Clinical Nutrition Approaches to Medical Management of Children with Obesity and Critical Illnesses

Context: Childhood obesity is a serious health problem worldwide and the number of critically ill obese children is rapidly increasing in Pediatric Intensive Care Units (PICUs). Given the importance of optimal energy and nutrient delivery that may lead to improved clinical outcomes in PICUs, we addressed the nutrition support aspects of managing critically ill obese children in PICUs. Evidence Acquisition: This review was conducted on the National Library of Medicine’s PubMed, Scopus, Cochrane, and Embase databases using a combination of relevant MeSH terms and keywords to provide updates on the nutritional management of obese patients in PICUs. The MeSH terms included “Child”, “Pediatrics”, “Infants”, “Obesity”, “Morbid Obesity”, “Obesity Management”, “Complications”, “Nutrition Assessment”, “Diet Therapy”, and “Intensive Care Units”. The keywords were as followed: critical care, critical illness, intensive care enteral and parenteral nutrition, morbidity, and mortality. The reference lists of the relevant articles were also reviewed to ensure adequate study identification. Thereafter, 348 records were identified and screened for eligibility in the title and abstract and duplicate publications were removed. Finally, after assessment for eligibility, 42 relevant articles published in English from 1990 to 2018 were obtained and read thoroughly in the reviewing process. Results: Obese children are at a high risk of nutritional deprivation in PICUs. Obesity, metabolic stress, and inflammation can affect the metabolism of nutrients in critically ill obese children. Screening for potential micronutrient deficiencies, optimal isocaloric feeding with adequate macronutrients, and micronutrients should be considered in critically ill obese children. Conclusions: This review provided recent evidence to help intensivists for initial nutrition assessment and realistic nutrition care planning for critically ill obese children.