Determining Protein Requirements In The Acutely Ill Patient

This review discusses protein requirements in disease. It begins by explaining how protein requirements are determined in normal health and the process of nutritional adaptation. It points out the salient features of diseases that increase a patient’s protein requirement, with detailed attention to the effect of systemic inflammation both to increase protein requirements and prevent normal adaptation to starvation. The review also explains and reconciles problems of uncertainty about how much protein to provide to acutely ill patients. Finally, it provides the clinical information and physiologic reasoning necessary to choose appropriate amounts of protein to provide to individual acutely ill patients. This review contains 1 figure and 59 references  Key words: adaptation, cachexia, frailty, hypoalbuminemia, inflammation, malnutrition, muscle atrophy, nutritional requirements, protein-energy malnutrition, protein requirements, systemic inflammation