Effect of initiating enteral protein feeding on whole-body protein turnover in critically ill patients

The American Journal of Clinical Nutrition
Felix LiebauOlav Rooyackers

Abstract

Critically ill patients are susceptible to protein catabolism. Enteral feeding may ameliorate protein loss, but its effect is not well characterized in terms of protein kinetics. We established a method of quantifying the effect of enteral protein feeding on whole-body protein turnover and studied critically ill patients receiving early enteral nutrition. In a proof-of-concept study, we established, in healthy subjects (n = 6), a method of measuring the effect of continuous enteral protein feeding on whole-body protein turnover by using ¹³C-phenylalanine (¹³C-Phe) intrinsically labeled casein by a nasogastric feeding tube and an intravenous ²H₅-Phe tracer. The protocol was applied to study critically ill patients (n = 10) during the initial hypocaloric-hyponitrogenous dose of enteral nutrition. Patients were catabolic with a negative protein balance. The median splanchnic extraction fraction of hourly dietary Phe intake was 92% (range: 86-99%); that is, the availability of dietary Phe in arterial plasma was low. In patients with a stable parenteral amino acid supply (n = 7), the median net protein balance improved during enteral feeding from -8.6 to -5.8 μmol · kg body weight⁻¹ · h⁻¹ (P = 0.018). Whole-body protein turnover and...Continue Reading

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Oct 30, 2016·Frontiers in Pediatrics·Bryan Wilson, Katri Typpo
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