Correlation of energy and protein intake with nitrogen balance changes in late acute phase critically ill patients
Abstract
Background: The hypercatabolic process due to metabolic stress in critically ill patients, especially in the acute phase, is very high, causing protein degradation. Inadequate intake and high protein losses will result in a negative nitrogen balance. Objective: To analyze the correlation of energy and protein intake in the late acute phase with nitrogen balance changes. Methods: This study’s method was cross−sectional with consecutive sampling, conducted in the ICU of the university of Indonesia hospital. Energy and protein intake were assessed for 7 days. On days 3 and 7 of treatment, 24−hour urine urea nitrogen levels and nitrogen balance (NB) were assessed. Twenty three subjects participants in this study. Results: There was a positive correlation between energy and protein intake with NB on day 3 (r=0.5, p=0.01 ;r=0.6, p=0.003). The mean nitrogen balance changes was positive, namely 3.8 g. There was a significant correlation between energy and protein intake with NB changes (p>0.01) Conclusion: Energy and protein intake were positively correlated with nitrogen balance in the early acute phase. The results show that the administration of energy and protein starting at low intake in the early acute phase and gradually reaching the target intake during the late acute phase leads to an improvement in nitrogen balance.Downloads
References
Surbatovic M, Vojvodic D, Khan W. (2018). Immune response in critically ill patients. Mediators of Inflammation. July 16, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079405/pdf/MI2018-9524315.pdf
Bennett KA, Robertson LC, Al-Haddad M. (2015). Recognizing the critically ill patient. Anaesthesia and Intensive Care Medicine, 17(1): 1-4. January 25, 2015. Recognizing the critically ill patient - Anaesthesia & Intensive Care Medicine (anaesthesiajournal.co.uk)
The Society of Critical Care Medicine (SCCM). Critical care statistics in the United States, 2022. https://www.sccm.org/Communications/Critical-Care-Statistics
Rustini SA, Ni Made MEP, Hurai R, Ni Kadek AS, Susiladewi IAV, Ni Putu EDY, et al. Layanan keperawatan intensif 2023. https://simdos.unud.ac.id/uploads/file_penelitian_1_dir/d186c65b1bd87f4c064956c01f47b31c.pdf
Elke G, Hartl WH, Kreymann KG, Adolph M, Felbinger TW, Graf T, et al. (2019). Clinical nutrition in critical care medicine guideline of the German Society for Nutritional Medicine (DGEM). Clinical Nutrition ESPEN 2019(33): 220-275 https://doi.org/10.1016/j.clnesp.2019.05.002
Preiser JC, Ichai C, Orban JC, Groeneveld ABJ. (2014). Metabolic response to the stress of critical illness. British Journal of Anaesthesia, 113 (6): 945–54. June 26, 2014 Metabolic response to the stress of critical illness (bjanaesthesia.org)
Hsu C, Sun C, Tsai C, Chen M, Wang S, Hsu J, et al. (2021). Metabolism of proteins and amino acids in critical illness: from physiological alterations to relevant clinical practice. Journal of Multidisciplinary Healthcare, 14:1107–1117. May 2021. https://www.researchgate.net/publication/351573137_Metabolism_of_Proteins_and_Amino_Acids_in_Critical_Illness_From_Physiological_Alterations_to_Relevant_Clinical_Practice
Weiner ID, Mitch WE, Sands JM. (2014). Urea and ammonia metabolism and the control of renal nitrogen excretion. Clinical Journal American Soc Nephrology, 10(8): 1444-1458. August 7, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527031/
Churrniadita N, Sutanto LB, Sedono R. (2017). Nitrogen balance and its relation with energy and protein intake in critically ill elderly patients. World Nutrition Journal 2017; 1(1). https://worldnutrijournal.org/OJS/index.php/WNJ/article/view/0002
Wiryana M, Sinardja IK, Senapathi TGA, Widnyana IMG, Panji PAS, Aryabiantara IW, et al. (2016). Correlation between protein intake and nitrogen balance of surgical patients in anesthesiology and intensive care installation, Sanglah General Hospital, Denpasar, Bali, Indonesia. Bali Medical Journal 2016; 5(2): 61-65. https://www.semanticscholar.org/paper/Correlation-Between-Protein-Intake-and-Nitrogen-of-Wiryana-Sinardja/202ef1e24020cc4b8cbfc8ddcfca9222273a34c0
