An update on essential micronutrients in critical illness

Berger, Mette M.

doi:10.1097/mcc.0000000000001062

Cited by 6 publications

(2 citation statements)

References 100 publications

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“…Moreover, the recent shift in feeding guidelines toward more restrictive feeding in the acute phase may contribute to development of micronutrient deficiencies. Micronutrients are crucial for vital functions such as ATP production, antioxidant and immune defenses, gene transcription and as cofactors for numerous enzymes [54]. Symptoms of micronutrient deficiencies are unspecific and resemble those of critical illness [55].…”

Section: Micronutrient Administration In Critical Illnessmentioning

confidence: 99%

Nutrition in the intensive care unit: from the acute phase to beyond

de Man,

Gunst,

Reintam Blaser

2024

Intensive Care Med

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Recent randomized controlled trials (RCTs) have shown no benefit but dose-dependent harm by early full nutritional support in critically ill patients. Lack of benefit may be explained by anabolic resistance, suppression of cellular repair processes, and aggravation of hyperglycemia and insulin needs. Also early high amino acid doses did not provide benefit, but instead associated with harm in patients with organ dysfunctions. However, most studies focused on nutritional interventions initiated during the first days after intensive care unit admission. Although the intervention window of some RCTs extended into the post-acute phase of critical illness, no large RCTs studied nutritional interventions initiated beyond the first week. Hence, clear evidence-based guidance on when and how to initiate and advance nutrition is lacking. Prolonged underfeeding will come at a price as there is no validated metabolic monitor that indicates readiness for medical nutrition therapy, and an adequate response to nutrition, which likely varies between patients. Also micronutrient status cannot be assessed reliably, as inflammation can cause redistribution, so that plasma micronutrient concentrations are not necessarily reflective of total body stores. Moreover, high doses of individual micronutrients have not proven beneficial. Accordingly, current evidence provides clear guidance on which nutritional strategies to avoid, but the ideal nutritional regimen for individual patients remains unclear. In this narrative review, we summarize the findings of recent studies, discuss possible mechanisms explaining the results, point out pitfalls in interpretation of RCTs and their effect on clinical practice, and formulate suggestions for future research.

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Section: Micronutrient Administration In Critical Illnessmentioning

confidence: 99%

Nutrition in the intensive care unit: from the acute phase to beyond

de Man,

Gunst,

Reintam Blaser

2024

Intensive Care Med

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“…Numerous experimental [201][202][203] and clinical studies have shown an association between low serum zinc concentration and critical illness [204][205][206]. During critical illness, plasma zinc value concentrations decrease rapidly due to a combination of deregulated intakes [206], excretion [207], and zinc redistribution into the cellular compartment [208].…”

Section: Plasma Concentrations In Critical Illness Sepsis and Covid-19mentioning

confidence: 99%

The Anti-Oxidative, Anti-Inflammatory, Anti-Apoptotic, and Anti-Necroptotic Role of Zinc in COVID-19 and Sepsis

Briassoulis,

Ilia

et al. 2023

Antioxidants

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Zinc is a structural component of proteins, functions as a catalytic co-factor in DNA synthesis and transcription of hundreds of enzymes, and has a regulatory role in protein–DNA interactions of zinc-finger proteins. For many years, zinc has been acknowledged for its anti-oxidative and anti-inflammatory functions. Furthermore, zinc is a potent inhibitor of caspases-3, -7, and -8, modulating the caspase-controlled apoptosis and necroptosis. In recent years, the immunomodulatory role of zinc in sepsis and COVID-19 has been investigated. Both sepsis and COVID-19 are related to various regulated cell death (RCD) pathways, including apoptosis and necroptosis. Lack of zinc may have a negative effect on many immune functions, such as oxidative burst, cytokine production, chemotaxis, degranulation, phagocytosis, and RCD. While plasma zinc concentrations decline swiftly during both sepsis and COVID-19, this reduction is primarily attributed to a redistribution process associated with the inflammatory response. In this response, hepatic metallothionein production increases in reaction to cytokine release, which is linked to inflammation, and this protein effectively captures and stores zinc in the liver. Multiple regulatory mechanisms come into play, influencing the uptake of zinc, the binding of zinc to blood albumin and red blood cells, as well as the buffering and modulation of cytosolic zinc levels. Decreased zinc levels are associated with increasing severity of organ dysfunction, prolonged hospital stay and increased mortality in septic and COVID-19 patients. Results of recent studies focusing on these topics are summarized and discussed in this narrative review. Existing evidence currently does not support pharmacological zinc supplementation in patients with sepsis or COVID-19. Complementation and repletion should follow current guidelines for micronutrients in critically ill patients. Further research investigating the pharmacological mechanism of zinc in programmed cell death caused by invasive infections and its therapeutic potential in sepsis and COVID-19 could be worthwhile.

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New randomized controlled trials on micronutrients in critical care nutrition: A narrative review

Halim,

Huang,

Lee

et al. 2024

Nut in Clin Prac

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There has been increasing interest in the role of micronutrient supplementation in critical care. This narrative review summarizes the recent studies on micronutrients in critically ill patients. We searched two databases for primary randomized controlled trials that investigated the effects of micronutrient supplementation in patients with critical illness published from January 2021 to August 2023. Personal files, reference lists of included studies, and previous reviews were also screened. Twelve studies reported on vitamin C, four studies on vitamin D, three studies on thiamin, two studies on multivitamins, and one study on cobalamin. The therapeutic effects of vitamin C appear mixed, although vitamin C monotherapy appears more promising than vitamin C combination therapy. Intramuscular administration of vitamin D appeared to lower mortality, mechanical ventilation duration, and intensive care unit stay, whereas enteral administration showed limited clinical benefits. Intravenous thiamin was not associated with improved outcomes in patients with septic shock or hypophosphatemia. Preliminary evidence suggests reduced vasopressor dose with cobalamin. Decreased disease severity and hospital stay in patients with COVID‐19 with vitamins A–E requires further investigation, whereas providing solely B‐group vitamins did not demonstrate therapeutic effects. It is currently premature to endorse the provision of high‐dose micronutrients in critical illness to improve clinical outcomes. This review may help to inform the design of future trials that will help better elucidate the optimal dosage and form of micronutrients, methods of administration, and subgroups of patients with critical illness who may most benefit.

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An update on essential micronutrients in critical illness

Cited by 6 publications

References 100 publications

Nutrition in the intensive care unit: from the acute phase to beyond

Nutrition in the intensive care unit: from the acute phase to beyond

The Anti-Oxidative, Anti-Inflammatory, Anti-Apoptotic, and Anti-Necroptotic Role of Zinc in COVID-19 and Sepsis

New randomized controlled trials on micronutrients in critical care nutrition: A narrative review

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