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Cited by 50Clinical Nutrition and GastroenterologyMuscle metabolism and nutritionNutrition and Health in Aging

The 2017 Sir David P Cuthbertson lecture. Amino acids and muscle protein metabolism in critical care

Wolfe, Robert R.·2018·Clinical Nutrition
DOI 10.1016/j.clnu.2017.12.010
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Abstract

In this short review, our current understanding of key aspects of the catabolic response are presented in the context of the seminal contributions of Sir David Cuthbertson. Studies have confirmed that an increase in resting energy expenditure occurs in almost all forms of critical illness and injury. However, meeting the resulting increase in caloric requirement is not an insurmountable problem. The primary focus of nutritional support should be the net loss of body protein. Increased intake of dietary protein may ameliorate, but usually will not entirely reverse, the accelerated loss of body protein because of anabolic resistance. Anabolic resistance is due, at least in part, to impaired inward transport efficiency of amino acids from blood into muscle. Simultaneous consumption of excess non-protein calories in an anabolic resistant state provides minimal additional benefit, and may cause potentially adverse effects, including accumulation of liver fat and excess production of carbon dioxide. Because of the limited effectiveness of dietary protein and non-protein caloric intake, it is likely that traditional nutritional support alone will not reverse the net loss of body protein in the catabolic state. The reversal of the catabolic response can only be accomplished in many patients by combining reasonable nutritional support with appropriate metabolic control. Metabolic control may be achieved with the use of a number of pharmacological approaches, including propranolol, insulin or testosterone. Regardless of the approach, ensuring an adequate availability of dietary essential amino acids is necessary for pharmacologic therapy to result in an increased rate of protein synthesis.

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  • Muscle cells benefit from this response despite net catabolism of muscle mass.

    “Simultaneously, muscle cells benefit from this response despite net catabolism of muscle mass.89, 90”

    From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [90]

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Authors
Wolfe, R. R.
Affiliations
University of Arkansas for Medical Sciences (US)
Corresponding author
Wolfe, Robert R.
ORCID
Wolfe, Robert R.
Venue
Clinical Nutrition
Publisher
Elsevier BV
Published
2018-08
Volume
37
Issue
4
Pages
1093-1100
ISSN
0261-5614 (ISSN-L)
DOI
10.1016/j.clnu.2017.12.010
OpenAlex
W2781337831
Cited by
50
References
39
Citations by year
2026: 4 · 2025: 2 · 2024: 3 · 2023: 8 · 2022: 5 · 2021: 5 · 2020: 12 · 2019: 7 · 2018: 4
FWCI
0.65
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Shriners Hospitals
  • Abbott Nutrition
  • Baxter Nutrition
  • National Institutes of Health (P30 AG028718)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords
amino acids, muscle protein metabolism, critical illness, catabolic response, anabolic resistance, nutritional support, resting energy expenditure, protein loss, essential amino acids, metabolic control, propranolol, insulin, testosterone
MeSH terms
Amino Acids, Critical Care, Energy Metabolism, Humans, Metabolism, Muscle Proteins, Nutritional Requirements

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