Effect of Protein-Fortified Diet on Nitrogen Balance in Critically Ill Patients: Results from the OPINiB Trial.

Matteo Danielis,Omar Trombini,Giulia Lorenzoni,Danila Azzolina,Dario Gregori,Amato De Monte,Anna Iacobucci,Fabio Beltrame

doi:10.3390/nu11050972

Matteo Danielis, Omar Trombini + Show 6 more

Open Access

https://doi.org/10.3390/nu11050972

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Abstract

Nitrogen balance (NB) is considered a good marker of adequate protein intake and it has been suggested to be a good predictor of patients’ health outcomes. However, in literature, there is a lack of large randomized trials examining NB-guided protein intake in patients in intensive care units (ICUs). A randomized controlled trial enrolling patients admitted to ICU was done to compare changes in NB. Participants were randomized to a standard or protein-fortified diet (protein intake of 1.8 g/kg/day according to the guidelines of the Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition). The primary endpoint was represented by the NB on Day 1, 3, and study exit. Forty patients were enrolled in the study (19 in the protein-fortified group). The longitudinal analysis showed that, on Day 3, patients randomized to the protein-fortified diet were more likely (p < 0.001) to present better NB (at 3 days, patients in the protein-fortified diet were estimated to have a nitrate value of 5.22 g more than patients in the standard diet, 95% CI 3.86–6.58). The protein-fortified diet was found to be significantly and directly associated with changes in NB in critically ill patients admitted to ICU.

Highlights

The nitrogen balance (NB) reflects the gain or loss of total body protein and is represented by the difference between dietary nitrogen intake and nitrogen losses
The hypermetabolism and whole-body protein catabolism resulting from a stressful event in critically ill patients might lead to a negative NB [1]
Ill patients admitted to intensive care units (ICUs) usually exhibit intense protein catabolism, and this effect is undesired since protein losses are associated with increased morbidity and mortality [2]

Summary

Introduction

The nitrogen balance (NB) reflects the gain or loss of total body protein and is represented by the difference between dietary nitrogen intake and nitrogen losses (represented by nitrogen excreted in the urine and by insensible losses via the skin and gastrointestinal tract). It is considered an easy and inexpensive method that is useful for the assessment of protein turnover and the effectiveness of nutritional therapy [1]. The hypermetabolism and whole-body protein catabolism resulting from a stressful event in critically ill patients might lead to a negative NB [1].

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