Role of Glucagon in Catabolism and Muscle Wasting of Critical Illness and Modulation by Nutrition

Thiessen, Steven; Derde, Sarah; Derese, Inge; Dufour, Thomas; Vega, Chloé Albert; Langouche, Lies; Goossens, Chloë; Peersman, Nele; Vermeersch, Pieter; Perre, Sarah Vander; Holst, Jens J.; Wouters, Pieter; Vanhorebeek, Ilse; Berghe, Greet Van den

doi:10.1164/rccm.201702-0354oc

Cited by 53 publications

(38 citation statements)

References 42 publications

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“…The underlying mechanisms are not fully understood and are currently being investigated. Besides increased urea generation reported in the EAT-ICU (Early Goal-Directed Nutrition in ICU Patients) trial [ 35 ], increased production of glucagon leading to further oxidation of amino acids has also been reported [ 36 ].…”

Section: High Nitrogen Intake During the Early Phase Of Critical Illnmentioning

confidence: 99%

High protein intake during the early phase of critical illness: yes or no?

Preiser

2018

Crit Care

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The rationale for the provision of nitrogen from proteins given via the enteral route or from intravenous amino acids is to boost the synthesis of muscle proteins, and thereby to limit the severity of intensive care unit-acquired weakness by the prevention of muscle loss. However, the optimal timing for supplemental nitrogen provision is a matter of debate and controversy. Indeed, consistent data from retrospective studies support an association between high early protein intakes and better outcomes, while recent post-hoc findings from prospective studies raise safety concerns. This pro–con paper details the arguments of both sides and highlights the need for large-scale prospective studies assessing the safety and efficacy of different levels of protein intake in combination with physical activity and summarizes the currently recruiting clinical trials.

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Section: High Nitrogen Intake During the Early Phase Of Critical Illnmentioning

confidence: 99%

High protein intake during the early phase of critical illness: yes or no?

Preiser

2018

Crit Care

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“…The increased level of glucagon in plasma is responsible for the decomposition of amino acids in the liver. This phenomenon is additionally intensified by the infusion of amino acids and does not protect against the degradation of muscle proteins [47]. In addition, the supply of increased amounts of protein leads to thermogenesis, meaning a significant increase in body temperature, often misinterpreted as a sign of infection and treated with antibiotics.…”

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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“…At least in one large study, where protein delivery was sufficient between 1.2 to 1.5 g/kg/IBW per day, outcomes in the permissive underfeeding group (receiving 40-60% of estimated energy needs) appeared similar to those with standard feeding (prescribed 70-100% of estimated energy needs). 11 Despite these results, there are potential costs to aggressive protein administration during the acute phase of illness due to increased urea generation, 13 as well as increased glucagon production, 32 which may further fuel the catabolic cascade.…”

Section: Protein Goalsmentioning

confidence: 99%

Reconsidering Nutritional Support in Critically Ill Patients

Korwin

Honiden

2019

Semin Respir Crit Care Med

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Provision of nutrition is universally considered a key element of supportive care in the intensive care unit (ICU). Despite this, there is a relative dearth of high-quality data, and where available, results are often conflicting. As we understand more about the process of recovery for critically ill patients, ICU nutrition might be better thought of as active therapy that can and should be tailored to the needs of patients in more dynamic ways. With the advent of the programmable feeding pump, continuous feeding modes have become the default manner in which patients are fed in many ICUs. In the modern ICU era, where the goal of critical care has shifted from mere survival to surviving and living well, non-continuous modes of feeding may have advantages related to fewer feeding interruptions, ICU mobilization, optimizing protein synthesis and autophagy, as well as restoring gastrointestinal physiology and the circadian rhythm. More research is desperately required to provide a framework in order to guide best nutrition practices for clinicians at the bedside.

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Role of Glucagon in Catabolism and Muscle Wasting of Critical Illness and Modulation by Nutrition

Cited by 53 publications

References 42 publications

High protein intake during the early phase of critical illness: yes or no?

High protein intake during the early phase of critical illness: yes or no?

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

Reconsidering Nutritional Support in Critically Ill Patients

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