Protein Requirements in the Critically Ill

Ferrie, Suzie; Allman‐Farinelli, Margaret; Daley, Mark; Smith, Kristine A.

doi:10.1177/0148607115618449

Cited by 202 publications

(107 citation statements)

References 31 publications

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“…For protein goals, the requirements were determined at 1.2–1.5 g/kg/d, corrected for underweight or overweight (BMI <18.5 to BMI = 20 and BMI >30 to BMI = 27.5). 22 , 23 Energy and protein intakes were calculated as a percentage of requirements. If deemed necessary by the dietitian, additional sip and/or tube feeding was started.…”

Section: Methodsmentioning

confidence: 99%

Handgrip Strength Is Associated With Treatment Modifications During Neoadjuvant Chemoradiation in Patients With Esophageal Cancer

et al. 2017

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Rationale: It has been shown that early nutrition intervention improves nutrition status (NS) and treatment tolerance in patients with esophageal cancer. However, it remains unknown whether pretreatment parameters of NS are associated with treatment modifications (TMs) during neoadjuvant chemoradiation (CR) in patients who are intensively nutritionally supervised during treatment. Methods:All outpatients with esophageal cancer who were scheduled for CR in the VU medical center from 2006–2015 were included. NS was assessed by body mass index (BMI), weight loss in the past 6 months (WL), fat mass index (FMI) and fat-free mass index (FFMI), handgrip strength (HGS), and energy/protein intake. Logistic regression analyses, adjusted for age, sex, previous tumor, tumor stage, and physical status, were applied. TMs were defined as delay, dose reduction or discontinuation of chemotherapy and/or radiotherapy, hospitalization, or mortality (yes/no). Results: In total, 162 patients were included (73% male; mean age 65 ± 9 years). Mean BMI was 25.1 ± 4.5 kg/m2, and WL was 4.8 ± 5.1 kg. HGS and FFMI were below the 10th percentile of reference values in 21 and 37 patients, respectively. Thirty-five (22%) patients experienced at least 1 TM during CR; unplanned hospitalization (n = 18, 11%) was the most prevalent. After adjustments for confounders, only HGS was statistically significantly associated with TMs (odds ratio, 0.93; 95% confidence interval, 0.88–1.00). Conclusion: In this group of intensively supervised patients with esophageal cancer, pretreatment parameters of NS had little influence on TMs during CR. Only a lower HGS was associated with TMs.

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Section: Methodsmentioning

confidence: 99%

Handgrip Strength Is Associated With Treatment Modifications During Neoadjuvant Chemoradiation in Patients With Esophageal Cancer

et al. 2017

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“…Ferrie et al [51] studied the group of 120 critically ill patients requiring PN, comparing the effects after the administration of a high dose (ultimately 1.2 g per kg of body weight per day) and a low dose of amino acids (ultimately 0.8 g per kg of body weight per day). The primary end point in the study was the grip strength of patients, which did not differ statistically significantly in both groups.…”

Section: Amino Acids Composition and Demandmentioning

confidence: 99%

“…These results show that the supply of lower doses of amino acids than recommended may not have a negative impact on the prognosis of critically ill patients. However, it should be noted that patients included in the study, in addition to the different amino acid supplies, received various doses of glucose (higher in patients receiving fewer amino acids), which could affect the final results of the study [51]. Despite numerous reports supporting the current recommendations of scientific associations concerning the supply of amino acids in critically ill patients, there is still a discussion questioning the benefits of early amino acids supplementation which, according to some authors, may lead to the inhibition of autophagy and the catabolic process by supplied amino acids [52].…”

Section: Amino Acids Composition and Demandmentioning

confidence: 99%

Clinical Nutrition of Critically Ill Patients in the Context of the Latest ESPEN Guidelines

et al. 2019

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The group of patients most frequently in need of nutritional support are intensive care patients. This year (i.e., 2019), new European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines of clinical nutrition in intensive care were published, updating and gathering current knowledge on the subject of this group of patients. Planning the right nutritional intervention is often a challenging task involving the necessity of the choice of the enteral nutrition (EN) or parenteral nutrition (PN) route of administration, time of initiation, energy demand, amino acid content and demand as well as the use of immunomodulatory nutrition. The aim of this study was to specify and discuss the basic aspects of the clinical nutrition of critically ill patients recommended by ESPEN guidelines. Clinical nutrition in intensive care seems to be the best-studied type of nutritional intervention. However, meta-analyses and clinical studies comparing EN and PN and their impact on the prognosis of the intensive care patients showed ambiguous results. The nutritional interventions, starting with EN, should be initiated within 24–48 h whereas PN, if recommended, should be implemented within 3–7 days. The recommended method of calculation of the energy demand is indirect calorimetry, however, there are also validated equations used worldwide in everyday practice. The recommended protein intake in this group of patients and the results of insufficient or too high supply was addressed. In light of the concept of immunomodulatory nutrition, the use of appropriate amino acid solutions and lipid emulsion that can bring a positive effect on the modulation of the immune response was discussed.

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“…The classic nitrogen balance study shows a cumulated improvement in whole body nitrogen economy for a protein intake of 1.2 g/kg/24 h as compared to a lower intake, but no further improvement in nitrogen economy above that level of intake [22]. A recent randomized comparison between 0.8 and 1.2 g/kg/24 h over 7 days reports improved handgrip strength and thigh muscle thickness, with a marginal difference in nitrogen balance [23]. In another study, for the purpose of preventing kidney injury, critically ill patients were randomized to receive extra intravenous amino acids, giving a comparison between 0.75 and 1.75 g/kg/24 h of protein intake [24].…”

Section: Paucity Of Rctsmentioning

confidence: 99%

“…Inclusions may be confined to subjects on parenteral nutrition only [13, 23, 25, 26], BMI >17 [27], no signs of liver failure [17, 28], mechanical ventilation [13, 17, 19, 28], enteral nutrition only [20, 21, 29], no diabetes [17, 28, 29], and access to indirect calorimetry data [7, 13, 17, 28], etc. Although most journals demand a CONSORT diagram over screened and included patients, many studies do not communicate the level of selection that has preceded the screening.…”

Section: The Heterogeneitymentioning

confidence: 99%

High protein intake without concerns?

et al. 2017

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The high fashion in nutrition for the critically ill is to recommend a high protein intake. Several opinion leaders are surfing on this wave, expanding the suggested protein allowance upwards. At the same time, there is no new evidence supporting this change in recommendations. Observational data show that in clinical practice protein intake is most often far below current ESPEN recommendations of 1.2–1.5 g/kg/day. Therefore, it may be in the best interests of our patients just to adhere to that guideline, and not to stretch them upwards for protein intake? Here we give arguments to stay conservative.

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Protein Requirements in the Critically Ill

Abstract: The higher level of amino acids was associated with small improvements in a number of different measures, supporting guideline recommendations for ICU patients. This trial was registered at Australian New Zealand Clinical Trials Registry (www.anzctr.org.au) as ACTRN12609000366257.

Cited by 202 publications

References 31 publications

Handgrip Strength Is Associated With Treatment Modifications During Neoadjuvant Chemoradiation in Patients With Esophageal Cancer

Handgrip Strength Is Associated With Treatment Modifications During Neoadjuvant Chemoradiation in Patients With Esophageal Cancer

Clinical Nutrition of Critically Ill Patients in the Context of the Latest ESPEN Guidelines

High protein intake without concerns?

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