Protein supplementation in critical illness: why, when and how?

J.L.M. Bels*, Y.A. Abdelhamid, M.C.G. van de Poll

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

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Abstract

Purpose of reviewIn critically ill patients, optimal protein provision remains a challenge given the wide range in recommended protein delivery in international guidelines and the lack of robust, high quality evidence. As patients are confronted with poor functional outcomes after admission, often attributed to muscle wasting and persisting for multiple years, there is a pressing need for optimal nutritional strategies in the ICU, particularly including protein. This review will discuss the recent literature with regard to purpose, timing and mode of protein delivery.Recent findingsRecent studies on the effect of dose and timing of protein on clinical and functional outcomes are largely observational in nature and the protein delivery considered as "high" still often only nears the lower end of current recommendations. The majority of trials observed no effect of protein supplementation on mortality, muscle strength or function, though some report attenuation of muscle volume loss, especially when combined with muscle activation. There is no strong evidence that ICU patients should receive supplementation with any specific amino acids.Though adequate protein provision is likely important, it is difficult to come to a uniform conclusion regarding dosing and timing due to conflicting results in mostly observational studies as well as different cut-off values for high, moderate and low protein intake. This topic is currently subject to large clinical trials.
Original languageEnglish
Pages (from-to)146-153
Number of pages8
JournalCurrent Opinion in Clinical Nutrition and Metabolic Care
Volume26
Issue number2
DOIs
Publication statusPublished - 1 Mar 2023

Keywords

  • amino acids
  • critical illness
  • functional outcomes
  • nutritional strategies
  • protein supplementation
  • HYDROXY-BETA-METHYLBUTYRATE
  • ILL PATIENTS
  • FUNCTIONAL OUTCOMES
  • RANDOMIZED-TRIAL
  • MUSCLE MASS
  • NUTRITION
  • GLUTAMINE
  • THERAPY
  • DISEASE
  • IMPACT

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