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Open AccessFeature PaperReview

Nitrogen Balance and Protein Requirements for Critically Ill Older Patients

Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, 881 Madison Avenue, Suite 345, Memphis, TN 38163, USA
Nutrients 2016, 8(4), 226; https://doi.org/10.3390/nu8040226
Received: 7 March 2016 / Revised: 11 April 2016 / Accepted: 13 April 2016 / Published: 18 April 2016
(This article belongs to the Special Issue Nutrition for Older People)
Critically ill older patients with sarcopenia experience greater morbidity and mortality than younger patients. It is anticipated that unabated protein catabolism would be detrimental for the critically ill older patient. Healthy older subjects experience a diminished response to protein supplementation when compared to their younger counterparts, but this anabolic resistance can be overcome by increasing protein intake. Preliminary evidence suggests that older patients may respond differently to protein intake than younger patients during critical illness as well. If sufficient protein intake is given, older patients can achieve a similar nitrogen accretion response as younger patients even during critical illness. However, there is concern among some clinicians that increasing protein intake in older patients during critical illness may lead to azotemia due to decreased renal functional reserve which may augment the propensity towards worsened renal function and worsened clinical outcomes. Current evidence regarding protein requirements, nitrogen balance, ureagenesis, and clinical outcomes during nutritional therapy for critically ill older patients is reviewed. View Full-Text
Keywords: nitrogen balance; critical illness; requirements; trauma; protein; aging; elderly; catabolism; obesity nitrogen balance; critical illness; requirements; trauma; protein; aging; elderly; catabolism; obesity
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Dickerson, R.N. Nitrogen Balance and Protein Requirements for Critically Ill Older Patients. Nutrients 2016, 8, 226.

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