Protein Turnover and Metabolism in the Elderly Intensive Care Unit Patient

Stuart M. Phillips, Roland Dickerson, Frederick A. Moore, Douglas Paddon-Jones, Peter J.M. Weijs

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Many intensive care unit (ICU) patients do not achieve target protein intakes particularly in the early days following admittance. This period of iatrogenic protein undernutrition contributes to a rapid loss of lean, in particular muscle, mass in the ICU. The loss of muscle in older (aged >60 years) patients in the ICU may be particularly rapid due to a perfect storm of increased catabolic factors, including systemic inflammation, disuse, protein malnutrition, and reduced anabolic stimuli. This loss of muscle mass has marked consequences. It is likely that the older patient is already experiencing muscle loss due to sarcopenia; however, the period of stay in the ICU represents a greatly accelerated period of muscle loss. Thus, on discharge, the older ICU patient is now on a steeper downward trajectory of muscle loss, more likely to have ICU-acquired muscle weakness, and at risk of becoming sarcopenic and/or frail. One practice that has been shown to have benefit during ICU stays is early ambulation and physical therapy (PT), and it is likely that both are potent stimuli to induce a sensitivity of protein anabolism. Thus, recommendations for the older ICU patient would be provision of at least 1.2-1.5 g protein/kg usual body weight/d, regular and early utilization of ambulation (if possible) and/or PT, and follow-up rehabilitation for the older discharged ICU patient that includes rehabilitation, physical activity, and higher habitual dietary protein to change the trajectory of ICU-mediated muscle mass loss and weakness.

Original languageEnglish (US)
Pages (from-to)112S-120S
JournalNutrition in Clinical Practice
Volume32
Issue number1_suppl
DOIs
StatePublished - Apr 1 2017

Fingerprint

Intensive Care Units
Muscles
Proteins
Early Ambulation
Malnutrition
Rehabilitation
Period Circadian Proteins
Sarcopenia
Dietary Proteins
Muscle Weakness
Body Weight
Exercise
Inflammation
Therapeutics

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Protein Turnover and Metabolism in the Elderly Intensive Care Unit Patient. / Phillips, Stuart M.; Dickerson, Roland; Moore, Frederick A.; Paddon-Jones, Douglas; Weijs, Peter J.M.

In: Nutrition in Clinical Practice, Vol. 32, No. 1_suppl, 01.04.2017, p. 112S-120S.

Research output: Contribution to journalArticle

Phillips, Stuart M. ; Dickerson, Roland ; Moore, Frederick A. ; Paddon-Jones, Douglas ; Weijs, Peter J.M. / Protein Turnover and Metabolism in the Elderly Intensive Care Unit Patient. In: Nutrition in Clinical Practice. 2017 ; Vol. 32, No. 1_suppl. pp. 112S-120S.
@article{6720d4c2faf945dcb776ab9fe2d5f199,
title = "Protein Turnover and Metabolism in the Elderly Intensive Care Unit Patient",
abstract = "Many intensive care unit (ICU) patients do not achieve target protein intakes particularly in the early days following admittance. This period of iatrogenic protein undernutrition contributes to a rapid loss of lean, in particular muscle, mass in the ICU. The loss of muscle in older (aged >60 years) patients in the ICU may be particularly rapid due to a perfect storm of increased catabolic factors, including systemic inflammation, disuse, protein malnutrition, and reduced anabolic stimuli. This loss of muscle mass has marked consequences. It is likely that the older patient is already experiencing muscle loss due to sarcopenia; however, the period of stay in the ICU represents a greatly accelerated period of muscle loss. Thus, on discharge, the older ICU patient is now on a steeper downward trajectory of muscle loss, more likely to have ICU-acquired muscle weakness, and at risk of becoming sarcopenic and/or frail. One practice that has been shown to have benefit during ICU stays is early ambulation and physical therapy (PT), and it is likely that both are potent stimuli to induce a sensitivity of protein anabolism. Thus, recommendations for the older ICU patient would be provision of at least 1.2-1.5 g protein/kg usual body weight/d, regular and early utilization of ambulation (if possible) and/or PT, and follow-up rehabilitation for the older discharged ICU patient that includes rehabilitation, physical activity, and higher habitual dietary protein to change the trajectory of ICU-mediated muscle mass loss and weakness.",
author = "Phillips, {Stuart M.} and Roland Dickerson and Moore, {Frederick A.} and Douglas Paddon-Jones and Weijs, {Peter J.M.}",
year = "2017",
month = "4",
day = "1",
doi = "10.1177/0884533616686719",
language = "English (US)",
volume = "32",
pages = "112S--120S",
journal = "Nutrition in Clinical Practice",
issn = "0884-5336",
publisher = "SAGE Publications Ltd",
number = "1_suppl",

}

TY - JOUR

T1 - Protein Turnover and Metabolism in the Elderly Intensive Care Unit Patient

AU - Phillips, Stuart M.

AU - Dickerson, Roland

AU - Moore, Frederick A.

AU - Paddon-Jones, Douglas

AU - Weijs, Peter J.M.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Many intensive care unit (ICU) patients do not achieve target protein intakes particularly in the early days following admittance. This period of iatrogenic protein undernutrition contributes to a rapid loss of lean, in particular muscle, mass in the ICU. The loss of muscle in older (aged >60 years) patients in the ICU may be particularly rapid due to a perfect storm of increased catabolic factors, including systemic inflammation, disuse, protein malnutrition, and reduced anabolic stimuli. This loss of muscle mass has marked consequences. It is likely that the older patient is already experiencing muscle loss due to sarcopenia; however, the period of stay in the ICU represents a greatly accelerated period of muscle loss. Thus, on discharge, the older ICU patient is now on a steeper downward trajectory of muscle loss, more likely to have ICU-acquired muscle weakness, and at risk of becoming sarcopenic and/or frail. One practice that has been shown to have benefit during ICU stays is early ambulation and physical therapy (PT), and it is likely that both are potent stimuli to induce a sensitivity of protein anabolism. Thus, recommendations for the older ICU patient would be provision of at least 1.2-1.5 g protein/kg usual body weight/d, regular and early utilization of ambulation (if possible) and/or PT, and follow-up rehabilitation for the older discharged ICU patient that includes rehabilitation, physical activity, and higher habitual dietary protein to change the trajectory of ICU-mediated muscle mass loss and weakness.

AB - Many intensive care unit (ICU) patients do not achieve target protein intakes particularly in the early days following admittance. This period of iatrogenic protein undernutrition contributes to a rapid loss of lean, in particular muscle, mass in the ICU. The loss of muscle in older (aged >60 years) patients in the ICU may be particularly rapid due to a perfect storm of increased catabolic factors, including systemic inflammation, disuse, protein malnutrition, and reduced anabolic stimuli. This loss of muscle mass has marked consequences. It is likely that the older patient is already experiencing muscle loss due to sarcopenia; however, the period of stay in the ICU represents a greatly accelerated period of muscle loss. Thus, on discharge, the older ICU patient is now on a steeper downward trajectory of muscle loss, more likely to have ICU-acquired muscle weakness, and at risk of becoming sarcopenic and/or frail. One practice that has been shown to have benefit during ICU stays is early ambulation and physical therapy (PT), and it is likely that both are potent stimuli to induce a sensitivity of protein anabolism. Thus, recommendations for the older ICU patient would be provision of at least 1.2-1.5 g protein/kg usual body weight/d, regular and early utilization of ambulation (if possible) and/or PT, and follow-up rehabilitation for the older discharged ICU patient that includes rehabilitation, physical activity, and higher habitual dietary protein to change the trajectory of ICU-mediated muscle mass loss and weakness.

UR - http://www.scopus.com/inward/record.url?scp=85018731154&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85018731154&partnerID=8YFLogxK

U2 - 10.1177/0884533616686719

DO - 10.1177/0884533616686719

M3 - Article

VL - 32

SP - 112S-120S

JO - Nutrition in Clinical Practice

JF - Nutrition in Clinical Practice

SN - 0884-5336

IS - 1_suppl

ER -