{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:03:09Z","timestamp":1792425789420,"version":"4.5.0"},"reference-count":40,"publisher":"Wiley","issue":"1S","license":[{"start":{"date-parts":[[2017,2,6]],"date-time":"2017-02-06T00:00:00Z","timestamp":1486339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,2,6]],"date-time":"2017-02-06T00:00:00Z","timestamp":1486339200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nut in Clin Prac"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:p>Despite tremendous advances in critical care, multiple\u2010organ failure continues to be a significant problem. However, in recent years, far fewer patients with multiple\u2010organ failure die early, but many experience ongoing immune dysregulation and are developing persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Most PICS patients are discharged to nonhome destinations, fail to rehabilitate, and succumb to indolent death. From a nutrition perspective, patients with PICS experience persistent inflammation\u2010induced cachexia despite evidenced\u2010based recommended intensive care unit nutrition support. Recent basic and translational research indicates that prolonged expansion of myeloid\u2010derived suppressor cells plays a central role in the pathogenesis of PICS. Myeloid\u2010derived suppressor cells express arginase 1, which depletes arginine, causing immunosuppression and impaired wound healing. This is the rationale for arginine supplementation in PICS. Other nutrition support recommendations for PICS are based on inferences made from other patient populations who experience similar persistent inflammation\u2010induced cachexia. These include patients with established cancers, major burns, and sarcopenia. These patients experience anabolic resistance, but studies show that this can be overcome by providing higher levels of protein and certain specific amino acids. Nutrition support guidelines recommend provision of &gt;1.5 g\/kg\/d of protein and indicate that higher levels may be needed. Protein composition is also important. There is good evidence that leucine can promote anabolism in patients with cancer and sarcopenia. Finally, anabolic interventions\u2014including intensive insulin, oxandrolone, propranolol, and resistance exercise\u2014have proven to be effective in patients with major burns and are likely relevant in combating PICS cachexia.<\/jats:p>","DOI":"10.1177\/0884533616687502","type":"journal-article","created":{"date-parts":[[2017,2,7]],"date-time":"2017-02-07T08:08:09Z","timestamp":1486454889000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":51,"title":["Nutrition Support for Persistent Inflammation, Immunosuppression, and Catabolism Syndrome"],"prefix":"10.1002","volume":"32","author":[{"given":"Frederick A.","family":"Moore","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart M.","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig 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