Mohamed Mohamed A, Doleman Brett, Phillips Bethan E, Williams John P
Centre of Metabolism, Ageing and Physiology (COMAP), MRC-Versus Arthritis Centre of Musculoskeletal Ageing Research (CMAR) and Nottingham NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK.
Department of Anaesthetics and Intensive Care, Royal Derby Hospital, Derby DE22 3NE, UK.
Nutrients. 2025 Aug 12;17(16):2613. doi: 10.3390/nu17162613.
owing to altered protein metabolism during critical illness, skeletal muscles are utilised as a source of protein, with subsequent debilitating effects on both muscle structure and function. Protein nutrition has been shown to improve clinical outcomes in critically unwell patients; however, the impact on muscle function is less established. Therefore, the aim of this review was to systematically determine the effect of protein dose on skeletal muscle strength in critically ill patients.
we searched five databases (Ovid MEDLINE, Embase, Emcare, CINAHL, and PubMed) and clinical trial registers for randomised controlled trials (RCTs) of non-pregnant, adult patients admitted to an intensive care unit (ICU), which assessed the impact of different doses of protein nutrition on muscle strength. Studies investigating only muscle structure or with co-interventions were excluded. Six RCTs were eligible for inclusion, and five were suitable for meta-analysis.
there was a significant difference in skeletal muscle strength with higher versus lower protein intakes, with a mean difference of 2.36 kg (95% CI: 0.37-4.35). The mean difference in protein dose was 0.46 g/kg/d (95% CI: 0.29-0.64). Inconsistency was evident across the included studies, with risk of bias ranging from moderate to high.
muscle strength of ICU patients does appear to be affected by different protein doses. However, trials focusing on muscle function are limited by number and quality, highlighting a clear need for future work.
由于危重病期间蛋白质代谢改变，骨骼肌被用作蛋白质来源，随后对肌肉结构和功能产生衰弱作用。蛋白质营养已被证明可改善危重病患者的临床结局；然而，其对肌肉功能的影响尚不明确。因此，本综述的目的是系统地确定蛋白质剂量对危重病患者骨骼肌力量的影响。
我们检索了五个数据库（Ovid MEDLINE、Embase、Emcare、CINAHL和PubMed）以及临床试验注册库，以查找针对入住重症监护病房（ICU）的非妊娠成年患者的随机对照试验（RCT），这些试验评估了不同剂量蛋白质营养对肌肉力量的影响。仅研究肌肉结构或有联合干预措施的研究被排除。六项RCT符合纳入标准，五项适合进行荟萃分析。
高蛋白摄入量与低蛋白摄入量相比，骨骼肌力量存在显著差异，平均差异为2.36千克（95%置信区间：0.37 - 4.35）。蛋白质剂量的平均差异为0.46克/千克/天（95%置信区间：0.29 - 0.64）。纳入的研究中存在明显的不一致性，偏倚风险从中度到高度不等。
ICU患者的肌肉力量似乎确实受到不同蛋白质剂量的影响。然而，关注肌肉功能的试验在数量和质量上存在局限性，这凸显了未来研究的明确需求。
