as the reference parameter for protein administration. In case FFM cannot be measured, we describe an estimation based on measurements of 1420 healthy humans. While energy delivery based on SBW22 will result in a progressive hypoalimentation (based on calories/kg body weight) with increasing body mass index (BMI), a protein dose based on FFM will ensure an equal protein delivery over a broad range of BMI for both sexes. We propose this simple and physiological approach that should be evaluated in a clinical trial. **Keywords:** critically ill; energy target; fat free mass; human; intensive care; lean body mass; nutrition; obesity; protein target. © 2026 The Author(s). Nutrition in Clinical Practice published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Feeding the critically ill obese patient: a systematic review protocol. ](https://pubmed.ncbi.nlm.nih.gov/26571286/) Secombe P, Harley S, Chapman M, Aromataris E.Secombe P, et al.JBI Database System Rev Implement Rep. 2015 Oct;13(10):95-109. doi: 10.11124/jbisrir-2015-2458.JBI Database System Rev Implement Rep. 2015.PMID: 26571286 * [ Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. ](https://pubmed.ncbi.nlm.nih.gov/36321557/) Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P.Crider K, et al.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217.Cochrane Database Syst Rev. 2022.Update in: [Cochrane Database Syst Rev. 2026 Feb 18;2:CD014217. doi: 10.1002/14651858.CD014217.pub2.](https://pubmed.ncbi.nlm.nih.gov/41705996/)PMID: 36321557Free PMC article.Updated. * [ [Summary of the best evidence for the energy and protein intake targets and calculation in critically ill patients]. ](https://pubmed.ncbi.nlm.nih.gov/37593865/) Deng Y, Ren Y, Wang W, Sun R, Pei H, Song H.Deng Y, et al.Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Aug;35(8):849-855. doi: 10.3760/cma.j.cn121430-20230130-00043.Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023.PMID: 37593865Chinese. * [ Nutrition management of obese critically ill adults: A survey of critical care dietitians in Australia and New Zealand. ](https://pubmed.ncbi.nlm.nih.gov/32819821/) Lambell KJ, Miller EG, Tatucu-Babet OA, Peake S, Ridley EJ.Lambell KJ, et al.Aust Crit Care. 2021 Jan;34(1):3-8. doi: 10.1016/j.aucc.2020.06.005. Epub 2020 Aug 18.Aust Crit Care. 2021.PMID: 32819821 * [ Individualised energy and protein targets achieved during intensive care admission are associated with lower mortality in mechanically ventilated COVID-19 patients: The COFEED-19 study. ](https://pubmed.ncbi.nlm.nih.gov/37918128/) Melchers M, Hubertine Hermans AJ, Hulsen SB, Kehinde Kouw IW, Hubert van Zanten AR.Melchers M, et al.Clin Nutr. 2023 Dec;42(12):2486-2492. doi: 10.1016/j.clnu.2023.10.002. Epub 2023 Oct 18.Clin Nutr. 2023.PMID: 37918128 [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42663498) ## References 1. 1. CDC New CDC Data Show Adult Obesity Prevalence Remains High. 2024. 2. 1. Dickerson RN, Andromalos L, Brown JC, et al. Obesity and critical care nutrition: Current practice gaps and directions for future research. Crit Care. 2022;26(1):283. 3. 1. Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr. 2023;42(9):1671‐1689. 4. 1. Elke G, Hartl WH, Kreymann KG, et al. Clinical nutrition in critical care medicine—Guideline of the German Society for Nutritional Medicine (DGEM). Clin Nutr ESPEN. 2019;33:220‐275. 5. 1. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr. 2016;40(2):159‐211. 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