Michelle, can you share some of the negative consequences to these patients with obesity who may also have undetected malnutrition?

Yeah.

Specifically, I think lack of nutrition therapy can be detrimental to clinical outcomes, specifically because these patients have higher protein turnover and a greater rate of catabolism than patients without obesity.

So this makes nutrition really important to support things like wound healing, functional status, and even survival.

So if we're delaying nutrition therapy, enteral or parenteral nutrition, these are the outcomes that would be impacted most.

So I wanna talk a little about undetected malnutrition and the importance of using a validated tool such as the ASPEN and Academy Indicators for Malnutrition or the Global Leadership Initiative on Malnutrition, uh, or GLIM.

Both of these tools or frameworks incorporate the evaluation of intake and weight history, but also a nutrition-focused physical exam.

Michelle, for those patients with obesity and critical illness, what would be their indications for PN, and when would you start this therapy?