title: Protein Turnover and Metabolism in the Elderly Intensive Care Unit Patient.
abstract: Many intensive care unit (ICU) patients do not achieve target protein intakes particularly in the early days following admittance. This period of iatrogenic protein undernutrition contributes to a rapid loss of lean, in particular muscle, mass in the ICU. The loss of muscle in older (aged >60 years) patients in the ICU may be particularly rapid due to a perfect storm of increased catabolic factors, including systemic inflammation, disuse, protein malnutrition, and reduced anabolic stimuli. This loss of muscle mass has marked consequences. It is likely that the older patient is already experiencing muscle loss due to sarcopenia; however, the period of stay in the ICU represents a greatly accelerated period of muscle loss. Thus, on discharge, the older ICU patient is now on a steeper downward trajectory of muscle loss, more likely to have ICU-acquired muscle weakness, and at risk of becoming sarcopenic and/or frail. One practice that has been shown to have benefit during ICU stays is early ambulation and physical therapy (PT), and it is likely that both are potent stimuli to induce a sensitivity of protein anabolism. Thus, recommendations for the older ICU patient would be provision of at least 1.2-1.5 g protein/kg usual body weight/d, regular and early utilization of ambulation (if possible) and/or PT, and follow-up rehabilitation for the older discharged ICU patient that includes rehabilitation, physical activity, and higher habitual dietary protein to change the trajectory of ICU-mediated muscle mass loss and weakness.
authors.affiliation: 1 McMaster University, Department of Kinesiology, Hamilton, Ontario, Canada.
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Phillips
authors.affiliation: 2 Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Roland N
authors.initials: RN
authors.lastname: Dickerson
authors.affiliation: 3 Department of Surgery, Division of Acute Care Surgery, and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, Florida, USA.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore
authors.affiliation: 4 Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Paddon-Jones
authors.affiliation: 5 Nutrition and Dietetics, Department of Internal Medicine, Department of Intensive Care Medicine, and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.|6 Nutrition and Dietetics, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
authors.forename: Peter J M
authors.initials: PJ
authors.lastname: Weijs
mesh_terms: D000368:Aged; D001835:Body Weight; D003422:Critical Care; D004044:Dietary Proteins / Q000378:metabolism*; D004434:Early Ambulation; D006801:Humans; D007362:Intensive Care Units; D018908:Muscle Weakness; D009751:Nutritional Requirements; D010351:Patient Discharge; D055948:Sarcopenia
chemical_list: D004044:Dietary Proteins
keywords: aged; anabolic resistance; intensive care unit; leucine; protein turnover; sarcopenia; skeletal muscle