低熱量高營養密度配方對長期依賴呼吸器體重過重病人營養狀況之影響：A Pilot Study

Effects of High Nutrient Density Hypocaloric Formula on Nutritional Status in Long Term Ventilator-Dependent Overweight Patients: A Pilot Study

長期使用呼吸器之體位過重患者常不利於臨床照護與疾病治療。歐洲腸道靜脈營養協會提出對於非急症期之肥胖患者，建議提供熱量20～25 kcal/kg actual weight（wt.）/day，美國腸道靜脈營養協會則是建議熱量為11～14 kcal/kg actual wt./day。本研究針對長期使用呼吸器之體重過重患者，給予低熱量、高蛋白質高營養密度均衡配方，觀察是否能在維持營養狀況下，降低患者體重。呼吸照護病房入院超過1 年且身體質量指數（body mass index, BMI） 24 kg/m2 之患者，排除腎衰竭及水腫後，給予高蛋白質高營養密度均衡配方16.2 ± 2.6 kcal/kg actual wt.（蛋白質:脂肪：醣類= 24%: 23%: 53%）並監測四個月，每月測量體重及檢測營養相關生化值。經4個月前後測，BMI 由26.4 ± 3.4 kg/m2 顯著降至25.2 ± 2.7 kg/m2，白蛋白則在四個月內由3.39 ±0.46 g/dl 顯著提升至3.59 ± 0.45 g/dl，總蛋白在介入後亦顯著提升，其他生化值包括白血球、血色素、血中尿素氮、肌酸酐、鈉及鉀皆在正常範圍內。因此，對於長期使用呼吸器之體重過重病人，若經過營養師正確調配高蛋白質高營養密度均衡配方，給予低熱量攝取不僅可降低患者體重，並維持營養狀況。

Clinical care and enteral feeding of long-term ventilator-dependent overweight patients are difficult. The caloric recommendation for non-critically ill patients is 20～25 kcal/kg actual weight（wt.）/day as suggested by the European Society for Parenteral and Enteral Nutrition. The Society of Critical Care Medicine/American Society for Parenteral and Enteral Nutrition suggests a caloric intake of 11～14 kcal/kg actual wt. /day. This study evaluated whether a hypocaloric, nutrient-complete, highprotein formula can induce weight loss but maintain the nutritional status in long-term ventilator-dependent overweight patients. Patients who had stayed in a respiratory care unit for over a year and had a body mass index（BMI）of 24 kg/m2 were enrolled. Exclusion criteria included patients with poor kidney function and edema. Patients in the cohort were given a modulated, nutrient-complete, high-protein formula with 16.2 ± 2.6 kcal/kg actual wt.（protein: fat: carbohydrate of 24%: 23%: 53%）for 4 months. They were checked monthly for weight and nutrition-related biochemical data. In a comparison of 4-months pre- and post-intervention results, patients' BMI values significantly dropped from 26.4 ±3.4 to 25.2 ± 2.7 kg/m2. Albumin significantly increased from 3.39 ± 0.46 to 3.59 ± 0.45 g/dl in 4 months. Total protein also significantly increased after the intervention. Other biochemical data such as white blood cells, hemoglobin, blood urea nitrogen, creatinine, sodium, and potassium were all maintained within a normal range. In conclusion, a hypocaloric, nutrient-complete, high-protein formula selected by dietitians can induce weight loss while maintaining the nutritional status in long-term ventilator-dependent overweight patients.