The effect of protein intake and resistance training on muscle mass in acutely ill old medical patients – A randomized controlled trial

Buhl, Sussi Friis; Andersen, Aino Leegaard; Andersen, Jens Rikardt; Andersen, Ove; Jensen, Jens–Erik Beck; Rasmussen, Anne Mette L.; Pedersen, Mette Merete; Damkjær, Lars; Gilkes, Hanne; Petersen, Janne

doi:10.1016/j.clnu.2015.02.015

Cited by 16 publications

(19 citation statements)

References 25 publications

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“…20 In a recent study, elderly patients were given inhospital protein supplementation (~14 g d À1 ) in addition to 12 weeks of resistance training following discharge. 26 In fact, during the first 24 hours of admission, protein intake was 0.74 g kg À1 and 1.56 g kg À1 in the intervention group and control group, respectively. Surprisingly, this did not result in any changes in muscle mass from admission to the 3-months follow-up assessment, despite significant difference in both total protein intake and energy intake between intervention group and control group.…”

Section: Nutritionmentioning

confidence: 90%

“…Moreover, long‐term (~24 days) patients with a high protein intake are more likely to increase physical function during hospitalization . In a recent study, elderly patients were given in‐hospital protein supplementation (~14 g d −1 ) in addition to 12 weeks of resistance training following discharge . In fact, during the first 24 hours of admission, protein intake was 0.74 g kg −1 and 1.56 g kg −1 in the intervention group and control group, respectively.…”

Section: Nutritionmentioning

confidence: 99%

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Changes in muscle mass during acute short-term hospitalization of elderly patients: A mini-review

Norheim

2018

Transl Sports Med

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It has long been a presumption that hospitalization is associated with a loss of muscle mass in elderly patients. However, only a handful of studies have directly measured whether such a loss actually occurs. This mini-review highlights some of the most recent research related to changes in muscle mass during acute shortterm hospitalization of elderly patients. Despite a high prevalence of physical inactivity during hospitalization, there is a lack of research measuring changes for habitual levels. The effect of inflammation on muscle mass in elderly patients is still uncertain. Nutritional supplementation beyond what is currently being prescribed in hospitals may have additional benefits on muscle mass. Dehydration prior to hospital admission may obscure true changes in muscle mass when using current state-of-the-art measures due to in-hospital rehydration. The current literature does not support the notion of in-hospital loss of muscle mass in acutely admitted elderly patients; however, there is a need for more precise measures of muscle mass that are able to account for fluctuations in hydration status. Moreover, future studies assessing changes in muscle mass should also measure changes in physical activity levels, inflammation status, and nutritional intake during acute hospitalization. K E Y W O R D Satrophy, disuse, elderly, hydration status, inflammation, protein intake | INTRODUCTIONThere are several physiological changes related to increasing age in humans, one of which is the progressive loss of skeletal muscle mass. 1 This loss, which has been termed sarcopenia, is multifactorial in nature and its exact etiology is yet to be established. A large body of research has been put into understanding this phenomenon, mostly focusing on factors such as physical inactivity, poor nutrition, inflammatory processes, and endocrine changes. Interestingly, some researchers have suggested that repeated hospitalizations in elderly may accelerate sarcopenia. 2 It has long been a presumption that hospitalization is associated with a loss of muscle mass in elderly patients. However, only a handful of studies have directly measured whether such a loss actually occurs during acute hospitalization. A recent meta-analysis investigated changes in muscle mass in older patients during either elective or acute admission. 3 The electively admitted patients showed a decrease in muscle mass [standardized mean difference (95% confidence interval): À0.44 (À0.61, À0.27)], whereas the acutely admitted showed no change [À0.25 (À0.58, 0.09)]. Although only two studies were used in the analysis of acutely admitted patients, other studies that were not included show similar results. 4,5 Several factors may explain these findings. This mini-review highlights some of the most recent studies in the field of geriatrics with a focus on changes in muscle mass during acute short-term hospitalization of elderly patients. The main putative mechanisms explaining these findings are discussed, and a hypothetical model illustrating changes in muscle m...

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Section: Nutritionmentioning

confidence: 90%

Section: Nutritionmentioning

confidence: 99%

Changes in muscle mass during acute short-term hospitalization of elderly patients: A mini-review

Norheim

2018

Transl Sports Med

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“…In a recent issue of Clinical Nutrition (March 2015), Buhl and coworkers [1] reported the results of their randomized control study in which a combination of protein supplement and resistance training failed to maintain muscle mass and physical function in geriatric patients after systemic inflammatory syndrome, in contrast to what was expected. We agree with the study concept; however, we have several concerns about the interpretation, design, and statistical methods employed.…”

Section: Dear Editormentioning

confidence: 91%

Combined intervention of protein supplementation and resistance training in medical patients

Maeda

Wakabayashi

Shamoto³

2015

Clinical Nutrition

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“…Variability of patients and the heterogeneity of the disease states add to the complexity of determining protein kinetics for ICU patients. Factors such as age, sex, body habitus, preexisting nutrition state, muscle loading, route of nutrition therapy, and even the patient's microbiome all play a part in determining total‐body protein kinetics 16 – 20 . Extensive discussion of all of these factors is beyond the scope of this review.…”

Section: Protein Kinetics In the Icu—a Confusing Picturementioning

confidence: 99%

“…Two recent studies would challenge the results of these earlier studies. In a randomized trial evaluating protein intake and resistance training in acutely ill medical patients, no major outcome benefit was shown, although this was a very small study with several methodological flaws 18 . In another randomized clinical trial of exercise rehabilitation following critical illness, a 12‐month follow‐up concluded no benefit 55 .…”

Section: What Nutrition Interventions Work To Protect Lean Body Tissumentioning

confidence: 99%

Protein Kinetics and Metabolic Effects Related to Disease States in the Intensive Care Unit

et al. 2017

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Evaluating protein kinetics in the critically ill population remains a very difficult task. Heterogeneity in the intensive care unit (ICU) population and wide spectrum of disease processes creates complexity in assessing protein kinetics. Traditionally, protein has been delivered in the context of total energy. Focus on energy delivery has recently come into question, as the importance of supplemental protein in patient outcomes has been shown in several recent trials. The ICU patient is prone to catabolism, immobilization, and impaired immunity, which is a perfect storm for massive loss of lean body tissue with a unidirectional flow of amino acids from muscle to immune tissue for immunoglobulin production, as well as liver for gluconeogenesis and acute phase protein synthesis. The understanding of protein metabolism in the ICU has been recently expanded with the discovery of how the mammalian target of rapamycin complex 1 is regulated. The concept of "anabolic resistance" and identifying the quantity of protein required to overcome this resistance is gaining support among critical care nutrition circles. It appears that a minimum of at least 1.2 g/kg/d with levels up to 2.0 g/kg/d of protein or amino acids appears safe for delivery in the ICU setting and may yield a better clinical outcome.

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The effect of protein intake and resistance training on muscle mass in acutely ill old medical patients – A randomized controlled trial

Cited by 16 publications

References 25 publications

Changes in muscle mass during acute short-term hospitalization of elderly patients: A mini-review

Changes in muscle mass during acute short-term hospitalization of elderly patients: A mini-review

Combined intervention of protein supplementation and resistance training in medical patients

Protein Kinetics and Metabolic Effects Related to Disease States in the Intensive Care Unit

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