Early high protein intake and mortality in critically ill ICU patients with low skeletal muscle area and -density

Abstract Background Proteins are an essential part of medical nutrition therapy in critically ill patients. Guidelines almost universally recommend a high protein intake without robust evidence supporting its use. Methods Using a large international database, we modelled associations between the hazard rate of in-hospital death and live hospital discharge (competing risks) and three categories of protein intake (low: < 0.8 g/kg per day, standard: 0.8–1.2 g/kg per day, high: > 1.2 g/kg per day) during the first 11 days after ICU admission (acute phase). Time-varying cause-specific hazard ratios (HR) were calculated from piece-wise exponential additive mixed models. We used the estimated model to compare five different hypothetical protein diets (an exclusively low protein diet, a standard protein diet administered early (day 1 to 4) or late (day 5 to 11) after ICU admission, and an early or late high protein diet). Results Of 21,100 critically ill patients in the database, 16,489 fulfilled inclusion criteria for the analysis. By day 60, 11,360 (68.9%) patients had been discharged from hospital, 4,192 patients (25.4%) had died in hospital, and 937 patients (5.7%) were still hospitalized. Median daily low protein intake was 0.49 g/kg [IQR 0.27–0.66], standard intake 0.99 g/kg [IQR 0.89– 1.09], and high intake 1.41 g/kg [IQR 1.29–1.60]. In comparison with an exclusively low protein diet, a late standard protein diet was associated with a lower hazard of in-hospital death: minimum 0.75 (95% CI 0.64, 0.87), and a higher hazard of live hospital discharge: maximum HR 1.98 (95% CI 1.72, 2.28). Results on hospital discharge, however, were qualitatively changed by a sensitivity analysis. There was no evidence that an early standard or a high protein intake during the acute phase was associated with a further improvement of outcome. Conclusions Provision of a standard protein intake during the late acute phase may improve outcome compared to an exclusively low protein diet. In unselected critically ill patients, clinical outcome may not be improved by a high protein intake during the acute phase. Study registration ID number ISRCTN17829198

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A Prospective Comparative Study of Moderate Versus High Protein Intake for Critically Ill Patients with Acute Renal Failure

Renal Failure ◽

10.3109/08860229709026265 ◽

1997 ◽

Vol 19 (1) ◽

pp. 111-120 ◽

Cited By ~ 33

Author(s):

Rinaldo Bellomo ◽

John Seacombe Bapplsci ◽

Michael Daskalakis ◽

Michael Farmer ◽

Christopher Wright ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Comparative Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Protein Intake ◽

High Protein ◽

High Protein Intake ◽

Prospective Comparative Study

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Effects of higher habitual protein intake on resistance-training-induced changes in body composition and muscular strength in untrained older women: A clinical trial study

Nutrition and Health ◽

10.1177/0260106019838365 ◽

2019 ◽

Vol 25 (2) ◽

pp. 103-112 ◽

Cited By ~ 1

Author(s):

Hellen CG Nabuco ◽

Crisieli M Tomeleri ◽

Paulo Sugihara Junior ◽

Rodrigo R Fernandes ◽

Edilaine F Cavalcante ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Older Women ◽

Muscle Mass ◽

Protein Intake ◽

Muscular Strength ◽

Skeletal Muscle Mass ◽

High Protein ◽

High Protein Intake ◽

Induced Changes

Background: Aging is accompanied by progressive and accentuated decline in muscular strength and skeletal muscle mass, affecting health and functional autonomy. Both resistance training (RT) and diet are strategies that may contribute to improvement in the health of the elderly. Aim: The purpose of this study was to evaluate the effects of higher habitual protein intake on RT-induced changes in body composition and strength in untrained postmenopausal women. Methods: Seventy older women were submitted to an RT program. Body composition, muscular strength, and dietary intake (24 h dietary recall) were performed pre- and post-intervention. To verify different intervention effects according to protein intake of the participants, the sample was separated into tertiles according to protein intake: low, moderate, and high protein intake. Results: A time vs. group interaction ( p < 0.05) was observed, with high protein intake presenting greater increases compared with low protein intake, for skeletal muscle mass (5.3% vs. 1.3%), lower limb lean soft tissue (4.9% vs. 1.4%), upper lean soft tissue (4.9% vs. 1.2%), preacher curl (24% vs. 15.2%), and total strength (16.4% vs. 11.7%). A time vs. group interaction ( p < 0.05) was observed, with high protein intake presenting greater increases compared with moderate protein intake, for skeletal muscle mass (5.3% vs. 3.2%). In all groups, a main effect of time ( p < 0.05) was observed for knee extension and chest press. Conclusions: We conclude that intake of >1.0 g/kg/day of protein promotes gains in skeletal muscle mass and muscular strength after RT in untrained older women.

