Hogeschool van Amsterdam

Urban Vitality

Protein turnover and metabolism in the elderly intensive care unit patient


Many intensive care unit (ICU) patients do not achieve target protein intakes particularly in the early days following admittance. This period of iatrogenic protein undernutrition contributes to a rapid loss of lean, in particular muscle, mass in the ICU. The loss of muscle in older (aged >60 years) patients in the ICU may be particularly rapid due to a perfect storm of increased catabolic factors, including systemic inflammation, disuse, protein malnutrition, and reduced anabolic stimuli. This loss of muscle mass has marked consequences. It is likely that the older patient is already experiencing muscle loss due to sarcopenia; however, the period of stay in the ICU represents a greatly accelerated period of muscle loss. Thus, on discharge, the older ICU patient is now on a steeper downward trajectory of muscle loss, more likely to have ICU-acquired muscle weakness, and at risk of becoming sarcopenic and/or frail. One practice that has been shown to have benefit during ICU stays is early ambulation and physical therapy (PT), and it is likely that both are potent stimuli to induce a sensitivity of protein anabolism. Thus, recommendations for the older ICU patient would be provision of at least 1.2-1.5 g protein/kg usual body weight/d, regular and early utilization of ambulation (if possible) and/or PT, and follow-up rehabilitation for the older discharged ICU patient that includes rehabilitation, physical activity, and higher habitual dietary protein to change the trajectory of ICU-mediated muscle mass loss and weakness.

Reference Phillips, S. M., Dickerson, R. N., Moore, F. A., Paddon-Jones, D., & Weijs, P. J. M. (2017). Protein turnover and metabolism in the elderly intensive care unit patient. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 32(1_suppl), 112S-120S. https://doi.org/10.1177/0884533616686719
Published by  Faculty Sports and Nutrition 1 January 2017

Publication date

Jan 2017


Stuart M. Phillips
Roland N. Dickerson
Frederick A. Moore
Douglas Paddon-Jones