Nutrition Support for Persistent Inflammation, Immunosuppression, and Catabolism Syndrome

Frederick A. Moore, Stuart M. Phillips, Craig J. McClain, Jayshil J. Patel, Robert Martindale

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Despite tremendous advances in critical care, multiple-organ failure continues to be a significant problem. However, in recent years, far fewer patients with multiple-organ failure die early, but many experience ongoing immune dysregulation and are developing persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Most PICS patients are discharged to nonhome destinations, fail to rehabilitate, and succumb to indolent death. From a nutrition perspective, patients with PICS experience persistent inflammation-induced cachexia despite evidenced-based recommended intensive care unit nutrition support. Recent basic and translational research indicates that prolonged expansion of myeloid-derived suppressor cells plays a central role in the pathogenesis of PICS. Myeloid-derived suppressor cells express arginase 1, which depletes arginine, causing immunosuppression and impaired wound healing. This is the rationale for arginine supplementation in PICS. Other nutrition support recommendations for PICS are based on inferences made from other patient populations who experience similar persistent inflammation-induced cachexia. These include patients with established cancers, major burns, and sarcopenia. These patients experience anabolic resistance, but studies show that this can be overcome by providing higher levels of protein and certain specific amino acids. Nutrition support guidelines recommend provision of >1.5 g/kg/d of protein and indicate that higher levels may be needed. Protein composition is also important. There is good evidence that leucine can promote anabolism in patients with cancer and sarcopenia. Finally, anabolic interventions - including intensive insulin, oxandrolone, propranolol, and resistance exercise - have proven to be effective in patients with major burns and are likely relevant in combating PICS cachexia.

Original languageEnglish (US)
Pages (from-to)121S-127S
JournalNutrition in Clinical Practice
Volume32
Issue number1_suppl
DOIs
StatePublished - Apr 1 2017

Fingerprint

Immunosuppression
Inflammation
Cachexia
Sarcopenia
Multiple Organ Failure
Burns
Arginine
Oxandrolone
Arginase
Nutrition Policy
Proteins
Translational Medical Research
Critical Care
Propranolol
Leucine
Wound Healing
Intensive Care Units
Neoplasms
Exercise
Insulin

Keywords

  • arginine
  • critical illness
  • dietary proteins
  • enteral nutrition
  • inflammation
  • leucine
  • multiple organ failure
  • nutritional support
  • parenteral nutrition

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Nutrition Support for Persistent Inflammation, Immunosuppression, and Catabolism Syndrome. / Moore, Frederick A.; Phillips, Stuart M.; McClain, Craig J.; Patel, Jayshil J.; Martindale, Robert.

In: Nutrition in Clinical Practice, Vol. 32, No. 1_suppl, 01.04.2017, p. 121S-127S.

Research output: Contribution to journalArticle

Moore, Frederick A. ; Phillips, Stuart M. ; McClain, Craig J. ; Patel, Jayshil J. ; Martindale, Robert. / Nutrition Support for Persistent Inflammation, Immunosuppression, and Catabolism Syndrome. In: Nutrition in Clinical Practice. 2017 ; Vol. 32, No. 1_suppl. pp. 121S-127S.
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