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MON-P020: Early High Protein Intake without Energy Overfeeding in Critically Ill Patients

Clinical Nutrition ◽

10.1016/s0261-5614(17)31063-4 ◽

2017 ◽

Vol 36 ◽

pp. S186-S187

Author(s):

W.G. Looijaard ◽

N. Denneman ◽

B. Broens ◽

P.J. Weijs ◽

H.M. Oudemans-van Straaten

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Protein Intake ◽

High Protein ◽

High Protein Intake

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Alcohol Consumption Reduces the Beneficial Influence of Protein Intake on Muscle Mass in Middle-Aged Korean Adults: A 12-Year Community-Based Prospective Cohort Study

Nutrients ◽

10.3390/nu11092143 ◽

2019 ◽

Vol 11 (9) ◽

pp. 2143

Author(s):

Eunjin So ◽

Hyojee Joung

Keyword(s):

Skeletal Muscle ◽

Alcohol Consumption ◽

Muscle Mass ◽

Protein Intake ◽

Skeletal Muscle Mass ◽

Reference Group ◽

High Protein ◽

Study Endpoint ◽

Middle Aged ◽

High Protein Intake

The influence of alcohol consumption on the association of protein intake with muscle mass was assessed using data from the Korean Genome and Epidemiology Study. Dietary protein intakes of 4412 middle-aged participants with normal baseline muscle mass were assessed using a semi-quantitative Food Frequency Questionnaire, and baseline alcohol consumption data (e.g., frequency and amount) were collected using a structured questionnaire. The skeletal muscle mass index (SMI), defined as the weight-adjusted skeletal muscle mass, was measured using multi-frequency bioelectrical impedance analyses every 2 years until the study endpoint. Low muscle mass was defined as a SMI <2 standard deviations below the sex-specific normal mean for a young reference group. During a 12-year follow-up, 395 subjects developed a low SMI. After multivariate adjustments, high protein intake (≥1.2 g/kg body weight (BW)) was shown to reduce the risk of low SMI development in both men (hazard ratio (HR): 0.24; 95% confidence interval (CI): 0.12, 0.51; p for trend < 0.001) and women (HR: 0.29; 95% CI: 0.16, 0.53; p for trend < 0.001), compared with low protein intake (<0.8 g/kg BW). Alcohol consumption attenuated the protective influence of protein intake against low SMI development in women (HR: 0.64; 95% CI: 0.18, 2.25; p for trend = 0.478). Among the total subjects, heavy drinkers with high protein intake were not significantly associated with the development of a low SMI (HR: 0.20; 95% CI: 0.03, 1.50; p = 0.117). Additional research should clarify the dose-response effects of alcohol consumption on muscle mass relative to daily protein intake.

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SUN-LB266: Feasibility of Early High Protein Intake by the Enteral Route in Critically Ill Patients

Clinical Nutrition ◽

10.1016/s0261-5614(16)30622-7 ◽

2016 ◽

Vol 35 ◽

pp. S143

Author(s):

W.G. Looijaard ◽

E.A. Worner ◽

A.E. van derVeen ◽

P.J. Weijs ◽

H.M. Oudemans-van Straaten

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Protein Intake ◽

High Protein ◽

High Protein Intake

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High-protein intake and early exercise in adult intensive care patients: a prospective, randomized controlled trial to evaluate the impact on functional outcomes

BMC Anesthesiology ◽

10.1186/s12871-021-01492-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

José Raimundo Araujo de Azevedo ◽

Hugo César Martins Lima ◽

Pedro Henrique Dias Brasiliense Frota ◽

Ivna Raquel Olimpio Moreira Nogueira ◽

Suellen Christine de Souza ◽

...

Keyword(s):

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Protein Intake ◽

High Protein ◽

Control Group ◽

High Protein Intake ◽

Early Exercise ◽

Icu Discharge ◽

The Impact

Abstract Background We evaluated the efficacy of high protein intake and early exercise versus standard nutrition care and routine physiotherapy on the outcome of critically ill patients. Methods We randomized mechanically ventilated patients expected to stay in the intensive care unit (ICU) for 4 days. We used indirect calorimetry to determine energy expenditure and guide caloric provision to the patients randomized to the high protein and early exercise (HPE) group and the control group. Protein intakes were 1.48 g/kg/day and 1.19 g/kg/day medians respectively; while the former was submitted to two daily sessions of cycle ergometry exercise, the latter received routine physiotherapy. We evaluated the primary outcome physical component summary (PCS) score at 3 and 6 months) and the secondary outcomes (handgrip strength at ICU discharge and ICU and hospital mortality). Results We analyzed 181 patients in the HPE (87) and control (94) group. There was no significant difference between groups in relation to calories received. However, the amount of protein received by the HPE group was significantly higher than that received by the control group (p < 0.0001). The PCS score was significantly higher in the HPE group at 3 months (p = 0.01) and 6 months (p = 0.01). The mortality was expressively higher in the control group. We found an independent association between age and 3-month PCS and that between age and group and 6-month PCS. Conclusion This study showed that a high-protein intake and resistance exercise improved the physical quality of life and survival of critically ill patients. Trial registration Research Ethics Committee of Hospital São Domingos: Approval number 1.487.683, April 09, 2018. The study protocol was registered in ClinicalTrials.gov (NCT03469882, March 19,2018).

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