BackgroundCritically ill patients are subject to severe skeletal muscle wasting during intensive care unit (ICU) stay, resulting in impaired short- and long-term functional outcomes and health-related quality of life. Increased protein provision may improve functional outcomes in ICU patients by attenuating skeletal muscle breakdown. Supporting evidence is limited however and results in great variety in recommended protein targets.MethodsThe PRECISe trial is an investigator-initiated, bi-national, multi-center, quadruple-blinded randomized controlled trial with a parallel group design. In 935 patients, we will compare provision of isocaloric enteral nutrition with either a standard or high protein content, providing 1.3 or 2.0 g of protein/kg/day, respectively, when fed on target. All unplanned ICU admissions with initiation of invasive mechanical ventilation within 24 h of admission and an expected stay on ventilator support of at least 3 days are eligible. The study is designed to assess the effect of the intervention on functional recovery at 1, 3, and 6 months following ICU admission, including health-related quality of life, measures of muscle strength, physical function, and mental health. The primary endpoint of the trial is health-related quality of life as measured by the Euro-QoL-5D-5-level questionnaire Health Utility Score. Overall between-group differences will be assessed over the three time points using linear mixed-effects models.DiscussionThe PRECISe trial will evaluate the effect of protein on functional recovery including both patient-centered and muscle-related outcomes.Trial registrationClinicalTrials.gov Identifier: NCT04633421. Registered on November 18, 2020. First patient in (FPI) on November 19, 2020. Expected last patient last visit (LPLV) in October 2023.
MULTIFILE
Background & aims: High protein delivery during early critical illness is associated with lower mortality, while energy overfeeding is associated with higher mortality. Protein-to-energy ratios of traditional enteral formulae are sometimes too low to reach protein targets without energy overfeeding. This prospective feasibility study aimed to evaluate the ability of a new enteral formula with a high protein-to-energy ratio to achieve the desired protein target while avoiding energy overfeeding.Methods: Mechanically ventilated non-septic patients received the high protein-to-energy ratio nutrition during the first 4 days of ICU stay (n = 20). Nutritional prescription was 90% of measured energy expenditure. Primary endpoint was the percentage of patients reaching a protein target of ≥1.2 g/kg ideal body weight on day 4. Other endpoints included a comparison of nutritional intake to matched historic controls and the response of plasma amino acid concentrations. Safety endpoints were gastro-intestinal tolerance and plasma urea concentrations. Results: Nineteen (95%) patients reached the protein intake target of ≥1.2 g/kg ideal body weight on day 4, compared to 65% in historic controls (p = 0.024). Mean plasma concentrations of all essential amino acids increased significantly from baseline to day 4. Predefined gastro-intestinal tolerance was good, but unexplained foul smelling diarrhoea occurred in two patients. In one patient plasma urea increased unrelated to acute kidney injury. Conclusions: In selected non-septic patients tolerating enteral nutrition, recommended protein targets can be achieved without energy overfeeding using a new high protein-to-energy ratio enteral nutrition.
MULTIFILE
BackgroundICU patients lose muscle mass rapidly and maintenance of muscle mass may contribute to improved survival rates and quality of life. Protein provision may be beneficial for preservation of muscle mass and other clinical outcomes, including survival. Current protein recommendations are expert-based and range from 1.2 to 2.0 g/kg. Thus, we performed a systematic review and meta-analysis on protein provision and all clinically relevant outcomes recorded in the available literature.MethodsWe conducted a systematic review and meta-analyses, including studies of all designs except case control and case studies, with patients aged ≥18 years with an ICU stay of ≥2 days and a mean protein provision group of ≥1.2 g/kg as compared to <1.2 g/kg with a difference of ≥0.2 g/kg between protein provision groups. All clinically relevant outcomes were studied. Meta-analyses were performed for all clinically relevant outcomes that were recorded in ≥3 included studies.ResultsA total of 29 studies published between 2012 and 2022 were included. Outcomes reported in the included studies were ICU, hospital, 28-day, 30-day, 42-day, 60-day, 90-day and 6-month mortality, ICU and hospital length of stay, duration of mechanical ventilation, vomiting, diarrhea, gastric residual volume, pneumonia, overall infections, nitrogen balance, changes in muscle mass, destination at hospital discharge, physical performance and psychological status. Meta-analyses showed differences between groups in favour of high protein provision for 60-day mortality, nitrogen balance and changes in muscle mass.ConclusionHigh protein provision of more than 1.2 g/kg in critically ill patients seemed to improve nitrogen balance and changes in muscle mass on the short-term and likely 60-day mortality. Data on long-term effects on quality of life are urgently needed.
