Protein Requirements in Critically Ill Older Adults

Rachel R Deer, Elena Volpi, Rachel R Deer, Elena Volpi

Abstract

Critically ill elderly patients' nutritional needs are not well understood and vary with the phase of illness and recovery. Patients' nutritional needs should be assessed early in hospitalization and re-assessed throughout the stay with additional attention during the transitions from critical illness, to severe illness, to post-hospital rehabilitation. In this review, we summarize recent findings and highlight recommendations for protein supplementation in critically ill geriatric patients throughout the stages of recovery. Future research specifically focusing on protein dose, its relationship with caloric needs, and delivery modality must be conducted to provide more specific guidelines for clinical practice.

Keywords: hospitalization; nutrition; older adult; protein.

Conflict of interest statement

The authors received in the past a competitive research grant from the National Dairy Council.

References

    1. Wurtman J.J., Lieberman H., Tsay R., Nader T., Chew B. Calorie and nutrient intakes of elderly and young subjects measured under identical conditions. J. Gerontol. 1988;43:B174–B180. doi: 10.1093/geronj/43.6.B174.
    1. Burd N.A., Gorissen S.H., van Loon L.J. Anabolic resistance of muscle protein synthesis with aging. Exerc. Sport Sci. Rev. 2013;41:169–173. doi: 10.1097/JES.0b013e318292f3d5.
    1. Dickinson J.M., Volpi E., Rasmussen B.B. Exercise and nutrition to target protein synthesis impairments in aging skeletal muscle. Exerc. Sport Sci. Rev. 2013;41:216–223. doi: 10.1097/JES.0b013e3182a4e699.
    1. Deutz N.E., Wolfe R.R. Is there a maximal anabolic response to protein intake with a meal? Clin. Nutr. 2013;32:309–313. doi: 10.1016/j.clnu.2012.11.018.
    1. Mamerow M.M., Mettler J.A., English K.L., Casperson S.L., Arentson-Lantz E., Sheffield-Moore M., Layman D.K., Paddon-Jones D. Dietary protein distribution positively influences 24-h muscle protein synthesis in healthy adults. J. Nutr. 2014;144:876–880. doi: 10.3945/jn.113.185280.
    1. Paddon-Jones D., Leidy H. Dietary protein and muscle in older persons. Curr. Opin. Clin. Nutr. Metab. Care. 2014;17:5–11. doi: 10.1097/MCO.0000000000000011.
    1. Luiking Y.C., Deutz N.E., Memelink R.G., Verlaan S., Wolfe R.R. Postprandial muscle protein synthesis is higher after a high whey protein, leucine-enriched supplement than after a dairy-like product in healthy older people: A randomized controlled trial. Nutr. J. 2014;13:9. doi: 10.1186/1475-2891-13-9.
    1. Thalacker-Mercer A.E., Drummond M.J. The importance of dietary protein for muscle health in inactive, hospitalized older adults. Ann. N. Y. Acad. Sci. 2014;1328:1–9. doi: 10.1111/nyas.12509.
    1. Campbell W.W., Johnson C.A., McCabe G.P., Carnell N.S. Dietary protein requirements of younger and older adults. Am. J. Clin. Nutr. 2008;88:1322–1329.
    1. Morse M.H., Haub M.D., Evans W.J., Campbell W.W. Protein requirement of elderly women: Nitrogen balance responses to three levels of protein intake. J. Gerontol. A Biol. Sci. Med. Sci. 2001;56:M724–M730. doi: 10.1093/gerona/56.11.M724.
    1. Rafii M., Chapman K., Owens J., Elango R., Campbell W.W., Ball R.O., Pencharz P.B., Courtney-Martin G. Dietary protein requirement of female adults >65 years determined by the indicator amino acid oxidation technique is higher than current recommendations. J. Nutr. 2014;145:18–24. doi: 10.3945/jn.114.197517.
    1. Tang M., McCabe G.P., Elango R., Pencharz P.B., Ball R.O., Campbell W.W. Assessment of protein requirement in octogenarian women with use of the indicator amino acid oxidation technique. Am. J. Clin. Nutr. 2014;99:891–898. doi: 10.3945/ajcn.112.042325.
