Whole body protein kinetics during hypocaloric and normocaloric feeding in critically ill patients

Agneta Berg, Olav Rooyackers, Bo-Michael Bellander, Jan Wernerman, Agneta Berg, Olav Rooyackers, Bo-Michael Bellander, Jan Wernerman

Abstract

Introduction: Optimal feeding of critically ill patients in the ICU is controversial. Existing guidelines rest on rather weak evidence. Whole body protein kinetics may be an attractive technique for assessing optimal protein intake. In this study, critically ill patients were investigated during hypocaloric and normocaloric IV nutrition.

Methods: Neurosurgical patients on mechanical ventilation (n = 16) were studied during a 48-hour period. In random order 50% and 100% of measured energy expenditure was given as IV nutrition during 24 hours, corresponding to hypocaloric and normocaloric nutrition, respectively. At the end of each period, whole body protein turnover was measured using d5-phenylalanine and 13C-leucine tracers.

Results: The phenylalanine tracer indicated that whole-body protein synthesis was lower during hypocaloric feeding, while whole-body protein degradation and amino acid oxidation were unaltered, which resulted in a more negative protein balance, namely -1.9 ± 2.1 versus -0.7 ± 1.3 mg phenylalanine/kg/h (P = 0.014). The leucine tracer indicated that whole body protein synthesis and degradation and amino acid oxidation were unaltered, but the protein balance was negative during hypocaloric feeding, namely -0.3 ± 0.5 versus 0.6 ± 0.5 mg leucine/kg/h (P < 0.001).

Conclusion: In the patient group studied, hypocaloric feeding was associated with a more negative protein balance, but the amino acid oxidation was not different. The protein kinetics measurements and the study's investigational protocol were useful for assessing the efficacy of nutrition support on protein metabolism in critically ill patients.

Figures

Figure 1
Figure 1
A schematic illustration of the study protocol. IC, indirect calorimetry; EE, energy expenditure; PN, parenteral nutrition; IV, intravenous.
Figure 2
Figure 2
Whole body protein kinetics, calculated using a phenylalanine tracer, in critically ill mechanically ventilated neurosurgical patients (n = 16) who received normocaloric and hypocaloric intravenous nutrition in random order during two consecutive days. Patients were randomized to receive normocaloric before hypocaloric (filled symbols), or hypocaloric before normocaloric (open symbols) nutrition. (A) Whole-body protein synthesis; (B) whole-body protein degradation; (C) phenylalanine oxidation; (D) whole-body protein balance. P-values are for paired comparisons. Phe, phenylalanine. Red lines indicate mean values.
Figure 3
Figure 3
Whole body protein kinetics, calculated using a leucine tracer, in critically ill mechanically ventilated neurosurgical patients (n = 16) who received normocaloric and hypocaloric intravenous nutrition in random order during two consecutive days. Patients were randomized to receive normocaloric before hypocaloric (filled symbols), or hypocaloric before normocaloric (open symbols) nutrition. (A) Whole-body protein synthesis; (B) whole-body protein degradation; (C) leucine oxidation; and (D) whole-body protein balance. P-values are for paired comparisons. Leu, leucine. Red lines indicate mean values.

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