Nitrogen requirements in severely injured patients

Larsson, Jörgen; Lennmarken, C.; Mårtensson, Jerker; Sandstedt, S.; Vinnars, E.

doi:10.1002/bjs.1800770418

Cited by 118 publications

(39 citation statements)

References 14 publications

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“…Of the 33 studies, 10 were not isoenergetic [39,41,44,46,64,71,73,75,80,81] and additionally a further three [58,59,77] did not provide sufficient detail to ascertain this. A number of the studies also failed to assess actual intake (as distinct from prescribed intake) [54,56,57,59,61,64,74,78,80]. This is not only relevant for oral diets where intake is voluntary, but also in non-volitional feeding (enteral or parenteral) where intake may be interrupted for various reasons including tube problems, medication administration, surgical procedures, and poor tolerance of the nutrition.…”

Section: Resultsmentioning

confidence: 99%

Back to Basics: Estimating Protein Requirements for Adult Hospital Patients. A Systematic Review of Randomised Controlled Trials

Ferrie¹,

Rand²,

Palmer³

2013

FNS

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Aim: To review the supporting evidence for protein requirements in hospitalised adults, and compare the findings with commonly-used guidelines and resources. Methods: a systematic review was conducted based on a computerised bibliographic search of MEDLINE, EMBASE and CINAHL from 1950 to October 2011, as well as a citation review of relevant articles and guidelines. Studies were included if they were randomised clinical trials in hospitalised or chronically ill adults, comparing two or more different levels of protein intake. Information about study quality, setting, and findings was extracted using standardised protocols. Due to the heterogeneity of study characteristics, no meta-analysis was undertaken. Results: 116 papers were obtained in the search and 33 of these met all inclusion criteria. Five studies could not be obtained. The remainder reported outcome measures such as nitrogen balance, anthropometric measurements (including body weight, BMI, and mid-arm circumference), blood electrolyte levels and serum urea, which provide support for recommended protein intakes in various clinical conditions. The results were summarized and compared with current recommendations. Conclusion: high-level evidence to support current recommendations is lacking. The studies reviewed generally agreed with current guidelines and resources.

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Section: Resultsmentioning

confidence: 99%

Back to Basics: Estimating Protein Requirements for Adult Hospital Patients. A Systematic Review of Randomised Controlled Trials

Ferrie¹,

Rand²,

Palmer³

2013

FNS

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“…Studies in the critically ill show that provision at normal maintenance levels is associated with a marked negative N balance and that levels of approximately 0 . 25 g N/kg per d are needed to minimise net losses (Shaw et al 1987;Larsson et al 1990;Ishibashi et al 1998). Nevertheless, the same studies and others, such as those by Wolfe et al (1983), show that patients are still in net negative balance and that higher provision still does not help (Table 1).…”

Section: Nitrogen Requirements In Serious Illnessmentioning

confidence: 99%

Protein and the critically ill; do we know what to give?

Stroud

2007

Proc. Nutr. Soc.

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Excellence (NICE) has recommended that nutrition support in seriously-ill or injured patients should start at £ 50 % of the estimated target energy and protein needs. This recommendation has caused some concern, since taking the NICE approach leads to these sick individuals receiving an initial N provision of only £ 0 . 12 g N/kg per d, as opposed to levels of approximately 0 . 25 g N/kg per d that have been widely recommended by other expert groups. The basis of the recommendation for higher levels of N provision is that feeding at levels of ‡ 0 . 25 g N/kg per d reduces the inevitable net N loss of catabolism and hence minimises overall lean tissue wasting. However, although it has always been assumed that better N balance must equate with better outcome, there are teleological arguments that question the wisdom of providing more N to sicker patients and studies that imply that best N balance might not equate with best clinical progress. Furthermore, current evidence suggests that in most critical illness low initial intakes of both energy and N lead to improved survival. It therefore seems logical to aim, in the first instance, to feed the seriously ill at only modest levels. Further research is required to determine whether lowerenergy higher-N feeding would prove better or worse than this approach in terms of clinical benefit rather than just better N retention. Investigations to explore the use of feeds that are specifically designed to match the amino acid needs of illness are also required.

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“…Postoperative glucose metabolism is influenced by several factors, such as the severity of injury, body temperature, nutrients and septic complications (McManson et al 1988, Sjölin et al 1989, Larsson et al 1990, Sjölin 1993. In the present study, however, no such differences were seen between the groups.…”

Section: Figure 1 Serum Concentrations Of Igf-i In Patients Given Igfmentioning

confidence: 99%

Gastrointestinal growth factors and pancreatic islet hormones during postoperative IGF-I supplementation in man

Leinsköld

Adrian²,

Arnelo³

et al. 2000

Journal of Endocrinology

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Insulin-like growth factor-I (IGF-I) has been demonstrated to exert a nitrogen sparing effect, both experimentally and in patients after abdominal surgery. IGF-I is a major mediator for the anabolic effects of growth hormone (GH). Whether elevated circulating IGF-I levels are the sole mediator of the anabolic effects following GH has not been clarified. IGF-I influences glucose metabolism, both through its own specific receptor and by activating the insulin receptor, and has also been proposed to influence pancreatic islet secretion directly. In the present study, the postoperative effects of IGF-I on plasma levels of other gastrointestinal and pancreatic islet hormones and growth factors were measured in patients after abdominal surgery.Fifteen patients who were candidates for large bowel resection were randomly divided into two groups: IGF-Itreated (n=8) and placebo-treated (n=7). The IGF-I group received daily two s.c. injections of human recombinant IGF-I (80 µg/kg body weight) for five days, beginning on the morning of the first postoperative day. The other group received placebo injections. Fasting plasma levels of gastrointestinal growth factors (epidermal growth factor, transforming growth factor-, IGF-II), gastrointestinal hormones (gastrin, enteroglucagon, peptide YY), and islet hormones (insulin, islet amyloid polypeptide (IAPP) and pancreatic glucagon) were determined by RIA preoperatively and after five days of treatment.No significant effects of IGF-I on other growth factors or gastrointestinal hormones were seen. A marked increase in plasma insulin postoperatively compared with the preoperative levels (42 3 vs 61 5 pM, P<0·05) was seen in the placebo group, whereas the postoperative levels in the IGF-I-treated patients remained unchanged (44 3 vs 45 4 pM). A similar pattern was observed for IAPP and cortisol concentrations. No differences in glucagon concentrations were seen.In conclusion, these results suggest that IGF-I does not influence production of other gastrointestinal hormones thought to be involved in alimentary growth or pancreatic glucagon. In contrast, IGF-I caused a marked reduction of insulin and IAPP secretion. The inhibition of -cell secretion could be direct or, alternatively, could involve an improvement in postoperative insulin resistance, perhaps by reducing serum cortisol.

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Nitrogen requirements in severely injured patients

Cited by 118 publications

References 14 publications

Back to Basics: Estimating Protein Requirements for Adult Hospital Patients. A Systematic Review of Randomised Controlled Trials

Back to Basics: Estimating Protein Requirements for Adult Hospital Patients. A Systematic Review of Randomised Controlled Trials

Protein and the critically ill; do we know what to give?

Gastrointestinal growth factors and pancreatic islet hormones during postoperative IGF-I supplementation in man

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