special edition: protein

Protein where it matters: The demands and opportunities in medical nutrition

By Nathan Gray contact

- Last updated on GMT

Protein where it matters: The demands and opportunities in medical nutrition

Related tags: Nutrition, Metabolism

Protein is a vital part of providing nutrition to the critically ill, but what do we really know about protein demands for this specialist groups, and how can we better meet them.

Many manufacturers have outlined the ‘huge potential’ for protein in the aging market, and lots take an active role in developing and providing protein-rich foods for critically ill patients in the medical setting – yet, researchers continue to warn that not enough is known about the protein demands for these specific groups, and that delivering the right balance of nutrients in the right way remains a huge challenge.

Indeed, new research published in the journal Clinical Nutrition​, reviewing the evidence for a variety of different nutritional interventions for critically ill patients, notes that nutrition has the potential to positively impact patient outcomes - but warns that the identification of those at risk or those already malnourished “remains poorly defined in this population due to a lack of validated assessment tools.”

According to the review, led by Emma Ridley at Monash University, one of the biggest challenges in administration of nutrition therapy in critical illness is the prediction of each patient's true needs, which is commonly achieved using predictive equations based on age, gender, height, weight and severity of illness.

While these methods can provide an estimate of calorific and protein demands, the team warns that the methods can be ‘imprecise’ – adding that other more precise tools such as indirect calorimetry are a more accurate but less used measure.

Ridley and her colleagues also note that evidence is complicated by the influence of protein intake in combination with energy intake.

“As with energy provision, we do not know the optimum amount of protein to target to elicit positive patient outcomes,”​ said the authors. “Protein requirements in critical illness are increased, and even with appropriate provision, protein catabolism and the resultant negative nitrogen balance will never be prevented.”

According to the team, the normal range of protein requirements for ICU patients is between 1.2 grams and 2.0 grams per kg per day – warning that providing above this amount “has not shown any clinical benefit and does not overcome protein catabolism.”

They added that while large-scale research on nutrition for the critically ill is starting to focus on the impact of nutrition on a patient's whole hospital journey, from ICU to the ward, and their post-hospital outcomes, including quality of life, more can be done to understand how best to deliver protein in these settings.

“Further work should also focus on determining who will benefit most from which delivery mechanism, and at what point to intervene,”​ concluded Ridley and her team.

Small solutions

While more research may be needed to figure out exactly when, and how, to deliver protein to those who need it in a medical setting, research and development on new deleivery mechanisms and product concepts continues both within academia and industry.

A recent paper published in Current Opinion in Colloid & Interface Science​ suggested that the design of miro- and nano- protein particles with tailored properties has received an increased attention as a possible solution for the delivery of high quality protein in easy-to-use formats for the elderly and critically ill.

“In medical nutrition it is highly desirable to have drinkable, high protein formulations that should have low viscosities in order to be useful,”​ noted the team, led by Dilek Sağlam from Wageningen University.

Meanwhile, researchers writing in Trends in Food Science & Technology​ suggested that using proteins – and specifically plant-based proteins – as a vehicle for microencapsulation of other important nutrients holds promise.

Plant-based promise

While academics may be suggesting plant proteins as a technical solution for certain applications, the opportunity for using more sustainable plant proteins in medical nutrition has not been lost on the industry either.

Speaking at the inauguration of its new pea protein plant recently, Heidi Jacobs, director of R&D and QA at Cosucra told NutraIngredients that the company sees ‘clear opportunities’ in using its pea proteins for specific nutritional needs such medical nutrition.

“In medical nutrition and clinical foods, proteins are essential and I think in general there is a big demand in diversifying the protein sources – going from animal protein to vegetable protein and looking within those for clean label solutions,” ​she said. “Foods for the elderly are also a market that is expanding a lot, and where there are clear needs for high-protein foods for customers​.”

Cosucra CEO Jacques Crahay said that plant based proteins such as pea may also offer a cost cutting benefit for manufacturers of medical foods – adding that animal based solutions can be approximately three times more expensive than a plant-based solution.

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