title: Appropriate protein and specific amino acid delivery can improve patient outcome: fact or fantasy?
abstract: Protein utilization and requirements in critical illness are much researched and debated topics. The enhanced turnover and catabolism of protein in the setting of critical illness is well described and multifactorial in nature. The need to preserve lean body mass and enhance nitrogen retention in this state to improve immunologic function and reduce morbidity is well described. Debates as to the optimum amount of protein to provide in such states still exist, and a significant amount of research has contributed to our understanding of not only how much protein to supply to these patients, but how best to do so. Small peptide formulations, intact protein formulations, branched chain amino acids, and specialty formulas all exist, and their benefits, drawbacks, and potential uses have been investigated. Specific amino acid therapy has become part of the concept of immunonutrition, or the modification and enhancement of the immune response with specific nutrients. In this article, we describe the changes in outcomes demonstrated through the provision of protein, both as a macronutrient and as specific amino acids.
authors: Department of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center, Knoxville, TN 37920, USA. cmlawson@utmck.edu
authors: Christy M
authors: CM
authors: Lawson
authors: Keith R
authors: KR
authors: Miller
authors: Vance L
authors: VL
authors: Smith
authors: Stephen A
authors: SA
authors: McClave
references: Curr Opin Clin Nutr Metab Care. 2004 Jan;7(1):45-51
references: 15090903
references: Arch Surg. 2002 Feb;137(2):174-80
references: 11822956
references: Ann Surg. 1987 Mar;205(3):288-94
references: 3103555
references: Clin Nutr. 2011 Aug;30(4):513-6
references: 21281994
references: Nutr Clin Pract. 2010 Jun;25(3):257-64
references: 20581319
references: Amino Acids. 2006 Feb;30(1):81-6
references: 15924211
references: Lancet. 2001 Sep 1;358(9283):696-701
references: 11551575
references: Ann Surg Oncol. 2007 Oct;14(10):2798-806
references: 17632760
references: Arch Surg. 1999 Dec;134(12):1309-16
references: 10593328
references: J Biol Chem. 2009 Dec 18;284(51):35338-47
references: 19820234
references: Curr Pharm Des. 2010;16(37):4089-102
references: 21247398
references: J Nutr Biochem. 2003 May;14(5):251-8
references: 12832028
references: Ann Surg. 2008 Aug;248(2):212-20
references: 18650630
references: Am J Clin Nutr. 1985 Oct;42(4):577-84
references: 3931450
references: Crit Care Med. 2002 Sep;30(9):2022-9
references: 12352035
references: J Trauma. 1990 Jul;30(7):825-8; discussion 828-9
references: 2116533
references: Ann Surg. 2009 Jun;249(6):1062-3; author reply 1063-4
references: 19474663
references: Clin Nutr. 2006 Apr;25(2):210-23
references: 16697087
references: N Engl J Med. 2005 Oct 6;353(14):1489-501
references: 16207851
references: Br J Nutr. 2002 Jan;87 Suppl 1:S121-32
references: 11895148
references: Nutr Clin Pract. 2003 Dec;18(6):461-82
references: 16215082
references: Shock. 2005 Dec;24(6):583-9
references: 16317391
references: Curr Opin Gastroenterol. 2005 Mar;21(2):197-200
references: 15711213
references: J Nutr. 2007 Jun;137(6 Suppl 2):1687S-1692S
references: 17513448
references: Am J Kidney Dis. 2009 Feb;53(2):208-17
references: 18950911
references: Proc Nutr Soc. 2007 Aug;66(3):378-83
references: 17637090
references: J Trauma. 2004 Sep;57(3):660-78; discussion 679
references: 15454822
references: J Gastroenterol. 2000;35 Suppl 12:7-12
references: 10779207
references: Eur J Clin Nutr. 2005 Jan;59(1):145-7
references: 15266308
references: Ann Surg. 1996 Apr;223(4):395-405
references: 8633918
references: Dis Esophagus. 2008;21(8):708-11
references: 18847452
references: Arch Surg. 1999 Apr;134(4):428-33
references: 10199318
references: Laryngoscope. 1999 Jun;109(6):915-21
references: 10369282
references: J Immunol. 1989 Dec 1;143(11):3641-6
references: 2584712
references: Gastroenterology. 2002 Jun;122(7):1763-70
references: 12055582
references: Clin Sci (Lond). 2009 Jun 02;117(1):23-30
references: 19105791
references: J Nutr. 2006 Jan;136(1 Suppl):295S-8S
references: 16365102
references: J Ren Nutr. 2007 May;17(3):179-88
references: 17462550
references: Curr Opin Clin Nutr Metab Care. 2006 Sep;9(5):607-12
references: 16912558
references: JPEN J Parenter Enteral Nutr. 1989 Jul-Aug;13(4):382-6
references: 2778942
references: JPEN J Parenter Enteral Nutr. 1992 Nov-Dec;16(6):499-504
references: 1494204
references: Shock. 2010 Apr;33(4):344-52
references: 19789465
references: Am J Kidney Dis. 2006 Dec;48(6):879-88
references: 17162142
references: Gastroenterology. 2006 Feb;130(2 Suppl 1):S106-16
references: 16473057
references: Clin Nutr. 2005 Aug;24(4):502-9
references: 15899538
references: Nutrition. 2011 Apr;27(4):440-4
references: 21167685
references: Curr Opin Clin Nutr Metab Care. 2003 Mar;6(2):217-22
references: 12589192
references: J Ren Nutr. 2010 Sep;20(5 Suppl):S31-4
references: 20797568
references: World J Gastroenterol. 2009 Jun 7;15(21):2570-8
references: 19496185
references: J Nutr. 2004 Oct;134(10 Suppl):2826S-2829S; discussion 2853S
references: 15465794
references: Br J Nutr. 1988 Jul;60(1):121-36
references: 3044443
references: Nutrition. 2002 Jul-Aug;18(7-8):546-52
references: 12093428
references: JPEN J Parenter Enteral Nutr. 2009 May-Jun;33(3):277-316
references: 19398613
references: World J Surg. 2009 Sep;33(9):1815-21
references: 19629583
references: JPEN J Parenter Enteral Nutr. 1991 Jan-Feb;15(1):42-7
references: 1901107
references: An Acad Bras Cienc. 2010 Jun;82(2):417-30
references: 20563423
references: J Nephrol. 2001 Nov-Dec;14(6):433-9
references: 11783598
references: Scand J Surg. 2007;96(1):46-50
references: 17461312
references: J Nutr. 2000 Jul;130(7):1835S-40S
references: 10867060
references: Am J Clin Nutr. 2009 Jan;89(1):142-52
references: 19056593
references: Intensive Care Med. 2001 Jan;27(1):84-90
references: 11280678