And considering that at least twenty-five percent of the critically ill patients have obesity, in your experience, what is the impact in the ICU of not starting these folks on nutrition support?

Thank you for the question, Peggy.

I think this really connects directly to what Colleen and Michelle just described.

One of the biggest problems is the assumption that a patient's adipose tissue protects them from the consequences of inadequate nutrition.

It may provide stored energy, but it's not going to provide the amino acids needed to preserve skeletal muscle, support immune function, promote wound healing, and facilitate recovery for our critically ill patients.

Critical illness is especially catabolic, so patients can lose muscle very quickly, even while their weight and BMI remain high.

Since this loss may be less visible in patients with obesity, malnutrition and sarcopenia can be overlooked.

Angela, for the average critically ill patient who is obese, what are their nutrient needs for PN in terms of energy, protein, and other PN nutrients?