Effects Of Whey Protein Early Added In Homogenized Meals On Elderly Critically Ill Patients With Hypoproteinemia

PurposeRecent studies have been controversial about the effect of early enteral nutrition and increasing protein-intake on critically ill patients.In this paper,the author tested and monitored the plasma protein nutrition index,nutrition risk screening assessment and scores,disease status assessment and scores,gastrointestinal complications,infection,clinical outcome,metabolic complications and other clinical indexes of the elderly critical patients with hypoproteinemia in the Intensive Care Unit(ICU)of a AAA-Class hospital in Jinan,Shandong Province,and then discuss and analyze that,in early period,the whey protein may be added to enable the protein intake to achieve the target within 4-7d and more than 70%of the total energy without the after-effect of excessive feeding,so as to fully evaluate the nutrition-support treatment effect.MethodsThe retrospective cohort study was adopted,in the way of continuous disease case enrollment.The study last from Jul.1,2017 to Dec.31,2019.The author referred to the medical records and screened 90 patients in strict accordance with the inclusion and exclusion criteria,including 50 cases with the common homogenized diets and 40 cases with the homogenized diet added with the whey protein,named by EN1 group and EN2 group separately.Patients in both groups took the same proportion of three productive nutrients except whey protein.They were adjusted according to the change of disease conditions and the tolerance degree.The final nutrient intake of the two groups was the same except the whey protein contents.The data acquired was then used to analyze and compare the data of two groups of the patients.ResultThere is no significant difference for the basic information and the baseline data of various indexes before the nutrition support therapy for two groups of the patients(P>0.05),indicating that there is no obvious heterogeneity.The comparison of the EN1 groups was conducted before and after the nutrition support therapy and it was found that there were of the significant decrease trends for Hemoglobin(Hb),Total Protein(TP),Albumin(ALB),nutrition risk in critically ill(NUTRIC),the geriatric nutritional risk index(GNRI),Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)(P<0.05).The score of the Nutritional Risk Screening(NRS2002)was significantly increased(P<0.05).The data analysis for the EN2 group before and after the nutrition support therapy showed that Hb,ALB and Prealbumin(PA)were increased,but there were not significant(P>0.05).The TP was obviously improved(P=0.002)and the improved NUTRIC score and APACHE Ⅱ score were obviously decreased(P<0.05).For the comparison between the groups after receiving the nutrition support therapy,the ALB level,NRS2002 score,GNRI score,diarrhea status of the EN2 group were significantly better than the EN1 group(P<0.05).The therapeutic effects of Hb,TP and PA in EN2 group were also better than those in EN1 group,but there was no remarkable variation(P>0.05).In view of the range comparison before and after the nutrition support therapy,the Hb,TP,ALB and PA of the EN2 group increased significantly when compared with that of the EN1 group(P<0.05).It was observed from the intra and inter group-comparison before and after the nutrition support therapy for two groups of the patients that,there was no obvious difference in the infection,clinical results and hospitalization expenses and metabolic complications,etc.(P>0.05).ConclusionAfter the initiation of early enteral nutrition,the whey protein was added to guarantee that the target protein intake could be achieved within 4-7d and the total energy could achieve more than 70%of the target intake without the after-effect of excessive feeding,which could significantly increase the plasma protein of elderly critical patients with hypoproteinemia and improve the malnutrition,so the incidence of diarrhea was low.Nutritional risk and severity of disease in both groups decrease after nutrition support.There were no significant differences in the incidence of gastric retention,clinical outcomes and hospitalization costs,infection,and metabolic complications.To sum up,the study suggests that after excluding the influence of energy intake on the therapeutic effect of nutritional support,the effects of the common homogenized diets added with whey protein were better than single common homogenized diets.The homogenized diet added with the whole whey protein powder could be taken as the good enteral nutrition preparation,and it could be applied to the elderly critical patients with hypoproteinemia.