MULTIFILE
Micro and macro algae are a rich source of lipids, proteins and carbohydrates, but also of secondary metabolites like phytosterols. Phytosterols have important health effects such as prevention of cardiovascular diseases. Global phytosterol market size was estimated at USD 709.7 million in 2019 and is expected to grow with a CAGR of 8.7% until 2027. Growing adoption of healthy lifestyle has bolstered demand for nutraceutical products. This is expected to be a major factor driving demand for phytosterols. Residues from algae are found in algae farming and processing, are found as beachings and are pruning residues from underwater Giant Kelp forests. Large amounts of brown seaweed beaches in the province of Zeeland and are discarded as waste. Pruning residues from Giant Kelp Forests harvests for the Namibian coast provide large amounts of biomass. ALGOL project considers all these biomass residues as raw material for added value creation. The ALGOL feasibility project will develop and evaluate green technologies for phytosterol extraction from algae biomass in a biocascading approach. Fucosterol is chosen because of its high added value, whereas lipids, protein and carbohydrates are lower in value and will hence be evaluated in follow-up projects. ALGOL will develop subcritical water, supercritical CO2 with modifiers and ethanol extraction technologies and compare these with conventional petroleum-based extractions and asses its technical, economic and environmental feasibility. Prototype nutraceutical/cosmeceutical products will be developed to demonstrate possible applications with fucosterol. A network of Dutch and African partners will supply micro and macro algae biomass, evaluate developed technologies and will prototype products with it, which are relevant to their own business interests. ALGOL project will create added value by taking a biocascading approach where first high-interest components are processed into high added value products as nutraceutical or cosmeceutical.
Micro and macro algae are a rich source of lipids, proteins and carbohydrates, but also of secondary metabolites like phytosterols. Phytosterols have important health effects such as prevention of cardiovascular diseases. Global phytosterol market size was estimated at USD 709.7 million in 2019 and is expected to grow with a CAGR of 8.7% until 2027. Growing adoption of healthy lifestyle has bolstered demand for nutraceutical products. This is expected to be a major factor driving demand for phytosterols.Residues from algae are found in algae farming and processing, are found as beachings and are pruning residues from underwater Giant Kelp forests. Large amounts of brown seaweed beaches in the province of Zeeland and are discarded as waste. Pruning residues from Giant Kelp Forests harvests for the Namibian coast provide large amounts of biomass. ALGOL project considers all these biomass residues as raw material for added value creation.The ALGOL feasibility project will develop and evaluate green technologies for phytosterol extraction from algae biomass in a biocascading approach. Fucosterol is chosen because of its high added value, whereas lipids, protein and carbohydrates are lower in value and will hence be evaluated in follow-up projects. ALGOL will develop subcritical water, supercritical CO2 with modifiers and ethanol extraction technologies and compare these with conventional petroleum-based extractions and asses its technical, economic and environmental feasibility. Prototype nutraceutical/cosmeceutical products will be developed to demonstrate possible applications with fucosterol.A network of Dutch and African partners will supply micro and macro algae biomass, evaluate developed technologies and will prototype products with it, which are relevant to their own business interests. ALGOL project will create added value by taking a biocascading approach where first high-interest components are processed into high added value products as nutraceutical or cosmeceutical.
The seaweed aquaculture sector, aimed at cultivation of macroalgal biomass to be converted into commercial applications, can be placed within a sustainable and circular economy framework. This bio-based sector has the potential to aid the European Union meet multiple EU Bioeconomy Strategy, EU Green Deal and Blue Growth Strategy objectives. Seaweeds play a crucial ecological role within the marine environment and provide several ecosystem services, from the take up of excess nutrients from surrounding seawater to oxygen production and potentially carbon sequestration. Sea lettuce, Ulva spp., is a green seaweed, growing wild in the Atlantic Ocean and North Sea. Sea lettuce has a high nutritional value and is a promising source for food, animal feed, cosmetics and more. Sea lettuce, when produced in controlled conditions like aquaculture, can supplement our diet with healthy and safe proteins, fibres and vitamins. However, at this moment, Sea lettuce is hardly exploited as resource because of its unfamiliarity but also lack of knowledge about its growth cycle, its interaction with microbiota and eventually, possible applications. Even, it is unknown which Ulva species are available for aquaculture (algaculture) and how these species can contribute to a sustainable aquaculture biomass production. The AQULVA project aims to investigate which Ulva species are available in the North Sea and Wadden Sea which can be utilised in onshore aquaculture production. Modern genomic, microbiomic and metabolomic profiling techniques alongside ecophysiological production research must reveal suitable Ulva selections with high nutritional value for sustainable onshore biomass production. Selected Ulva spp lines will be used for production of healthy and safe foods, anti-aging cosmetics and added value animal feed supplements for dairy farming. This applied research is in cooperation with a network of SME’s, Research Institutes and Universities of Applied Science and is liaised with EU initiatives like the EU-COST action “SeaWheat”.