    1. Volpi E., Campbell W.W., Dwyer J.T., Johnson M.A., Jensen G.L., Morley J.E., Wolfe R.R. Is the optimal level of protein intake for older adults greater than the recommended dietary allowance? J. Gerontol. A Biol. Sci. Med. Sci. 2013;68:677–681. doi: 10.1093/gerona/gls229.
    1. Bauer J., Biolo G., Cederholm T., Cesari M., Cruz-Jentoft A.J., Morley J.E., Phillips S., Sieber C., Stehle P., Teta D., et al. Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the prot-age study group. J. Am. Med. Dir. Assoc. 2013;14:542–559. doi: 10.1016/j.jamda.2013.05.021.
    1. Deutz N.E., Bauer J.M., Barazzoni R., Biolo G., Boirie Y., Bosy-Westphal A., Cederholm T., Cruz-Jentoft A., Krznaric Z., Nair K.S., et al. Protein intake and exercise for optimal muscle function with aging: Recommendations from the espen expert group. Clin. Nutr. 2014;33:929–936. doi: 10.1016/j.clnu.2014.04.007.
    1. Ferrie S., Allman-Farinelli M., Daley M., Smith K. Protein requirements in the critically ill: A randomized controlled trial using parenteral nutrition. J. Parenter. Enter. Nutr. 2016;40:795–805. doi: 10.1177/0148607115618449.
    1. Jones C., Bäckman C., Griffiths R.D. Intensive care diaries and relatives’ symptoms of posttraumatic stress disorder after critical illness: A pilot study. Am. J. Crit. Care. 2012;21:172–176. doi: 10.4037/ajcc2012569.
    1. Cuesta J.M., Singer M. The stress response and critical illness: A review. Crit. Care Med. 2012;40:3283–3289. doi: 10.1097/CCM.0b013e31826567eb.
    1. Berg A., Rooyackers O., Bellander B.M., Wernerman J. Whole body protein kinetics during hypocaloric and normocaloric feeding in critically ill patients. Crit. Care. 2013;17:R158. doi: 10.1186/cc12837.
    1. Friedrich O., Reid M.B., Van den Berghe G., Vanhorebeek I., Hermans G., Rich M.M., Larsson L. The sick and the weak: Neuropathies/myopathies in the critically ill. Physiol. Rev. 2015;95:1025–1109. doi: 10.1152/physrev.00028.2014.
    1. Narsale A.A., Carson J.A. Role of interleukin-6 in cachexia: Therapeutic implications. Curr. Opin. Support. Palliat. Care. 2014;8:321–327. doi: 10.1097/SPC.0000000000000091.
    1. Drummond M.J., Dickinson J.M., Fry C.S., Walker D.K., Gundermann D.M., Reidy P.T., Timmerman K.L., Markofski M.M., Paddon-Jones D., Rasmussen B.B., et al. Bed rest impairs skeletal muscle amino acid transporter expression, mtorc1 signaling, and protein synthesis in response to essential amino acids in older adults. Am. J. Physiol. Endocrinol. Metab. 2012;302:E1113–E1122. doi: 10.1152/ajpendo.00603.2011.
    1. Drummond M.J., Timmerman K.L., Markofski M.M., Walker D.K., Dickinson J.M., Jamaluddin M., Brasier A.R., Rasmussen B.B., Volpi E. Short-term bed rest increases TLR4 and IL-6 expression in skeletal muscle of older adults. Am. J. Physiol. Regul. Integr. Comp. Physiol. 2013;305:R216–R223. doi: 10.1152/ajpregu.00072.2013.
    1. Vivanti A., Ward N., Haines T. Nutritional status and associations with falls, balance, mobility and functionality during hospital admission. J. Nutr. Health Aging. 2011;15:388–391. doi: 10.1007/s12603-010-0302-8.
    1. Powers J., Samaan K. Malnutrition in the icu patient population. Crit. Care Nurs. Clin. N. Am. 2014;26:227–242. doi: 10.1016/j.ccell.2014.01.003.
    1. Weijs P.J., Stapel S.N., de Groot S.D., Driessen R.H., de Jong E., Girbes A.R., Strack van Schijndel R.J., Beishuizen A. Optimal protein and energy nutrition decreases mortality in mechanically ventilated, critically ill patients: A prospective observational cohort study. J. Parenter. Enter. Nutr. 2012;36:60–68. doi: 10.1177/0148607111415109.
