Effect of initiating enteral protein feeding on whole-body protein turnover in critically ill patients

Liebau, Felix; Wernerman, Jan; Loon, Luc J. C. van; Rooyackers, Olav

doi:10.3945/ajcn.114.091934

Cited by 51 publications

(50 citation statements)

References 35 publications

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“…Therefore, we would advocate a more conservative attitude in general recommendations pending creation of more solid knowledge. We see no rationale for a higher protein intake than the ESPEN guidelines recommendation, even if whole body protein balance is more positive as our own studies demonstrate [11, 13–15], unless clinical relevant advantages can be demonstrated in randomized studies. In parallel, we need to better identify the possible risks involved with a high-protein intake on the level of the individual patient.…”

Section: Discussionmentioning

confidence: 91%

“…Overall, this limited knowledge of the regulation of quantities of individual protein as well as mixed protein in tissues or in the whole body make it difficult to decide on what grounds recommendations of protein intake should rest. At a whole body level, and as a group, critically ill patients utilize extra nutritional proteins to build body protein and they do not oxidize these [11, 13–15], but due to the black box principle it is not clear which protein are synthesized and whether they benefit the patient.…”

Section: Physiologymentioning

confidence: 99%

“…All measurements were performed after short-term (<48 h) nutrition exposures. From published data in [11, 13–15]

Fig. 2The measured oxidation of phenylalanine during measurements of whole body protein turnovers in healthy volunteers.…”

Section: Relation To Protein Turnovermentioning

confidence: 99%

“…All measurements were performed after short-term (<48 h) nutrition exposures. From published data in [11, 13–15]…”

Section: Relation To Protein Turnovermentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 91%

Section: Physiologymentioning

confidence: 99%

“…All measurements were performed after short-term (<48 h) nutrition exposures. From published data in [11, 13–15]

Fig. 2The measured oxidation of phenylalanine during measurements of whole body protein turnovers in healthy volunteers.…”

Section: Relation To Protein Turnovermentioning

confidence: 99%

“…All measurements were performed after short-term (<48 h) nutrition exposures. From published data in [11, 13–15]…”

Section: Relation To Protein Turnovermentioning

confidence: 99%

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High protein intake without concerns?

et al. 2017

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“…The recommended procedure is to measure the enteral uptake in parallel to the measurements of protein turnover by tracer techniques, by assessing the enteral uptake by an additional tracer. This is illustrated by a comparison between healthy volunteers and intensive care unit (ICU) patients, who exhibit very different levels of first‐pass elimination 5 . Furthermore, it is usually not possible to have an amino acid tracer in your dietary proteins digested.…”

Section: Basic Physiology Of Feedingmentioning

confidence: 99%

Assessment of Protein Turnover in Health and Disease

et al. 2017

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To identify protein requirements, it is necessary to be familiar with basic physiology, practical methods, and dose response of protein delivery. This review evaluates available methodology, with emphasis on the limitations of existing techniques most often related to the underlying assumption. Historically, nitrogen balance has been the dominating technique. It is still the gold standard, although there are considerable problems related to the underlying assumptions to have reliable readings. When minimal requirements needed to be defined, the indicator amino acid oxidation technique came into practice. In situations of longer term steady states, it serves a purpose. In situations of disease or in aging, it has proven to be more problematic. More recently, whole-body protein turnover measurements have shown to be useful in situations where the underlying assumptions for the other techniques are not possible to meet.

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Systematic Review With Meta‐Analysis of Patient‐Centered Outcomes, Comparing International Guideline–Recommended Enteral Protein Delivery With Usual Care

Fetterplace

Gill

Chapple

et al. 2019

J Parenter Enteral Nutr

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Background: International guidelines recommend that protein be administered enterally to critically ill patients at doses between 1.2 and 2 g/kg per day Observational data indicate that patients frequently receive less protein. The aim of this systematic review was to evaluate patient-centered outcomes with guideline-recommended enteral protein compared with usual care. Methods: A systematic review was performed of randomized controlled trials including critically ill adult patients provided predominately enteral nutrition with mean protein at ࣙ1.2 g/kg per day (intervention) and <1.2 g/kg per day (comparator). Random-effects models were applied for outcomes reported in ࣙ3 trials. Results: Of 1375 abstracts, 69 full-text articles were reviewed, and 6 trials meet the inclusion criteria, including 511 patients. The intervention group received a mean (SD) of 1.3 (0.08) g/kg per day, and the comparator group received 0.75 (0.15) g/kg per day protein. Insufficient data were available for meta-analyses on the primary outcome (muscle mass or strength). According to our meta-analyses, mortality at 28 days (5 studies) (risk ratio 0.92 [95% Cl 0.63-1.35], P = .66) and the durations of intensive care unit (6 studies) and hospital admission (4 studies) were similar between the intervention and comparator, with some uncertainty due to sample sizes and heterogeneity. Conclusion: There are insufficient data to conclude whether protein provision within the current international guideline recommendations improves outcomes. In a limited dataset, enteral protein intakes near the lower level of current recommendations do not appear to reduce admission duration or mortality when compared with usual care in critically ill.

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Effect of initiating enteral protein feeding on whole-body protein turnover in critically ill patients

Cited by 51 publications

References 35 publications

High protein intake without concerns?

High protein intake without concerns?

Assessment of Protein Turnover in Health and Disease

Systematic Review With Meta‐Analysis of Patient‐Centered Outcomes, Comparing International Guideline–Recommended Enteral Protein Delivery With Usual Care

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