ESPEN 2020 Abstract Submission

Topic: Critical care

Abstract Submission Identifier: ESPEN20-ABS-1374

QUANTITATIVE PROTEIN INTAKE AND LOSS OF MUSCLE MASS IN CRITICALLY ILL PATIENTS: RESULTS OF A RANDOMIZED CONTROLLED TRIAL

E. Dresen^*, ¹, C. Weißbrich ², R. Fimmers ³, C. Putensen ², P. Stehle ¹

¹Institute of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, ²Department of Anesthesiology and Intensive Care Medicine, ³Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany

Rationale: Trauma-related degradation of muscle mass is accompanied by a loss of metabolic functions and is associated with adverse outcome of critically ill patients. We hypothesized that an increased quantity of protein/amino acids within a balanced nutrition therapy minimize muscle mass deprivation.

Methods: A randomized controlled trial (DRKS-ID: DRKS00013594) was conducted in critically ill patients (post-surgery, cardiac surgery, pulmonary diseases) in a routine clinical setting (SOP-guided therapy: combination of enteral and parenteral nutrition). Eligible subjects were randomly assigned to either an intervention group (IG: 1.8 g protein/kg body weight [bw]/d) or a standard group (SG: 1.2 g protein/kg bw/d). Energy intake was based on actual REE measurements (indirect calorimetry). Non-protein energy was provided by carbohydrates and fat (60:40%); commercial products used provided sufficient micronutrients. Individual energy and nutrient intake was monitored daily. Primary outcome was quadriceps muscle layer thickness (QMLT; sonography) measured at inclusion (d0), d16±2 (intermediate) and d28±2 (final) and presented as mean±SD. Power calculation was based on a pilot study in hospitalized patients (detection limit: 5% muscle mass changes; n=42 with 80% of power). Group comparisons were made using unpaired two-samples t-tests. Linear mixed models were applied to evaluate the effect of target protein intake (group), intervention day (time) and their interaction on QMLT (∆QMLT).

Results: Fourty-two per-protocol patients (65±15 y; 12 female; SAPS 45±11; TISS 20±7; SOFA 7±3) were included. In both IG and SG, daily protein intake was lower than target but significantly different between groups (IG: 1.5±0.5 g/kg bw/d; SG: 1.0±0.4 g/kg bw/d; P<0.001); mean total energy intake was slightly lower than planned at comparable levels (IG: 1989±655; SG: 1950±828 kcal/d; P=0.403). At d0, QMLT was not different between groups (IG: 13.5±7.4 mm; SG: 13.4±7.1 mm; n=21 each; P=0.967). ∆QMLT at intermediate (IG: -0.49±3.2 mm; SG: -0.002±3.3 mm; P=0.645) and final (IG: -2.00±3.0 mm; SG: -3.47±3.0 mm; P=0.219) measurement did not differ between groups. Muscle mass decreased generally in both groups over time with no treatment effect (time, P<0.001; intervention, P=0.368; time x intervention, P=0.242).

Conclusion: In contrast to our hypothesis, an increase of daily protein supply above 1 g/kg bw within proven routine nutrition concepts did not further affect critical illness-specific loss of muscle mass. Whether this observation is probably attributed to a still too low quantity or an inadequate quality of protein sources given remains questionable.

Disclosure of Interest: None Declared

Keywords: Muscle Mass, Protein Intake