    1. Ishibashi N., Plank L.D., Sando K., Hill G.L. Optimal protein requirements during the first 2 weeks after the onset of critical illness. Crit. Care Med. 1998;26:1529–1535. doi: 10.1097/00003246-199809000-00020.
    1. Allingstrup M.J., Esmailzadeh N., Wilkens Knudsen A., Espersen K., Hartvig Jensen T., Wiis J., Perner A., Kondrup J. Provision of protein and energy in relation to measured requirements in intensive care patients. Clin. Nutr. 2012;31:462–468. doi: 10.1016/j.clnu.2011.12.006.
    1. Puthucheary Z.A., Rawal J., McPhail M., Connolly B., Ratnayake G., Chan P., Hopkinson N.S., Phadke R., Padhke R., Dew T., et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310:1591–1600. doi: 10.1001/jama.2013.278481.
    1. Hoffer L.J., Bistrian B.R. Appropriate protein provision in critical illness: A systematic and narrative review. Am. J. Clin. Nutr. 2012;96:591–600. doi: 10.3945/ajcn.111.032078.
    1. Arabi Y.M., Casaer M.P., Chapman M., Heyland D.K., Ichai C., Marik P.E., Martindale R.G., McClave S.A., Preiser J.C., Reignier J., et al. The intensive care medicine research agenda in nutrition and metabolism. Intens. Care Med. 2017;43:1239–1256. doi: 10.1007/s00134-017-4711-6.
    1. Thibault R., Graf S., Clerc A., Delieuvin N., Heidegger C.P., Pichard C. Diarrhoea in the ICU: Respective contribution of feeding and antibiotics. Crit. Care. 2013;17:R153. doi: 10.1186/cc12832.
    1. Weijs P.J., Looijaard W.G., Beishuizen A., Girbes A.R., Oudemans-van Straaten H.M. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit. Care. 2014;18:701. doi: 10.1186/s13054-014-0701-z.
    1. Oshima T., Singer P., Pichard C. Parenteral or enteral nutrition: Do you have the choice? Curr. Opin. Crit. Care. 2016;22:292–298. doi: 10.1097/MCC.0000000000000313.
    1. Rooyackers O., Kouchek-Zadeh R., Tjäder I., Norberg Å., Klaude M., Wernerman J. Whole body protein turnover in critically ill patients with multiple organ failure. Clin. Nutr. 2015;34:95–100. doi: 10.1016/j.clnu.2014.01.020.
    1. Bohé J., Low J.F., Wolfe R.R., Rennie M.J. Latency and duration of stimulation of human muscle protein synthesis during continuous infusion of amino acids. J. Physiol. 2001;532:575–579. doi: 10.1111/j.1469-7793.2001.0575f.x.
    1. Liebau F., Sundström M., van Loon L.J., Wernerman J., Rooyackers O. Short-term amino acid infusion improves protein balance in critically ill patients. Crit. Care. 2015;19:106. doi: 10.1186/s13054-015-0844-6.
    1. López Martínez J., Sánchez-Izquierdo Riera J.A., Jiménez Jiménez F.J. Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus semicyuc-senpe: Acute renal failure. Nutr. Hosp. 2011;26(Suppl. S2):21–26.
    1. Ikizler T.A., Cano N.J., Franch H., Fouque D., Himmelfarb J., Kalantar-Zadeh K., Kuhlmann M.K., Stenvinkel P., TerWee P., Teta D., et al. Prevention and treatment of protein energy wasting in chronic kidney disease patients: A consensus statement by the international society of renal nutrition and metabolism. Kidney Int. 2013;84:1096–1107. doi: 10.1038/ki.2013.147.
    1. Doig G.S., Simpson F., Bellomo R., Heighes P.T., Sweetman E.A., Chesher D., Pollock C., Davies A., Botha J., Harrigan P., et al. Intravenous amino acid therapy for kidney function in critically ill patients: A randomized controlled trial. Intens. Care Med. 2015;41:1197–1208. doi: 10.1007/s00134-015-3827-9.
    1. Singer P., Berger M.M., Van den Berghe G., Biolo G., Calder P., Forbes A., Griffiths R., Kreyman G., Leverve X., Pichard C., et al. ESPEN guidelines on parenteral nutrition: Intensive care. Clin. Nutr. 2009;28:387–400. doi: 10.1016/j.clnu.2009.04.024.
