Abstract
Critically ill older patients with sarcopenia experience greater morbidity and mortality than younger patients. It is anticipated that unabated protein catabolism would be detrimental for the critically ill older patient. Healthy older subjects experience a diminished response to protein supplementation when compared to their younger counterparts, but this anabolic resistance can be overcome by increasing protein intake. Preliminary evidence suggests that older patients may respond differently to protein intake than younger patients during critical illness as well. If sufficient protein intake is given, older patients can achieve a similar nitrogen accretion response as younger patients even during critical illness. However, there is concern among some clinicians that increasing protein intake in older patients during critical illness may lead to azotemia due to decreased renal functional reserve which may augment the propensity towards worsened renal function and worsened clinical outcomes. Current evidence regarding protein requirements, nitrogen balance, ureagenesis, and clinical outcomes during nutritional therapy for critically ill older patients is reviewed.
Highlights
IntroductionCritical illness is associated with hypermetabolism and marked protein catabolism [1,2]
Critical illness is associated with hypermetabolism and marked protein catabolism [1,2].When excessive protein catabolism is left unabated, patients can experience decreased immunity, increased infections, and worsened survival [3,4,5,6]
Existing guidelines for current dietary protein intake recommendations for recommended dietary reference intake (DRI) or recommended dietary allowance (RDA) for adults is based on nitrogen balance studies [10]
Summary
Critical illness is associated with hypermetabolism and marked protein catabolism [1,2]. When excessive protein catabolism is left unabated, patients can experience decreased immunity, increased infections, and worsened survival [3,4,5,6]. Ill, older surgical or trauma patients with sarcopenia experience greater mortality, more post-operative complications, decreased ventilator-free days and decreased intensive care unit (ICU)-free days [7,8]. It is well established that older patients have less muscle mass and more fat mass than their younger counterparts of similar body weight [9]. Given the pre-existing depletion of muscle mass, it is anticipated that unabated protein catabolism would be detrimental for the critically ill older patient. It is important to appropriately identify who may be at risk for poorer clinical outcomes and who may benefit from an aggressive nutritional strategy
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