From the Guidelines
Severe protein malnutrition requires a minimum of 60 g/day and up to 1.5 g/kg IBW per day of protein intake, with higher amounts of up to 2.1 g/kg body mass during weight loss, and at least 90 g/day in cases of severe non-responsive protein malnutrition. The treatment approach should focus on nutritional rehabilitation, medical complications, and gradual refeeding. According to the most recent study 1, protein intake recommendations should be reassessed, particularly in cases of severe protein malnutrition.
Key Considerations
- Protein intake should be individualized, with a range of 60–120 g/day to maintain lean mass, as suggested by 1.
- In patients with severe protein malnutrition and/or malabsorption, at least 90 g/day or as high as 2.1 g/kg IBW per day of protein intake is recommended 1.
- The use of liquid protein supplements can facilitate adequate protein intake, especially in the first period after surgery or during the initial treatment phase 1.
- It is essential to monitor the patient's progress and adjust the protein intake accordingly to prevent complications and ensure optimal recovery.
Comparison with Other Guidelines
While other studies, such as 1, provide recommendations for protein intake in critical illness, the most recent and highest-quality study 1 prioritizes individualized protein intake and higher amounts for severe protein malnutrition. The ESPEN guidelines (2019) recommend 1.3 g/kg/day delivered enterally, but this may not be sufficient for severe protein malnutrition cases 1.
Clinical Implications
In clinical practice, it is crucial to prioritize the patient's nutritional needs and adjust the treatment plan accordingly. The goal is to provide adequate protein intake to support lean mass and prevent further malnutrition, while also monitoring for potential complications and adjusting the treatment plan as needed. By following the recommendations outlined in the most recent study 1, healthcare providers can optimize treatment outcomes for patients with severe protein malnutrition.
From the Research
Requirements for Severe Protein Malnutrition Treatment
The treatment of severe protein malnutrition requires a comprehensive approach, including:
- Early identification and diagnosis of malnutrition 2
- Nutritional risk screening and assessment to identify and quantify specific nutritional problems 2
- Development of nutritional care plans in a multidisciplinary approach 2
- Implementation of standardized nutritional management, including systematic risk screening and assessment 2
- Adequate and timely implementation of nutritional support, which has been linked to favorable outcomes such as decreased length of hospital stay, reduced mortality, and improvements in quality of life and functional status 2
Treatment Approaches
Different treatment approaches have been studied, including:
- High protein treatment, which has been recommended by international critical care nutrition guidelines, but its effectiveness has been challenged by recent studies 3
- Continuous 24-h nasal-jejunal tube feeding of a medium chain triglyceride (MCT) formulation in combination with pancreatic enzyme supplementation, which has been shown to be effective in treating severe post-bariatric hypoalbuminemia 4
- Supplementation and food-based approaches to prevent macro- and micronutrient deficiency 5
Diagnosis and Evaluation
Diagnosis and evaluation of severe protein malnutrition can be done using various parameters, including:
- Weight loss, muscle wasting, and BMI 3
- Serum or plasma levels of nutrients such as albumin, folate, vitamin C, B vitamins, vitamin D, selenium, copper, and zinc 5
- Nutritional biomarkers to evaluate nutrient intake and dietary exposure 5
Importance of Early Recognition and Treatment
Early recognition and treatment of severe protein malnutrition are critical to prevent rapid clinical deterioration and improve outcomes 6, 4