Why is feeding in excess of energy expenditure in burn patients not recommended?

• A. It may cause hyperglycemia, hepatic steatosis and prolonged ventilator dependence
• B. It increases lean body mass
• C. It reduces fat mass accumulation
• D. It has no effect on wound healing

Answer: (A)

Providing more energy than a burn patient actually needs pushes them into overfeeding, which carries several metabolic risks. In burn injuries the body is already in a hypermetabolic state with high energy demands, so excess calories—especially from carbohydrates—drive hyperglycemia as insulin cannot fully keep up with the glucose load. Hyperglycemia is linked to impaired wound healing and higher infection risk. Excess calories are also stored as fat in the liver, causing hepatic steatosis, which can compromise liver function and complicate nutrition management. Additionally, overfeeding increases carbon dioxide production; in patients on ventilation, this higher CO2 burden makes weaning more difficult and can prolong ventilator dependence. Overfeeding tends to raise fat mass rather than lean body mass and does not aid healing, which is why energy intake should meet but not exceed energy expenditure.