Will We Ever Agree on Protein Requirements in the Intensive Care Unit?

L. John Hoffer, Roland Dickerson, Robert G. Martindale, Stephen A. McClave, Juan B. Ochoa Gautier

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

The precise value of the normal adult protein requirement has long been debated. For many reasons - one of them being the difficulty of carrying out long-term nutrition experiments in free-living people - uncertainty is likely to persist indefinitely. By contrast, the controlled environment of the intensive care unit and relatively short trajectory of many critical illnesses make it feasible to use hard clinical outcome trials to determine protein requirements for critically ill patients in well-defined clinical situations. This article suggests how the physiological principles that underlie our understanding of normal protein requirements can be incorporated into the design of such clinical trials. The main focus is on 3 principles: (1) the rate of body nitrogen loss roughly predicts an individual's minimum protein requirement and is thus essential to measure to identify individual patients and clinical situations in which the minimum protein requirement is importantly increased, (2) existing muscle mass sets an upper limit on the rate at which amino acids can be mobilized from muscle for transfer to central proteins and sites of injury and is thus important to monitor to identify patients who are at greatest risk of protein deficiency-related adverse outcomes, and (3) negative energy balance increases the dietary protein requirement, so calorie-deprived patients - whether obese or not - should be enrolled in hard clinical outcome trials that compare the current practice of "permissive underfeeding" (underprovision of all nutrients, including protein) with hypocaloric nutrition supplemented by a suitably generous amount of protein.

Original languageEnglish (US)
Pages (from-to)94S-100S
JournalNutrition in Clinical Practice
Volume32
Issue number1_suppl
DOIs
StatePublished - Apr 1 2017

Fingerprint

Intensive Care Units
Proteins
Clinical Trials
Critical Illness
Controlled Environment
Protein Deficiency
Muscles
Nutritional Requirements
Dietary Proteins
Uncertainty
Reference Values
Nitrogen
Amino Acids
Food
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Hoffer, L. J., Dickerson, R., Martindale, R. G., McClave, S. A., & Ochoa Gautier, J. B. (2017). Will We Ever Agree on Protein Requirements in the Intensive Care Unit? Nutrition in Clinical Practice, 32(1_suppl), 94S-100S. https://doi.org/10.1177/0884533617694613

Will We Ever Agree on Protein Requirements in the Intensive Care Unit? / Hoffer, L. John; Dickerson, Roland; Martindale, Robert G.; McClave, Stephen A.; Ochoa Gautier, Juan B.

In: Nutrition in Clinical Practice, Vol. 32, No. 1_suppl, 01.04.2017, p. 94S-100S.

Research output: Contribution to journalArticle

Hoffer, LJ, Dickerson, R, Martindale, RG, McClave, SA & Ochoa Gautier, JB 2017, 'Will We Ever Agree on Protein Requirements in the Intensive Care Unit?', Nutrition in Clinical Practice, vol. 32, no. 1_suppl, pp. 94S-100S. https://doi.org/10.1177/0884533617694613
Hoffer, L. John ; Dickerson, Roland ; Martindale, Robert G. ; McClave, Stephen A. ; Ochoa Gautier, Juan B. / Will We Ever Agree on Protein Requirements in the Intensive Care Unit?. In: Nutrition in Clinical Practice. 2017 ; Vol. 32, No. 1_suppl. pp. 94S-100S.
@article{3ba71efd95be46f3b40c31f739bb8d4b,
title = "Will We Ever Agree on Protein Requirements in the Intensive Care Unit?",
abstract = "The precise value of the normal adult protein requirement has long been debated. For many reasons - one of them being the difficulty of carrying out long-term nutrition experiments in free-living people - uncertainty is likely to persist indefinitely. By contrast, the controlled environment of the intensive care unit and relatively short trajectory of many critical illnesses make it feasible to use hard clinical outcome trials to determine protein requirements for critically ill patients in well-defined clinical situations. This article suggests how the physiological principles that underlie our understanding of normal protein requirements can be incorporated into the design of such clinical trials. The main focus is on 3 principles: (1) the rate of body nitrogen loss roughly predicts an individual's minimum protein requirement and is thus essential to measure to identify individual patients and clinical situations in which the minimum protein requirement is importantly increased, (2) existing muscle mass sets an upper limit on the rate at which amino acids can be mobilized from muscle for transfer to central proteins and sites of injury and is thus important to monitor to identify patients who are at greatest risk of protein deficiency-related adverse outcomes, and (3) negative energy balance increases the dietary protein requirement, so calorie-deprived patients - whether obese or not - should be enrolled in hard clinical outcome trials that compare the current practice of {"}permissive underfeeding{"} (underprovision of all nutrients, including protein) with hypocaloric nutrition supplemented by a suitably generous amount of protein.",
author = "Hoffer, {L. John} and Roland Dickerson and Martindale, {Robert G.} and McClave, {Stephen A.} and {Ochoa Gautier}, {Juan B.}",
year = "2017",
month = "4",
day = "1",
doi = "10.1177/0884533617694613",
language = "English (US)",
volume = "32",
pages = "94S--100S",
journal = "Nutrition in Clinical Practice",
issn = "0884-5336",
publisher = "SAGE Publications Ltd",
number = "1_suppl",

