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

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

Effects of nutritional intervention by feeding high-protein foods containing BCAA for improving locomotive syndrome: Randomized Controlled Trial

[Purpose] Exercise guidance is an effective measure against locomotive syndrome. Appropriate nutritional management is also considered necessary in order to maintain the motor function. This study is the first exploratory and prospective research on the effects of exercise guidance and feeding high-protein foods in order to improve locomotive syndrome, in elderly people. [Method] We conducted a survey regarding five items related to locomotorium on the basic checklist prepared by the Japanese Ministry of Health, among men and women in their 60s and over living in Miyazaki Prefecture. Participation was solicited from those who responded “applicable” to three or more items, with those who gave their consent assigned to a food + exercise intervention group (EF group), an exercise intervention group (EX group), and a control group (C group) for research. Motor function surveys such as interviews, questionnaire, and locomotive syndrome risk test were conducted at the start of the study and three months later. The EX and EF groups were instructed to carry out locomotion training, while the EF group was asked to ingest one bag of high-protein test food daily immediately following exercise. The participants carried an activity meter and kept a record of their life in a diary during the study period. The EX and EF groups were encouraged to make recordings in a diary and carry an activity meter, while also getting a regular telephone contact once a week. [Results] An improvement in the motor function was observed in the EX and EF group compared to the C group via Locomotive syndrome risk testing. While the muscle mass decreased significantly during the study period in the C and EX group, no significant change was observed in limbs/trunk muscle mass in the EF group. [Conclusion] The locomotion training improved the results of the Locomotive syndrome risk testing. Although muscle mass decreased with exercise guidance alone, muscle mass loss was suppressed by feeding high-protein foods in addition to exercise. We conclude that feeding high-protein foods is useful for improving motor function and maintaining muscle mass, in addition to exercise guidance, as a measure against locomotive syndrome in elderly.

Adherence to Mediterranean-DASH Intervention for Neurodegenerative Delay Diet Can Decreased Risk of Age Associated Poor Muscle Strength; A Cross- Sectional from Kurdish Cohort Study

The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet aims to reduce dementia and the decline in brain health that often occurs as people get older. Loss of muscle strength (sarcopenia) is a geriatric syndrome that has associated with the loss of skeletal muscle mass and strength. The current study aimed to investigate the association between adherence to MIND diet and decrease the risk of age-associated poor muscle strength. This cross-sectional study was performed using data from Ravansar's non-communicable diseases (RaNCD) cohort study on 3181 adults (48.5% men) aged 35–65 years. The dietary intake of the studied participants was assessed by the use of a 114-item food frequency questionnaire (FFQ) developed by RaNCD cohort study. The MIND diet and the major dietary patterns were computed based on their dietary intake and three dietary patterns were identified including plant-based diet, high protein diet, and unhealthy diet. Hand grip strength (HGS) was measured using a hand-held hydraulic handgrip dynamometer and poor HGS was defined as HGS less than 32.8 and 20.5 kg in men and women, respectively. We found that greater adherence to MIND diet was associated with lower risk of poor HGS (OR: 0.65; CI 95%: 0.51-0.83). Furthermore, participants who were in third tertiles of plant- based and high protein diet were more likely 37% and 33% lower risk of poor HGS (OR: 0.63; CI 95%: 0.5-0.79), (OR: 0.67; CI 95%: 0.54-0.84), respectively. On the other hand, greater following to unhealthy diet was related to higher risk of poor HGS (OR: 1.39; CI 95%: 1.11-1.74). Overall, our findings provide that adhere to plant- based and high protein diet, as well as MIND diet had protective effects on age related poor HGS, while adherence to unhealthy diet can developed age related poor HGS.

Effects of physical activity and dietary supplement on fat free mass and bone mass density during weight loss – a systematic review and meta-analysis.

Background: After a diet- or surgery induced weight loss almost 1/3 of lost weight consists of fat free mass (FFM) if carried out without additional therapy. Exercise training and a sufficient supply of protein, calcium and vitamin D is recommended to reduce the loss of FFM. Objective: To investigate the effect of exercise training, protein, calcium, and vitamin D supplementation on the preservation of FFM during non-surgical and surgical weight loss and of the combination of all interventions together in adults with obesity. Methods: A systematic review was performed with a pairwise meta-analysis and an exploratory network meta-analysis according to the PRISMA statement. Results: Thirty studies were included in the quantitative analysis. The pairwise meta-analysis showed for Exercise Training + High Protein vs. High Protein a moderate and statistically significant effect size (SMD 0.45; 95% CI 0.04 to 0.86), for Exercise Training + High Protein vs. Exercise Training a high but statistically not significant effect size (SMD 0.91; 95% CI -0.59 to 2.41) and for Exercise Training alone vs. Control a moderate but statistically not significant effect size (SMD 0.67; 95% CI -0.25 to 1.60). In the exploratory network meta-analysis three interventions showed statistically significant effect sizes compared to Control and all of them included the treatment Exercise Training. Conclusions: Results underline the importance of exercise training and a sufficient protein intake to preserve FFM during weight loss in adults with obesity. The effect of calcium and vitamin D supplementation remains controversial and further research are needed.