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Protein supplementation for burns patients

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eMediNexus    07 December 2019

Burns are associated with significant metabolic derangements that necessitate nutritional support for burns patients. Burn injury results in a prolonged hypermetabolic state and an increase in catabolism which gives way to increased muscle wasting and cachexia. Metabolic rates of burn patients can exceed twice those of the normal levels. As a result, if the energy requirements are not fulfilled, it leads to impaired wound healing, organ dysfunction, and increased susceptibility to infections.1

Protein supplementation helps meet ongoing demands and limits the loss of lean body mass. Protein requirements for burned adults are estimated at 1.5-2.0 g/kg/day and 2.5-4.0 g/kg/day for burned children.1

Glutamine is one of the amino acids that have a role in the supply of energy to the liver and in healing wounds. Following burn injuries, glutamine gets quickly exhausted from muscle and serum.1

A study assessed the benefit of feeding increased amounts of protein to hypermetabolic burned patients. In all, 18 children with burns averaging 60% total surface area were randomized into two matched groups and assessed for at least six weeks. The first group received a normal diet with a balanced nutritional supplement, while the second group was given milk whey protein supplement. Despite having a higher caloric intake, the normal protein group exhibited worse opsonic index compared to the high protein group (0.42 ± 0.04 vs. 0.62 ± 0.05), lower levels of C3 (1371 ± 55 vs. 1585 ± 64 pg/ml), lower levels of immunoglobulin G (IgG) (805 ± 52 vs. 975 ± 56 Lg/ml), lower levels of transferrin (200 ± 10 vs. 283 ± 18 mg/dl), lower levels of total serum protein (5.5 ± 0.1 vs. 6.3 ± 0.2 g/dl), more bacteremic days (11% vs. 8%; Fig. 1) and worse survival (5/9-56% vs. 9/9-100%; Fig. 2). Patients given whey protein supplemented diet had significantly higher plasma levels of valine, lysine, threonine, leucine, arginine, isoleucine, proline, serine, asparagine, tryptophan, and tyrosine.2

Furthermore, glutamine supplementation in severely burned patients has been shown to decrease the incidence of infections, improve visceral protein levels, decrease the length of stay, and reduce mortality.3

A whey protein supplement, rich in branched chain amino acids (BCAAs) and glutamine, is therefore a potential source of protein to fulfil the requirements of burns patients.

Fig. 1. Frequency of bacteremic days in patients given normal diet vs. high protein diet with whey protein supplementation

 

Fig. 2. Survival rate in patients given normal diet vs. high protein diet with whey protein supplementation

References

  1. Clark A, Imran J, Madni T, Wolf SE. Nutrition and metabolism in burn patients. Burns Trauma. 2017; 5: 11.
  2. Alexander JW, MacMillan BG, Stinnett JD, et al. Beneficial effects of aggressive protein feeding in severely burned children. Ann Surg. 1980 Oct; 192(4): 505–517.
  3. Williams FN, Branski LK, Jeschke MG, Herndon DN. What, how, and how much should burn patients be fed? SurgClin North Am. 2011 Jun; 91(3): 609–629.

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