Protein Requirements in Illness: Considerations for Acute Care Nurse Practitioners

• The application of standardized, disease-based protein recommendations to any acutely ill patient is problematic, but even less is known about people who are obese.
• Evaluating energy requirements based on ideal body weight or adjusted body weight may not be appropriate for use in the determination of protein needs of patients who are obese.
• In people who were obese, the estimated protein needs were significantly higher than measured protein needs.
• In patients who were obese, the measured protein needs were neither significantly associated with actual body weight nor with estimated body weight.

This retrospective chart review (N = 150) examined weight, height, urinary urea nitrogen, and feeding method in acutely ill adults. Using 2 evidence-based approaches, estimated protein needs were compared with laboratory-measured protein requirements. Comparisons were significantly associated for normal weight patients (r = 0.21, P = .03) but not for patients who were obese (r = 0.10, P = .49), showing that the use of body weight and standard formulas to calculate protein needs may not be appropriate for individuals who are obese. Considerations for individual patients should be considered. More research is needed to determine how to accurately estimate protein during acute illness in patients who are obese.