The efficacy of high-protein nutritional support on mortality, clinical outcomes, and nutritional adequacy in critically ill patients: a double‑center randomized controlled trial.

IF 4.1 2区医学 Q2 NUTRITION & DIETETICS

Nutrition & Metabolism Pub Date : 2025-10-08 DOI:10.1186/s12986-025-01003-1

Mohaddeseh Badpeyma, Alireza Sedaghat, Ahmad Bagheri Moghaddam, Majid Khadem-Rezaiyan, Fatemeh Sistanian, Mohammad Bagherniya, Golnaz Ranjbar, Farzaneh Fazeli, Abdolreza Norouzy

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Abstract

Background: Although nutritional support is crucial in intensive care, the impact of protein intake remains unclear, emphasizing the need for further randomized controlled trials. This study aimed to evaluate the effects of high-protein versus conventional-protein nutritional support on clinical outcomes in critically ill patients, with 60-day mortality as the primary endpoint.

Method: In this double-blind, two-arm, parallel-group randomized controlled trial, 56 adult patients admitted to the intensive care unit [1] were enrolled. Participants received either high-protein support (2.2 g/kg/day, actual body weight [ABW]) or conventional-protein support (1.0 g/kg/day, ABW) for 12 days. Both groups targeted 25 kcal/kg/day energy intake. Patients and data analysts were blinded. Mortality was assessed at ICU discharge, on days 28 and 60, and at hospital discharge. Hospital mortality was defined as any death occurring during the hospital stay, including both the ICU and post-ICU periods. Mid-arm circumference (MAC) was measured as an indicator of muscle attenuation.

Results: Mean protein intake was 1.67 ± 0.33 vs. 0.93 ± 0.10 g/kg/day in high- vs. conventional-protein groups (P < 0.05). In-hospital mortality was significantly lower in the high-protein group (8 patients [28.6%]) compared to the conventional-protein group (16 patients [57.1%]; adjusted P = 0.049). Although 60-day mortality was also lower in the high-protein group (28.6% vs. 53.6%), the difference did not reach statistical significance (adjusted P = 0.07). A significant reduction in MAC attenuation was observed in the high-protein group (P < 0.001).

Conclusion: High-protein intake (1.67 g/kg/day) significantly reduced in-hospital mortality and improved preservation of muscle mass. Although 60-day mortality reduction was not significant, the trend suggests a meaningful benefit warranting further study.

Irct registration id: IRCT20180619040151N4.

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高蛋白营养支持对危重患者死亡率、临床结局和营养充足性的影响：一项双中心随机对照试验

背景：虽然营养支持在重症监护中至关重要，但蛋白质摄入的影响尚不清楚，强调需要进一步的随机对照试验。本研究旨在评估高蛋白与常规蛋白质营养支持对危重患者临床结果的影响，以60天死亡率为主要终点。方法：在这项双盲、双臂、平行组随机对照试验中，入组56例在重症监护病房[1]住院的成年患者。参与者接受为期12天的高蛋白支持（2.2 g/kg/天，实际体重[ABW]）或常规蛋白质支持（1.0 g/kg/天，ABW）。两组的目标是25千卡/公斤/天的能量摄入。患者和数据分析人员是盲法研究。在ICU出院、第28天和第60天以及出院时评估死亡率。住院死亡率定义为住院期间发生的任何死亡，包括ICU和ICU后时期。测量中臂围（MAC）作为肌肉衰减的指标。结果：高蛋白组和常规蛋白组的平均蛋白质摄入量分别为1.67±0.33 g/kg/d和0.93±0.10 g/kg/d (P结论：高蛋白摄入（1.67 g/kg/d）可显著降低住院死亡率并改善肌肉质量的保存。虽然60天死亡率降低并不显著，但这一趋势表明有意义的益处值得进一步研究。IRCT20180619040151N4。

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来源期刊

Nutrition & Metabolism 医学-营养学

CiteScore

8.40

自引率

0.00%

发文量

审稿时长

4-8 weeks

期刊介绍： Nutrition & Metabolism publishes studies with a clear focus on nutrition and metabolism with applications ranging from nutrition needs, exercise physiology, clinical and population studies, as well as the underlying mechanisms in these aspects. The areas of interest for Nutrition & Metabolism encompass studies in molecular nutrition in the context of obesity, diabetes, lipedemias, metabolic syndrome and exercise physiology. Manuscripts related to molecular, cellular and human metabolism, nutrient sensing and nutrient–gene interactions are also in interest, as are submissions that have employed new and innovative strategies like metabolomics/lipidomics or other omic-based biomarkers to predict nutritional status and metabolic diseases. Key areas we wish to encourage submissions from include: -how diet and specific nutrients interact with genes, proteins or metabolites to influence metabolic phenotypes and disease outcomes; -the role of epigenetic factors and the microbiome in the pathogenesis of metabolic diseases and their influence on metabolic responses to diet and food components; -how diet and other environmental factors affect epigenetics and microbiota; the extent to which genetic and nongenetic factors modify personal metabolic responses to diet and food compositions and the mechanisms involved; -how specific biologic networks and nutrient sensing mechanisms attribute to metabolic variability.