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Appropriate Protein and Specific Amino Acid Delivery Can Improve Patient Outcome: Fact or Fantasy?

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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.

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Disclosure

S.A. McClave: Received honoraria from Nettle Pharmaceuticals and Abbott Pharmaceuticals, and worked as a consultant for Kimberly Clark and Covidien Pharmaceuticals; C.M. Lawson; K.R. Miller; and V.L. Smith reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Department of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center, 1924 Alcoa Highway, Box U-11, Knoxville, TN, 37920, USA

    Christy M. Lawson

  2. Department of Surgery, University of Louisville, Louisville, KY, 40292, USA

    Keith R. Miller

  3. Department of Surgery, Division of Trauma/Critical Care, Stanford University, 300 Pasteur Drive, Room H3591, Stanford, CA, 94305-5641, USA

    Vance L. Smith

  4. Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, KY, 40292, USA

    Stephen A. McClave

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  1. Christy M. Lawson
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  2. Keith R. Miller
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  3. Vance L. Smith
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  4. Stephen A. McClave
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Correspondence to Christy M. Lawson.

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Lawson, C.M., Miller, K.R., Smith, V.L. et al. Appropriate Protein and Specific Amino Acid Delivery Can Improve Patient Outcome: Fact or Fantasy?. Curr Gastroenterol Rep 13, 380–387 (2011). https://doi.org/10.1007/s11894-011-0201-0

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