Protein-rich diet no improvement for intensive care patients

Although protein-rich food helps build muscle mass in many cases, this is not true for critically ill patients in Intensive Care. This shows research by Maastricht UMC+ and Hospital Oost-Limburg in Genk. Indeed, it leads to delayed discharge and lower quality of life after ICU admission. The results were published 18 August in The Lancet.

Patients who are seriously ill and whose vital functions, such as breathing, need to be supported to stay alive are admitted to an Intensive Care Unit (ICU). They lose muscle mass and weight from the very first moment of admission. Partly because of this, a long recovery process generally awaits them after ICU admission. 

Recovery and nutrition

More and more attention and research in medicine is focused on the recovery and rehabilitation of these patients after IC admission. In fact, research shows that recovery is faster if rehabilitation starts already in the ICU, for instance with physiotherapy and proper nutrition. Most patients in the ICU receive tube feeding because they cannot eat independently. In Corresponding European guideline for ICU feeding, this tube feeding contains about 1.3 grams of protein per kilo (weight of the patient). However, there is an idea that it might be better to administer more protein in order to stimulate muscle building in ICU patients. The US guideline, for example, advises treating physicians to consider including 2 grams of protein per kilogram in the diet.

Research

Because of this difference and in the context of the growing attention to protein-rich nutrition, intensivists Dieter Mesotten of Ziekenhuis Oost-Limburg and Marcel van de Poll of MUMC+ decided to conduct research into protein-rich nutrition for IC patients, focusing on the effects on recovery. At five Belgian and five Dutch ICUs, they looked at patients' nutrition. Half of the participating patients received the standard nutrition (1.3 g/kg) during ICU admission; the other received nutrition with a higher protein target (2 g/kg). For six months after admission, the researchers monitored recovery, including by looking at the time to hospital discharge, but also by measuring muscle strength and physical fitness and by asking about quality of life. The latter parameter was the most important of the study.

Lower quality of life

The study, conducted by physician-researcher at MUMC+ Julia Bels, now clearly shows that patients who received more protein actually had a lower quality of life after their ICU admission than those who received the regular diet.

In addition, the study shows that the higher protein dose also resulted in delayed discharge from hospital. The lower quality of life over six months after admission seemed remarkably stronger in women than in men. To date, no distinction is made between male and female patients in the ICU in terms of dietary protein dosage, but this could therefore be unjustified. According to the researchers, this finding could possibly be explained by the fact that women have relatively less muscle mass, making them more likely to get too much protein than men.

Clarity

There is not yet enough scientific knowledge about why exactly too much protein is unfavourable for patients. The researchers think it has to do with the processing of protein by the organs, while they need all their energy for recovery. In any case, intensivist Marcel van de Poll is happy that the research results provide clarity. ‘We continue to look for ways to invest in our patients’ recovery as early as possible. It is now clear that immediately starting protein-rich food is not a good investment. So I expect these results to tighten international guidelines.

In addition, these results again provide a good basis for follow-up research into proper nutrition for ICU patients. It is possible that protein-rich food can have a positive effect in the later phase of ICU admission, when patients can also exercise their muscles a bit again'.

More information:

https://www.limburger.nl/cnt/dmf20240816_94091788 

https://www.mumc.nl/actueel/nieuws/eiwitrijke-voeding-geen-verbetering-voor-patienten-op-intensive-care

Interview with Julia Bels and Marcel van de Poll in NRC next

https://www.nrc.nl/nieuws/2024/08/15/ic-patienten-die-extra-eiwit-krijgen-herstellen-juist-trager-en-gaan-later-naar-huis-a4862866