}

TY - JOUR

T1 - Will We Ever Agree on Protein Requirements in the Intensive Care Unit?

AU - Hoffer, L. John

AU - Dickerson, Roland

AU - Martindale, Robert G.

AU - McClave, Stephen A.

AU - Ochoa Gautier, Juan B.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - The precise value of the normal adult protein requirement has long been debated. For many reasons - one of them being the difficulty of carrying out long-term nutrition experiments in free-living people - uncertainty is likely to persist indefinitely. By contrast, the controlled environment of the intensive care unit and relatively short trajectory of many critical illnesses make it feasible to use hard clinical outcome trials to determine protein requirements for critically ill patients in well-defined clinical situations. This article suggests how the physiological principles that underlie our understanding of normal protein requirements can be incorporated into the design of such clinical trials. The main focus is on 3 principles: (1) the rate of body nitrogen loss roughly predicts an individual's minimum protein requirement and is thus essential to measure to identify individual patients and clinical situations in which the minimum protein requirement is importantly increased, (2) existing muscle mass sets an upper limit on the rate at which amino acids can be mobilized from muscle for transfer to central proteins and sites of injury and is thus important to monitor to identify patients who are at greatest risk of protein deficiency-related adverse outcomes, and (3) negative energy balance increases the dietary protein requirement, so calorie-deprived patients - whether obese or not - should be enrolled in hard clinical outcome trials that compare the current practice of "permissive underfeeding" (underprovision of all nutrients, including protein) with hypocaloric nutrition supplemented by a suitably generous amount of protein.

AB - The precise value of the normal adult protein requirement has long been debated. For many reasons - one of them being the difficulty of carrying out long-term nutrition experiments in free-living people - uncertainty is likely to persist indefinitely. By contrast, the controlled environment of the intensive care unit and relatively short trajectory of many critical illnesses make it feasible to use hard clinical outcome trials to determine protein requirements for critically ill patients in well-defined clinical situations. This article suggests how the physiological principles that underlie our understanding of normal protein requirements can be incorporated into the design of such clinical trials. The main focus is on 3 principles: (1) the rate of body nitrogen loss roughly predicts an individual's minimum protein requirement and is thus essential to measure to identify individual patients and clinical situations in which the minimum protein requirement is importantly increased, (2) existing muscle mass sets an upper limit on the rate at which amino acids can be mobilized from muscle for transfer to central proteins and sites of injury and is thus important to monitor to identify patients who are at greatest risk of protein deficiency-related adverse outcomes, and (3) negative energy balance increases the dietary protein requirement, so calorie-deprived patients - whether obese or not - should be enrolled in hard clinical outcome trials that compare the current practice of "permissive underfeeding" (underprovision of all nutrients, including protein) with hypocaloric nutrition supplemented by a suitably generous amount of protein.

UR - http://www.scopus.com/inward/record.url?scp=85015224804&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85015224804&partnerID=8YFLogxK

U2 - 10.1177/0884533617694613

DO - 10.1177/0884533617694613

M3 - Article

VL - 32

SP - 94S-100S

JO - Nutrition in Clinical Practice

JF - Nutrition in Clinical Practice

SN - 0884-5336

IS - 1_suppl

ER -