– Bariatric surgery is the goal standard- but patients need to be carefully screened and educated. Patients also need to have a proven track record of trying to and succeeding (at least for a time) in losing weight.
– Gastric banding is now fairly rare due to complications and lack of success long term, with gastric bypass (most common) starting to gradually decline as sleeve gastrectomies increase in prevalence.
– It doesn’t really matter which diet you follow, it’s all about energy in vs energy out and whatever you can stick to for the long haul.
– In a comparison of mediterranean vs low fat vs low GI/ moderate protein vs Atkins diets- Atkins had best initial weight loss, but in the long run all had similar results. Mediterranean and Low GI diets had the best longer term adherence (over 2 years).
I attended a number of sessions on feeding in ICU, and while none gave me a definitive guide to working out protein and energy requirements, I did learn:
– Indirect calorimetry (where available) is the gold standard for working out requirements.
– It appears the gap between under- and over- feeding is a matter of only a few hundred kCal- both are detrimental to outcomes.
– Recommendations for higher protein requirements in ICU (eg ASPEN, ESPEN) are based on very limited studies, but as Susie Ferrie showed, at least appear to be safe.
– I was impressed by a paradigm-shifting way of ensuring patients get their prescribed energy and protein requirements in ICU- the PEP UP protocol from US/Canada- The dietitian calculates the daily volume required and the nurse then adjusts the rate to meet the prescribed daily volume, increasing where necessary to make up for time off feeds for tests, procedures, attempts to extubate etc. http://www.nestlehealthscience.us/fields-of-application/disease-and-condition-areas/pep-up-protocol
– Studies show that reaching at least 80% of the patient’s estimated energy and protein requirements is a reasonable goal- very few ICUs achieve this worldwide- the PEP UP protocol can help to meet this.
– The FODMAP approach is really starting to be taken seriously in Europe- It was great to see the interest in a session introducing the diet to attendees.
– Some centres are using the FODMAP approach for GORD (without accompanying IBS symptoms)- one poster showed results from a small study showing a significant subjective improvement in symptoms.