An attenuated rate of leg muscle protein depletion and leg free amino acid efflux over time is seen in ICU long-stayers
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BACKGROUND: There is extensive documentation on skeletal muscle protein depletion during the initial phase of critical illness. However, for intensive care unit (ICU) long-stayers, objective data are very limited. In this study, we examined skeletal muscle protein and amino acid turnover in patients with a prolonged ICU stay. METHODS: Patients (n = 20) were studied serially every 8-12 days between days 10 and 40 of their ICU stay as long as patients stayed in the ICU. Leg muscle protein turnover was assessed by measurements of phenylalanine kinetics, for which we employed a stable isotope-labeled phenylalanine together with two-pool and three-pool models for calculations, and results were expressed per 100 ml of leg volume. In addition, leg muscle amino acid flux was studied. RESULTS: The negative leg muscle protein net balance seen on days 10-20 of the ICU stay disappeared by days 30-40 (p = 0.012). This was attributable mainly to an increase in the de novo protein synthesis rate (p = 0.007). It was accompanied by an attenuated efflux of free amino acids from the leg. Leg muscle protein breakdown rates stayed unaltered (p = 0.48), as did the efflux of 3-methylhistidine. The arterial plasma concentrations of free amino acids did not change over the course of the study. CONCLUSIONS: In critically ill patients with sustained organ failure and in need of a prolonged ICU stay, the initial high rate of skeletal muscle protein depletion was attenuated over time. The distinction between the acute phase and a more prolonged and more stable phase concerning skeletal muscle protein turnover must be considered in study protocols as well as in clinical practice. TRIAL REGISTRATION: Australian New Zealand Trial Registry, ACTRN12616001012460 . Retrospectively registered on 1 August 2016.
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Recent stable isotope studies demonstrate that amino acid conversion is improved with time, allowing an increase in whole body protein production only after the early period of the acute phase, even increasing further in the post-acute phase.
“Recent stable isotope studies [63,64] demonstrate that amino acid conversion is improved with time, allowing an increase in whole body protein production only after the early period of the acute phase, even increasing further in the post-acute phase.”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [63]
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ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit
Singer, P., Blaser, A. R., Berger, M. M., Calder, P. C., Casaer, M., Hiesmayr, M., Mayer, K., Montejo-Gonzalez, J. C., Pichard, C., Preiser, J.-C., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.07.011 · Cited by 793 · see citing works
High protein intake during the early phase of critical illness: Yes or no?
Preiser, J.-C. (2018) · Critical Care · doi:10.1186/s13054-018-2196-5 · Cited by 44 · see citing works
- Authors
- Gamrin-Gripenberg, L., Sundström-Rehal, M., Olsson, D., Grip, J., Wernerman, J., & Rooyackers, O.
- Affiliations
- Karolinska Institutet (SE)
- Karolinska University Hospital (SE)
- Corresponding author
- Rooyackers, Olav
- Venue
- Critical Care
- Published
- 2018-01-23
- Volume
- 22
- Issue
- 1
- Pages
- 13-13
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC5782367
- OpenAlex
- W2792457722
- Cited by
- 71
- References
- 1
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 12 · 2023: 6 · 2022: 10 · 2021: 6 · 2020: 11 · 2019: 4 · 2018: 4
- FWCI
- 3.46
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Critical Care (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Stockholms Läns Landsting
- Vetenskapsrådet
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- skeletal muscle protein turnover, phenylalanine kinetics, de novo protein synthesis, muscle protein degradation, 3-methylhistidine, prolonged ICU stay, critical illness, muscle atrophy, organ failure
- MeSH terms
- Aged, Amino Acids, Female, Humans, Intensive Care Units, Leg, Length of Stay, Male, Middle Aged, Muscle Proteins, Phenylalanine, Sweden, Time Factors, Muscle, Skeletal
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