Protein supplementation in clinical nutrition
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High-Protein Oral Nutritional Supplements in Clinical Nutrition
High-protein oral nutritional supplements (ONS) are widely used to address disease-related malnutrition, especially in older adults and hospitalized patients. Evidence from multiple randomized controlled trials shows that high-protein ONS can reduce complications, lower hospital readmissions, improve grip strength, increase protein and energy intake, and lead to weight gain, all with minimal reduction in normal food intake. These benefits are observed across various patient groups and care settings, suggesting broad applicability and potential economic advantages for healthcare systems .
Routine Protein Supplementation: Effects on Weight, Anthropometry, and Survival
Routine oral or enteral protein supplementation in adults consistently improves body weight and anthropometric measures, such as mid-arm muscle circumference. Some studies also report a reduction in mortality, although the evidence is less robust when only high-quality trials are considered. The benefits of supplementation are not limited to specific patient groups, indicating that routine protein supplementation can be broadly beneficial in clinical nutrition .
Protein Supplementation in Critical Illness
In critically ill patients, such as those with sepsis, trauma, or after major surgery, protein metabolism is significantly altered due to increased stress and inflammation. Adequate protein supplementation during this period is crucial and may have a greater impact on clinical outcomes than caloric supplementation alone. Sufficient protein intake can help counteract the increased protein breakdown and support recovery in these patients . Ongoing research is evaluating the combined effects of early protein (amino acid) supplementation and exercise in improving physical function and reducing muscle wasting in critically ill patients .
Protein and Amino Acid Supplements for Older Adults
Protein and amino acid supplementation is effective in enhancing muscle strength, improving body composition, and reducing frailty and sarcopenia in older adults. Whey protein, creatine, and milk protein, especially when combined with resistance training, yield the best results. Leucine and milk protein can also improve body composition even without exercise. However, the impact on physical performance is still inconclusive, and more research is needed to clarify the benefits of different protein types and supplementation strategies in older adults 410. Supplementing breakfast with a vitamin D and leucine-enriched whey protein drink has been shown to stimulate muscle protein synthesis and increase muscle mass in healthy older men, supporting muscle preservation .
Protein Supplementation in Cancer and Chronic Kidney Disease
In malnourished advanced cancer patients undergoing chemotherapy, whey protein isolate supplementation improves body composition, muscle strength, body weight, and reduces chemotherapy toxicity, especially when combined with nutritional counseling .
For patients with chronic kidney disease (CKD) on dialysis, oral protein-based supplements likely increase serum albumin and may improve prealbumin levels and muscle circumference, particularly in those on hemodialysis and those who are malnourished. However, the evidence is less clear regarding improvements in weight, body mass index, or lean mass, and it is uncertain if these changes translate into better clinical outcomes such as reduced mortality 68.
Conclusion
Protein supplementation in clinical nutrition offers clear benefits for improving nutritional status, muscle strength, and body composition in various patient populations, including the elderly, critically ill, cancer patients, and those with chronic kidney disease. While the evidence supports routine use in many settings, further high-quality research is needed to determine the optimal types, timing, and combinations of protein supplementation, as well as its impact on long-term clinical outcomes.
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