Nutrition Support Blog: One Weird Trick to Help Nourish Your Patients
September 13, 2011
I am amused by the little advertisements that show up on the sides of many web sites that offer “a simple technique to lose weight” or “one weird trick to help you stay asleep all night.” No doubt they appeal to that part of human nature that relishes the idea of a quick fix. However, our better sense realizes that there are generally no magic solutions and anything that sounds too good to be true generally is. Likewise, there are generally no magic formulas or secret tricks for improving the nutrition status of your patient. Just like the “secret” to weight loss is to eat less than you burn, the weird trick for improving the nutrition status of hospitalized patients is to provide nutrition before they become severely malnourished. (Amazing, isn’t it?)
Of course, in critically ill patients we have learned that it is a bit more complicated than just providing plenty of calories and protein. The realization that excessive calories and protein do not have the power to reverse the catabolism of critical illness, and can actually create negative consequences, was an epiphany for the world of nutrition support. Subsequent to learning that overfeeding was undesirable there has been a host of studies measuring the calorie expenditure of critically ill patients. However, compared to the number of studies of calorie expenditure there is limited data about the protein needs of critically ill patients. Anyone that has searched for data to support protein guidelines in adult critically ill patients quickly has their own epiphany over the dearth of good research. It is absolutely amazing that after 40 years of specialized nutrition support there are still no randomized studies of adult critically ill patients that allocate participants to different protein intakes. One of the few references that you will find is an observational study with inherent weaknesses that seriously limit the strength of the published conclusions.1
There is a new study (below) in Critical Care Medicine on protein needs in adolescents that adds to our knowledge of protein requirements in critical illness. The conclusions of the new study suggest that previous protein recommendations may have been inadequate to fully support protein synthesis.
Verbruggen SC, Coss-Bu J, Wu M, et al. Current recommended parenteral protein intakes do not support protein synthesis in critically ill septic, insulin-resistant adolescents with tight glucose control. Crit Care Med. 2011 Jul 14. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/21765361
The results investigated in this study are primarily protein synthesis, catabolism and nitrogen balance, rather than patient outcome. Nevertheless, with such limited data available it is encouraging to see some interest in determining optimum protein intake in the critically ill population. There is a real need for additional research in both the pediatric and adult populations to investigate ideal protein intake for both the early acute and later rehabilitation phase of critical illness.
1) Ishibashi N, Plank LD, Sando K, Hill GL. Optimal protein requirements during the first 2 weeks after the onset of critical illness. Crit Care Med. 1998 Sep;26(9):1529-35.
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