Ferrie S, Allman-Farinelli M, Daley M, Smith K. (2015). Protein requirements in the critically ill: a randomized controlled trial using parenteral nutrition. Journal of Parenteral and Enteral Nutrition 2015; 20(10). https://aspenjournals.onlinelibrary.wiley.com/doi/10.1177/0148607115618449
Clark A, Imran J, Madni T, Wolf SE. (2017). Nutrition and metabolism in burn patients. Biomed Central Burns and Trauma, 5: 11. April 17, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393025/
Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casear MP, et al. (2018). ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition, 38: 48-79. 2019. https://www.clinicalnutritionjournal.com/article/S0261-5614(18)32432-4/fulltext
Koekkoek WAC, van Setten CH, Olthof LE, Kars JCN, van Zanten ARH. (2018). Timing of protein intake and clinical outcomes of adult critically ill patient on prolonged mechanical ventilation: the protinvent retrospective study. Clinical Nutrition, 38(2): P883-890. April, 2019. https://www.clinicalnutritionjournal.com/article/S0261-5614(18)30075-X/fulltext
Bendavid I, Zusman O, Kagan I, Theilla M, Cohen J, Singer P. (2019). Early administration of protein in critically ill patients: a retrospective cohort study. Nutrients, 11(1): 106. January 7, 2019. https://www.mdpi.com/2072-6643/11/1/106
Sharma K, Mogensen KM, Robinson MK. (2018). Pathophysiology of critical illness and role of nutrition. Nutrition in Clinical Practice, 34(1): 12–22. December 23, 2018. https://aspenjournals.onlinelibrary.wiley.com/doi/10.1002/ncp.10232
Preiser JC, Ichai C, Ichai C, Groeneveld ABJ. (2016). Succesive phases of the metabolic response to stress. the stress response of critical illness. Metabolic and Hormonal Aspects Chapter 2: 5-18. https://www.bjanaesthesia.org/article/S0007-0912(17)30650-5/fulltext
Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W, et al. (2020). KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. American Journal of Kidney Disease, 76(3): S1-S107. November 21, 2020. https://www.ajkd.org/article/S0272-6386(20)30726-5/fulltext
Dupuis C, Bret A, Janer A, Guido O, Bouzgarrou R, Dopeux L, et al. (2022). Association of nitrogen balance trajectories with clinical outcomes in critically ill COVID-19 patient: a retrospective cohort study. Clinical Nutrition, 14(12): 2895-2902. September 6, 2022. https://europepmc.org/article/MED/36109282
Pfortmueller CA, Meisel C, Fux M, Schefold JC. (2017). Assessment of immune organ dysfunction in critical illness: utility of innate immune response markers. Intensive Care Medicine Experimental, 5:49. October 23, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653680/
Arabi YM, Al-Dorzi HM, Mehta S, Tamim HM, Haddad SH, Jones G, et al. (2017). Association of protein intake with the outcomes of critically ill patients: a post hoc analysis of the PermiT trial. American Journal Clinical Nutrition, 108: 988-996. November 23, 2018. https://www.nejm.org/doi/10.1056/NEJMoa1502826?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200www.ncbi.nlm.nih.gov
Sanches ACS, De Goes CR, Bufarah MNB, Balbi AL, Ponce D. (2016). Resting energy expenditure in critically ill patients: evaluation methods and clinical applications. Rev Assoc Med Bras, 62(7): 672-679. October, 2016. https://pubmed.ncbi.nlm.nih.gov/27925048/
Singer P. (2020). Protein metabolism and requirements in the ICU. Clinical Nutrition ESPEN, 38: P3-8. August, 2020. Protein metabolism and requirements in the ICU - Clinical Nutrition ESPEN
Submitted
Copyright (c) 2025 Githa Putri Puspita Sari, Fiastuti Witjaksono, Krisadelfa Sutanto, Anna Maurina Singal
This work is licensed under a Creative Commons Attribution 4.0 International License.
World Nutrition Journal provides immediate open access to its content under the Creative Commons Attribution License (CC BY 4.0). This permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
