ICU patients who receive extra protein recover more slowly and go home later

Is extra protein helpful or not for critically ill patients? High-protein diets help reduce muscle loss. The idea is that this will get you back on your feet faster. Maastricht Research, today The LancetIt now appears that patients in intensive care who received extra protein actually recovered less quickly and were able to go home later.

In Europe, intensive care patients receive 1.3 grams of protein per kilogram of body weight per day, according to guidelines. In the United States, doctors can increase that to 2 grams per kilogram. The assumption was that intensive care patients would benefit from more protein in their tubes or intravenously.

“Muscle loss starts as soon as you enter the hospital. So we thought you should start a high-protein diet as soon as possible,” says Marcel van de Pol, surgeon and intensive care specialist at Maastricht UMC+. 2 grams of protein per kilogram of body weight per day would be better than 1.3 grams if you end up in the intensive care unit.

But the evidence for that has been slim so far. Researchers looking at groups of patients saw that patients who received more protein were more likely to survive when they entered the intensive care unit. But was it the high-protein diet that caused them to die less? Maybe they received or did something else that made them die less.

Quality of life is measured

The doctors at Maastricht UMC+ hope to confirm with their study that patients recover better with 2 grams of protein per kilogram of body weight. They divided 935 intensive care unit patients in five Dutch and five Belgian hospitals into two groups. Half of these patients received 1.3 grams per kilogram of body weight. The other half received 2 grams without knowing it.

After 30, 90 and 180 days, five aspects of all patients’ quality of life were measured on a scale of 1 to 5. These components, including independence and pain, were translated into a score of 1. If patients died, the score was 0. The researchers also looked at how far the patients could walk in six minutes and how strong they were in their arms.

Patients who received the extra protein were sent home 9 percent faster on average. Their quality of life was lower and they had more frequent gastrointestinal complaints. Women even came out slightly worse than men. Van de Pol: “The promise was that 2 grams of protein would become the norm. Now the enthusiasm has been tempered. We have to go back to the drawing board.”

Protein inhibits the recovery process.

Why more protein might have a negative effect wasn’t part of the study, but Van de Pol has his doubts. “The body needs stimuli to convert protein into muscle,” says Van de Pol. “If patients can’t exercise, the liver and kidneys turn protein into waste.” Protein contains a lot of nitrogen. If it builds up in the body, it can be harmful.

In addition, the body may be less able to remove damaged cells and its defense against acute illness may be reduced. Protein inhibits the body’s recovery processes.

The harmful effects of higher protein intake may also explain why outcomes are worse for women than men, says van de Pol. Women have less muscle per kilogram of body weight. “It’s probably better to look at muscle mass rather than weight. And you can extend that to other groups: Many people come into the ICU with very little muscle.

Gender and muscle mass

The study is not an argument against high-protein foods in general, says van de Pol. If people receive physiotherapy and exercise more after a while, their protein requirements will also increase. “But I expect hospitals to become more cautious about high protein levels. The holy grail should be how you can find the right amount for each patient, at any given time. This depends, among other things, on gender, muscle mass and the stage of the disease.”

In addition, it remains important that patients start their admission to the hospital as fit as possible. If they have done strength training beforehand, the protein helps build muscle. The study’s first author, physician and researcher Julia Biles, said: “You lose muscle anyway, but if you go into the operation with more muscle, you have a greater margin.”