    1. Sobotka L., Schneider S.M., Berner Y.N., Cederholm T., Krznaric Z., Shenkin A., Stanga Z., Toigo G., Vandewoude M., Volkert D., et al. ESPEN guidelines on parenteral nutrition: Geriatrics. Clin. Nutr. 2009;28:461–466. doi: 10.1016/j.clnu.2009.04.004.
    1. Söderström L., Thors Adolfsson E., Rosenblad A., Frid H., Saletti A., Bergkvist L. Mealtime habits and meal provision are associated with malnutrition among elderly patients admitted to hospital. Clin. Nutr. 2013;32:281–288. doi: 10.1016/j.clnu.2012.07.013.
    1. Agarwal E., Miller M., Yaxley A., Isenring E. Malnutrition in the elderly: A narrative review. Maturitas. 2013;76:296–302. doi: 10.1016/j.maturitas.2013.07.013.
    1. White J.V., Guenter P., Jensen G., Malone A., Schofield M., Academy Malnutrition Work Group. A.S.P.E.N. Malnutrition Task Force. The A.S.P.E.N. Board of Directors Consensus statement of the academy of nutrition and dietetics/american society for parenteral and enteral nutrition: Characteristics recommended for the identification and documentation of adult malnutrition (undernutrition) J. Acad. Nutr. Diet. 2012;112:730–738. doi: 10.1016/j.jand.2012.03.012.
    1. Amaral T.F., Matos L.C., Tavares M.M., Subtil A., Martins R., Nazaré M., Sousa Pereira N. The economic impact of disease-related malnutrition at hospital admission. Clin. Nutr. 2007;26:778–784. doi: 10.1016/j.clnu.2007.08.002.
    1. Lew C.C.H., Wong G.J.Y., Cheung K.P., Chua A.P., Chong M.F.F., Miller M. Association between malnutrition and 28-day mortality and intensive care length-of-stay in the critically ill: A prospective cohort study. Nutrients. 2017;10 doi: 10.3390/nu10010010.
    1. McMurdo M.E., Price R.J., Shields M., Potter J., Stott D.J. Should oral nutritional supplementation be given to undernourished older people upon hospital discharge? A controlled trial. J. Am. Geriatr. Soc. 2009;57:2239–2245. doi: 10.1111/j.1532-5415.2009.02568.x.
    1. Neelemaat F., Lips P., Bosmans J.E., Thijs A., Seidell J.C., van Bokhorst-de van der Schueren M.A. Short-term oral nutritional intervention with protein and vitamin d decreases falls in malnourished older adults. J. Am. Geriatr. Soc. 2012;60:691–699. doi: 10.1111/j.1532-5415.2011.03888.x.
    1. Price R., Daly F., Pennington C.R., McMurdo M.E. Nutritional supplementation of very old people at hospital discharge increases muscle strength: A randomised controlled trial. Gerontology. 2005;51:179–185. doi: 10.1159/000083991.
    1. Deer R.R., Dickinson J.M., Fisher S.R., Ju H., Volpi E. Identifying effective and feasible interventions to accelerate functional recovery from hospitalization in older adults: A randomized controlled pilot trial. Contemp. Clin. Trials. 2016;49:6–14. doi: 10.1016/j.cct.2016.05.001.
    1. Deer R.R., Goodlett S.M., Fisher S.R., Baillargeon J., Dickinson J.M., Raji M., Volpi E. A randomized controlled pilot trial of interventions to improve functional recovery after hospitalization in older adults: Feasibility and adherence. J. Gerontol. A Biol. Sci. Med. Sci. 2017;73:187–193. doi: 10.1093/gerona/glx111.
    1. Dreyer H.C., Strycker L.A., Senesac H.A., Hocker A.D., Smolkowski K., Shah S.N., Jewett B.A. Essential amino acid supplementation in patients following total knee arthroplasty. J. Clin. Investig. 2013;123:4654–4666. doi: 10.1172/JCI70160.
    1. English K.L., Mettler J.A., Ellison J.B., Mamerow M.M., Arentson-Lantz E., Pattarini J.M., Ploutz-Snyder R., Sheffield-Moore M., Paddon-Jones D. Leucine partially protects muscle mass and function during bed rest in middle-aged adults. Am. J. Clin. Nutr. 2016;103:465–473. doi: 10.3945/ajcn.115.112359.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera