Overfeeding

OVERVIEW

• In the 1980s, the concept of parenteral hyperalimentation or hypercaloric feeding was dominant.
• this was stopped due to the sequelae, which limit attempts to rapidly correct malnutrition
• some early studies suggesting harm from early feeding were actually showing the effects of overfeeding

RISK FACTORS FOR OVERFEEDING

• extremes of size (e.g. very small, or very large) are susceptible
• non-protein calories are not included (e.g. glucose in IV fluids, lipid in propofol)
• errors in height or weight measurements /estimates or calculations
• failure to account for clinical state (e.g. decreased energy needs from sedation and mechanical ventilation)
• use of parenteral nutrition

EFFECTS

• hyperglycemia: osmotic diuresis, infection, hypertonic dehydration
• hyperlipidemia: hyperviscosity, immunosuppression, infections, pancreatitis, steatohepatitis, fat overload syndrome
• hypercapnia: respiratory acidosis, tachycardia, tachypnea, prolonged weaning from ventilator
• liver dysfunction, abnormal LFTs (cholestasis, transaminitis), steatohepatitis
• refeeding syndrome

References and Links

• Griffiths RD. Too much of a good thing: the curse of overfeeding. Crit Care. 2007;11(6):176. PMC2246202.
• Klein CJ, Stanek GS, Wiles CE 3rd. Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc. 1998 Jul;98(7):795-806. PMID: 9664922.
• Schulman RC, Mechanick JI. Can nutrition support interfere with recovery from acute critical illness? World Rev Nutr Diet. 2013;105:69-81. PMID: 23075588.