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The role of visceral proteins in the nutritional assessment of intensive care unit patients.

Abstract

PURPOSE OF REVIEW

This review analyses the recently published literature focusing on nutritional assessment in intensive care unit patients. The metabolic response to nutritional intervention is difficult to evaluate in critically ill patients whose body weight is influenced largely by massive fluid administration or losses. Visceral protein plasma levels have been proposed for this purpose, because they reflect hepatic synthesis in response to nutrient supply. However, in acute inflammatory states, liver activity is converted to the synthesis of acute-phase response proteins, resulting in a dramatic drop in visceral proteins, despite nutritional support.

RECENT FINDINGS

The data regarding visceral protein levels were examined in relation to nutritional supplementation, and compared with other nutritional parameters and clinical outcomes. Transthyretin and retinol-binding protein levels seem to be the most sensitive to nutritional intervention. They are also the earliest to rise at the decrease of acute-phase protein levels, therefore representing a good index of the reversing reprioritization of hepatic protein synthesis. An inconsistent relationship was found between visceral protein plasma levels and clinical outcome in intensive care unit patients, probably because of the difficulty in demonstrating clearly a beneficial effect of nutritional supplementation in highly catabolic conditions.

SUMMARY

In the acute stage of critical illness, the bi-weekly measurement of transthyretin together with acute-phase response protein plasma levels seems to be a 'window' on the metabolic condition (anabolism versus catabolism). However, only in the presence of stable inflammatory parameters do transthyretin levels reflect the adequacy of nutritional coverage.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Division of Clinical Nutrition, University Hospital, Geneva, Switzerland.

    ,

    Source

    MeSH

    Acute-Phase Proteins
    Critical Care
    Critical Illness
    Energy Metabolism
    Humans
    Nutrition Assessment
    Nutritional Status
    Prealbumin
    Retinol-Binding Proteins
    Retinol-Binding Proteins, Plasma
    Stress, Physiological

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    12589191

    Citation

    Raguso, Comasia A., et al. "The Role of Visceral Proteins in the Nutritional Assessment of Intensive Care Unit Patients." Current Opinion in Clinical Nutrition and Metabolic Care, vol. 6, no. 2, 2003, pp. 211-6.
    Raguso CA, Dupertuis YM, Pichard C. The role of visceral proteins in the nutritional assessment of intensive care unit patients. Curr Opin Clin Nutr Metab Care. 2003;6(2):211-6.
    Raguso, C. A., Dupertuis, Y. M., & Pichard, C. (2003). The role of visceral proteins in the nutritional assessment of intensive care unit patients. Current Opinion in Clinical Nutrition and Metabolic Care, 6(2), pp. 211-6.
    Raguso CA, Dupertuis YM, Pichard C. The Role of Visceral Proteins in the Nutritional Assessment of Intensive Care Unit Patients. Curr Opin Clin Nutr Metab Care. 2003;6(2):211-6. PubMed PMID: 12589191.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The role of visceral proteins in the nutritional assessment of intensive care unit patients. AU - Raguso,Comasia A, AU - Dupertuis,Yves M, AU - Pichard,Claude, PY - 2003/2/18/pubmed PY - 2003/7/8/medline PY - 2003/2/18/entrez SP - 211 EP - 6 JF - Current opinion in clinical nutrition and metabolic care JO - Curr Opin Clin Nutr Metab Care VL - 6 IS - 2 N2 - PURPOSE OF REVIEW: This review analyses the recently published literature focusing on nutritional assessment in intensive care unit patients. The metabolic response to nutritional intervention is difficult to evaluate in critically ill patients whose body weight is influenced largely by massive fluid administration or losses. Visceral protein plasma levels have been proposed for this purpose, because they reflect hepatic synthesis in response to nutrient supply. However, in acute inflammatory states, liver activity is converted to the synthesis of acute-phase response proteins, resulting in a dramatic drop in visceral proteins, despite nutritional support. RECENT FINDINGS: The data regarding visceral protein levels were examined in relation to nutritional supplementation, and compared with other nutritional parameters and clinical outcomes. Transthyretin and retinol-binding protein levels seem to be the most sensitive to nutritional intervention. They are also the earliest to rise at the decrease of acute-phase protein levels, therefore representing a good index of the reversing reprioritization of hepatic protein synthesis. An inconsistent relationship was found between visceral protein plasma levels and clinical outcome in intensive care unit patients, probably because of the difficulty in demonstrating clearly a beneficial effect of nutritional supplementation in highly catabolic conditions. SUMMARY: In the acute stage of critical illness, the bi-weekly measurement of transthyretin together with acute-phase response protein plasma levels seems to be a 'window' on the metabolic condition (anabolism versus catabolism). However, only in the presence of stable inflammatory parameters do transthyretin levels reflect the adequacy of nutritional coverage. SN - 1363-1950 UR - https://www.unboundmedicine.com/medline/citation/12589191/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=12589191 DB - PRIME DP - Unbound Medicine ER -