title: Summary Points and Consensus Recommendations From the International Protein Summit.
abstract: The International Protein Summit in 2016 brought experts in clinical nutrition and protein metabolism together from around the globe to determine the impact of high-dose protein administration on clinical outcomes and address barriers to its delivery in the critically ill patient. It has been suggested that high doses of protein in the range of 1.2-2.5 g/kg/d may be required in the setting of the intensive care unit (ICU) to optimize nutrition therapy and reduce mortality. While incapable of blunting the catabolic response, protein doses in this range may be needed to best stimulate new protein synthesis and preserve muscle mass. Quality of protein (determined by source, content and ratio of amino acids, and digestibility) affects nutrient sensing pathways such as the mammalian target of rapamycin. Achieving protein goals the first week following admission to the ICU should take precedence over meeting energy goals. High-protein hypocaloric (providing 80%-90% of caloric requirements) feeding may evolve as the best strategy during the initial phase of critical illness to avoid overfeeding, improve insulin sensitivity, and maintain body protein homeostasis, especially in the patient at high nutrition risk. This article provides a set of recommendations based on assessment of the current literature to guide healthcare professionals in clinical practice at this time, as well as a list of potential topics to guide investigators for purposes of research in the future.
authors.affiliation: 1 Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.|2 Department of Medicine, University of Louisville, Louisville, Kentucky, USA.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Hurt
authors.affiliation: 2 Department of Medicine, University of Louisville, Louisville, Kentucky, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McClave
authors.affiliation: 3 Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Martindale
authors.affiliation: 4 Nestlé HealthCare Nutrition, Inc, Florham Park, New Jersey, USA, and the Department of Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA.
authors.forename: Juan B
authors.initials: JB
authors.lastname: Ochoa Gautier
authors.affiliation: 5 Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Coss-Bu
authors.affiliation: 6 Department of Clinical Pharmacology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
authors.forename: Roland N
authors.initials: RN
authors.lastname: Dickerson
authors.affiliation: 7 Department of Critical Care Medicine, Queens University, Kingston, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.affiliation: 8 Department of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: L John
authors.initials: LJ
authors.lastname: Hoffer
authors.affiliation: 9 Department of Surgery, University of Florida, Gainesville, Florida, USA.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore
authors.affiliation: 10 Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Morris
authors.affiliation: 11 School of Health Professions, University of Texas Medical Branch, Galveston, Texas, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Paddon-Jones
authors.affiliation: 12 Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Jayshil J
authors.initials: JJ
authors.lastname: Patel
authors.affiliation: 13 Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Phillips
authors.affiliation: 14 Department of Surgery, Pontificia Universidad Javeriana Medical School, Hospital Universitario San Ignacio, Bogota, Colombia.
authors.forename: Saúl J
authors.initials: SJ
authors.lastname: Rugeles
authors.affiliation: 15 Department of Medicine, Northshore University Health System, Evanston, Illinois, USA.
authors.forename: Menaka
authors.initials: M
authors.lastname: Sarav Md
authors.affiliation: 16 Department of Medicine, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.
authors.forename: Peter J M
authors.initials: PJ
authors.lastname: Weijs
authors.affiliation: 17 Department of Clinical Science, Karolinska University, Stockholm, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Wernerman
authors.affiliation: 18 Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Hamilton-Reeves
authors.affiliation: 2 Department of Medicine, University of Louisville, Louisville, Kentucky, USA.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: McClain
authors.affiliation: 19 Department of Food and Nutrition, Barnes-Jewish Hospital, St Louis, Missouri, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Taylor
mesh_terms: D016638:Critical Illness; D004044:Dietary Proteins; D006801:Humans; D007362:Intensive Care Units; D009751:Nutritional Requirements; D009752:Nutritional Status; D018529:Nutritional Support
chemical_list: D004044:Dietary Proteins
keywords: amino acids; enteral nutrition; lean body mass; parenteral nutrition; protein