Attenuating Muscle Mass Loss in Critical Illness: the Role of Nutrition and Exercise

Chapple, Lee‐anne S.; Parry, Selina M.; Schaller, Stefan J.

doi:10.1007/s11914-022-00746-7

Cited by 16 publications

(13 citation statements)

References 103 publications

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“…To date, the evidence base for nutrition recommendations, particularly those including muscle wasting are limited. A recent review examining randomized controlled trials of nutrition interventions in critical illness that included an outcome of muscle mass, function, or strength found no nutrition intervention had an effect on strength or function, and the effect on muscle mass was conflicting [54]. This is likely a reflection of the complexity of nutrition as an intervention, the short-term nature of the interventions and the heterogeneity present both in the critical illness patient population and in the patient response to nutrition.…”

Section: Testing Novel Strategies With Standardised Meaningful Outcom...mentioning

confidence: 99%

Novel nutritional strategies to prevent muscle wasting

McClelland

Davies

Puthucheary

2023

Current Opinion in Critical Care

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Purpose of reviewMuscle wasting in critical illness has proven to be refractory to physical rehabilitation, and to conventional nutritional strategies. This presents one of the central challenges to critical care medicine in the 21st century. Novel strategies are needed that facilitate nutritional interventions, identify patients that will benefit and have measurable, relevant benefits.Recent findingsDrug repurposing was demonstrated to be a powerful technique in the coronavirus disease 2019 pandemic, and may have similar applications to address the metabolic derangements of critical illness. Newer biological signatures may aid the application of these techniques and the association between changes in urea:creatinine ratio and the development of skeletal muscle wasting is increasing. A core outcome set for nutrition interventions in critical illness, supported by multiple international societies, was published earlier this year should be adopted by future nutrition trials aiming to attenuate muscle wasting.SummaryThe evidence base for the lack of efficacy for conventional nutritional strategies in preventing muscle wasting in critically ill patients continues to grow. Novel strategies such as metabolic modulators, patient level biological signatures of nutritional response and standardized outcome for measurements of efficacy will be central to future research and clinical care of the critically ill patient.

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Section: Testing Novel Strategies With Standardised Meaningful Outcom...mentioning

confidence: 99%

Novel nutritional strategies to prevent muscle wasting

McClelland

Davies

Puthucheary

2023

Current Opinion in Critical Care

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“…In healthy overweight subjects, a 20% calorie restriction over 12–14 weeks led to a 3% reduction in appendicular lean body mass [ 32 ]. As muscle catabolism is accelerated during critical illness, any additional muscle loss from prolonged underfeeding may have a detrimental impact on muscle structure, function and recovery [ 33 ].…”

Section: The Clinical Relevance Of Energy Balancementioning

confidence: 99%

Indirect calorimetry: should it be part of routine care or only used in specific situations?

Rehal

Tatucu-Babet

Oosterveld

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review Indirect calorimetry is increasingly recommended to guide energy delivery in the ICU. This review aims to provide a critical overview of current literature in support of these recommendations. Recent findings There is insufficient evidence to ascertain a mortality benefit from indirect calorimetry-guided energy delivery. However, large variations in energy expenditure during critical illness pose a risk for significant under- and overfeeding if indirect calorimetry is not routinely used. Summary Even in the absence of demonstrable clinical benefits, there is a strong physiological rationale in favor of performing indirect calorimetry. Measurements can be prioritized in complex patients and should be repeated during prolonged ICU stay.

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“…This narrative review found that no nutrition intervention has shown an effect on strength and function. There was some indication that higher levels of early physical activity resulted in improved strength and function [8]. Although not included in this review, a prospectively planned sub-analysis of the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill trial – found patients had less weakness with late parental nutrition compared with early parental nutrition (absolute difference −9%, 95% confidence interval [CI] −16 to −1; P = 0·030) [10].…”

Section: Introductionmentioning

confidence: 99%

“…Two recent reviews summarized the literature within the acute (defined as within ICU for the purpose of this review) [8]; and sub-acute period of critical illness (defined as post-ICU for the purpose of this review) [9]. Within the acute period, the first review presented the evidence for physical activity and nutrition in attenuating muscle loss or improving strength and function – across varied ICU patient cohort although most required mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

Physical therapy and nutrition therapy: synergistic, antagonistic, or independent interventions?

Haines

Emery

Berney

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewPhysical therapy and nutrition therapy have predominantly been studied separately in the critically ill, however in clinical practice are often delivered in combination. It is important to understand how these interventions interact. This review will summarize the current science – where they are potentially synergistic, antagonistic, or independent interventions.Recent findingsOnly six studies were identified within the ICU setting that combined physical therapy and nutrition therapy. The majority of these were randomized controlled trials with modest sample sizes. There was an indication of benefit in the preservation of femoral muscle mass and short-term physical quality of life - particularly with high-protein delivery and resistance exercise, in patients who were predominantly mechanically ventilated patients, with an ICU length of stay of approximately 4–7 days (varied across studies). Although these benefits did not extend to other outcomes such as reduced length of ventilation, ICU or hospital admission. No recent trials were identified that combined physical therapy and nutrition therapy in post-ICU settings and is an area that warrants investigation.SummaryThe combination of physical therapy and nutrition therapy might be synergistic when evaluated within the ICU setting. However, more careful work is required to understand the physiological challenges in the delivery of these interventions. Combining these interventions in post-ICU settings is currently under-investigated, but may be important to understand any potential benefits to patient longitudinal recovery.

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Attenuating Muscle Mass Loss in Critical Illness: the Role of Nutrition and Exercise

Cited by 16 publications

References 103 publications

Novel nutritional strategies to prevent muscle wasting

Novel nutritional strategies to prevent muscle wasting

Indirect calorimetry: should it be part of routine care or only used in specific situations?

Physical therapy and nutrition therapy: synergistic, antagonistic, or independent interventions?

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