scholarly journals Protein intake and outcome of critically ill patients: analysis of a large international database using piece-wise exponential additive mixed models

Critical Care ◽  
2022 ◽  
Vol 26 (1) ◽  
Author(s):  
Wolfgang H. Hartl ◽  
Philipp Kopper ◽  
Andreas Bender ◽  
Fabian Scheipl ◽  
Andrew G. Day ◽  
...  

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

Renal Failure ◽  
1997 ◽  
Vol 19 (1) ◽  
pp. 111-120 ◽  
Author(s):  
Rinaldo Bellomo ◽  
John Seacombe Bapplsci ◽  
Michael Daskalakis ◽  
Michael Farmer ◽  
Christopher Wright ◽  
...  

2017 ◽  
Vol 36 ◽  
pp. S186-S187
Author(s):  
W.G. Looijaard ◽  
N. Denneman ◽  
B. Broens ◽  
P.J. Weijs ◽  
H.M. Oudemans-van Straaten

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

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 ◽  
...  

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).


Author(s):  
José Raimundo Araújo de Azevedo ◽  
Hugo Cesar Martins Lima ◽  
Widlani Sousa Montenegro ◽  
Suellen Christine de Carvalho Souza ◽  
Ivna Raquel Olimpio Moreira Nogueira ◽  
...  

2020 ◽  
Vol 39 (7) ◽  
pp. 2192-2201 ◽  
Author(s):  
Wilhelmus G.P.M. Looijaard ◽  
Ingeborg M. Dekker ◽  
Albertus Beishuizen ◽  
Armand R.J. Girbes ◽  
Heleen M. Oudemans-van Straaten ◽  
...  

1987 ◽  
Vol 252 (6) ◽  
pp. F1088-F1094 ◽  
Author(s):  
R. A. Stahl ◽  
S. Kudelka ◽  
U. Helmchen

Reduction of renal mass in the rat results in an increased glomerular prostaglandin (PG) and thromboxane (TX) formation that modulates renal hemodynamics. To evaluate whether dietary protein intake could exert effects on renal PG and TX formation after reduction of approximately 70% of renal mass, rats with remnant kidneys were placed on either a high-protein (HP) or a low-protein (LP) diet. After 2 wk on the diet, proteinuria, glomerular filtration rate (GFR), urinary PGE2 excretion, and glomerular PGE2, 6-keto PGF1 alpha, and TxB2 biosynthesis were significantly greater in the rats on HP diets. Two-wk administration of the thromboxane synthesis inhibitor UK 38485 reduced renal TxB2 formation by approximately 70%. In addition, chronic UK 38485 treatment significantly inhibited papillary PGE2 production. Neither chronic nor bolus administration of UK 38485 had an effect on proteinuria or GFR in rats on HP diets. Chronic UK 38485 treatment, however, reduced GFR and proteinuria in rats on LP diets. The bolus administration of UK 38485 did not alter GFR in animals receiving a LP diet. The cyclooxygenase inhibitor indomethacin reduced GFR only in rats on HP diets. The data demonstrate that HP intake stimulates renal prostanoid formation. The increased prostaglandin formation on HP intake modulates GFR in these rats.


Author(s):  
Franziska Tedeschi-Jockers ◽  
Simona Reinhold ◽  
Alexa Hollinger ◽  
Daniel Tuchscherer ◽  
Caroline Kiss ◽  
...  

Abstract Objectives Current guidelines and expert recommendations stress the need to implement enteral feeds with a higher protein-to-energy ratio to meet protein requirements as recommended while avoiding gastrointestinal side effects and energy overfeeding in ICU patients. Materials and methods Prospective tolerability study in 18 critically ill patients with a high protein formula (high protein-to-energy (HP:E) formula = Fresubin® Intensive; HPG) compared to a contemporary matched conventional therapy group (CTG). The primary outcome was GI intolerance defined as ≥300 ml daily gastric residual volume (GRV), vomiting, or diarrhea on days 1 and 2. Secondary outcomes were the percentage of patients reaching their protein target on day 4 and overall protein intake. Results Groups were comparable regarding demographic characteristics, disease severity, organ failures, mechanical ventilation, and NUTRIC score at baseline. Eighteen patients completed the 4-day feeding period. The number of events of GRV of ≥300 ml/day was equal in both groups (33.3%). The incidence of diarrhea and vomiting was low in the HPG (two patients concerned). EN did not need to be discontinued due to intolerance in any group. Seventy-two percent of patients reached protein targets ≥1.3 g/kgBW/d within 4 days after initiation of enteral feeding, which was superior to the CTG (33%). Post-hoc testing showed group differences of protein intake between HPG and CTG were significant at t = 72 h and t = 96 h. Energy targets were met in both groups. Conclusion The HP:E formula containing 33% whey protein hydrolysate is well tolerated in this tolerability study. Due to the HP:E ratio protein targets can be reached faster. Larger randomized trials are needed to confirm preliminary results. Trial registration ClinicalTrials.gov Identifier: NCT02678325. Registered 2 May 2016.


2021 ◽  
Vol 27 (1) ◽  
pp. 041-052
Author(s):  
Wittawas Sajjapong ◽  
◽  
Preeya Leelahagul ◽  
Sitha Pongphibool ◽  
Narupon Thongsuk ◽  
...  

Introduction: Many underweight males take commercial protein supplements to increase their body weight and build muscle. Nonetheless, commercial protein supplements may cause adverse effects. This study aimed to determine the effects of resistance training exercise combined with a high protein diet on body weight and muscle mass in underweight adolescent males. Methods: A repeated measures design study was conducted on nine males aged 12-15 years with low body weight. Energy and protein requirements were calculated, and energy and protein consumptions were measured for each meal during the high protein diet without exercise (HP) period and the high protein diet with resistance exercise (HPE) period. Subjects engaged in three resistance training sessions each week during HP-E period, for eight weeks. Dietary intake, body composition, blood biochemistry, physical fitness, and self-esteem were assessed. Results: In HP-E period, resistance training exercise combined with a high protein intake (2.14 g/kg/d) increased body weight and lean tissue mass (LTM) by 0.5 kg and 0.5 kg, respectively. Resistance training during HP-E period increased arm, leg, and trunk muscle strength by 20.2%, 7.2%, and 14.5%, respectively, more than high protein diet alone during HP period. High protein intake in HP-E period did not affect blood urea nitrogen (BUN) and creatinine levels (11.0 mg/dL and 0.70 mg/dL, respectively). Conclusion: Eight weeks of resistance training combined with a high protein diet increased body weight and LTM without adverse effects. In particular, resistance exercise predominantly increased muscle strength. Kidney function was not affected by high protein consumption throughout this study.


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