Dietary protein in the ICU in relation to health outcomes.

IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Danielle E Bear, Matthew J Summers, Lee-Anne S Chapple
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引用次数: 0

Abstract

Purpose of review: Critical care nutrition guidelines recommend provision of higher protein doses than recommended in health. These recommendations have been predominately based on lower quality evidence and physiological rationale that greater protein doses may attenuate the significant muscle loss observed in critically ill patients. This review discusses the mechanistic action of protein in the critically ill, details results from recent trials on health outcomes, discusses considerations for interpretation of trial results, and provides an overview of future directions.

Recent findings: Two recent large clinical trials have investigated different protein doses and the effect on clinical outcome. Important findings revealed potential harm in certain sub-groups of patients. This harm must be balanced with the potential for beneficial effects on muscle mass and physical function given that two recent systematic reviews with meta-analyses demonstrated attenuation of muscle loss with higher protein doses. Utilizing biological markers such as urea: creatinine ratio or urea levels may prove useful in monitoring harm from higher protein doses.

Summary: Future research should focus on prospectively investigating biological signatures of harm as well as taking into the consideration elements that will likely enhance the effectiveness of protein dose.

重症监护室中的膳食蛋白质与健康结果的关系。
审查目的:重症监护营养指南建议提供比健康人更高的蛋白质剂量。这些建议主要基于质量较低的证据和生理学原理,即更大剂量的蛋白质可减轻重症患者肌肉的显著流失。本综述讨论了蛋白质在危重病人中的作用机理,详细介绍了近期有关健康结果的试验结果,讨论了解释试验结果的注意事项,并概述了未来的发展方向:最近的两项大型临床试验研究了不同的蛋白质剂量及其对临床结果的影响。重要的研究结果表明,在某些亚组患者中,蛋白质可能会造成危害。鉴于最近两篇系统综述的荟萃分析表明,蛋白质剂量越大,肌肉流失越少,因此必须平衡这种危害与对肌肉质量和身体功能的潜在有益影响。利用尿素:肌酐比值或尿素水平等生物标志物可能有助于监测较高蛋白质剂量的危害:总结:未来的研究应侧重于前瞻性地调查危害的生物学特征,并考虑到可能会提高蛋白质剂量有效性的因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.30
自引率
6.50%
发文量
116
审稿时长
6-12 weeks
期刊介绍: A high impact review journal which boasts an international readership, Current Opinion in Clinical Nutrition and Metabolic Care offers a broad-based perspective on the most recent and exciting developments within the field of clinical nutrition and metabolic care. Published bimonthly, each issue features insightful editorials and high quality invited reviews covering two or three key disciplines which include protein, amino acid metabolism and therapy, lipid metabolism and therapy, nutrition and the intensive care unit and carbohydrates. Each discipline introduces world renowned guest editors to ensure the journal is at the forefront of knowledge development and delivers balanced, expert assessments of advances from the previous year.
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