{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:56:46Z","timestamp":1781650606405,"version":"3.54.5"},"reference-count":58,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T00:00:00Z","timestamp":1776470400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":41,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012041","name":"Versus Arthritis","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012041","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nutr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The current literature is lacking in relation to the impact of protein nutrition, with and without adjuvant exercise, on patient centred outcomes including muscle recovery following critical illness. The literature has shown that skeletal muscle health is significantly affected in critical illness with potential negative consequences on physical function and quality of life. This Delphi study aims to establish a consensus opinion for the benefits of protein supplementation alone or as part of multicomponent intervention along with physical exercise in critically ill patients through its iterative process to refine expert opinions with regards of this subject.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>We conducted this Delphi survey among different groups of experts with extensive experience in critical care management specifically in the area of nutrition and physical rehabilitation and prespecified a threshold of 80% of agreement or disagreement to accept or reject statements respectively; allowing for consensus to be achieved. Anonymous feedback was employed to refine statements across consequent rounds. Statistical stability was also tested to verify the consistency of responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study included 60 statements out of which 18 statements reached agreement (&gt;\/= 80%) and only 12 were identified at the near-consensus level (&gt;\/= 70%) across the three rounds. It was agreed that physical function, post critical illness quality of life and muscle centred outcomes comprising muscle mass and strength could be enhanced in response to protein provision and adjuvant exercise interventions. However, consensus could not be reached on the most appropriate protein dosage, timing of administration nor on its impact on conventional clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study is the first to seek a consensus on the potential benefits of optimal protein provision with and without concomitant exercise on various clinical and patient-centred aspects in the critically ill population. Consensus was attained for a limited number of statements, suggesting that further large robust clinical trials are still required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40795-026-01314-3","type":"journal-article","created":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T08:19:13Z","timestamp":1776500353000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Protein nutrition in the ICU: a Delphi exercise to highlight knowledge and opinions of different professional groups involved in patient critical care"],"prefix":"10.1186","volume":"12","author":[{"given":"Mohamed A","family":"Mohamed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethan E","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,18]]},"reference":[{"issue":"4","key":"1314_CR1","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1007\/s00134-020-05944-4","volume":"46","author":"I Vanhorebeek","year":"2020","unstructured":"Vanhorebeek I, Latronico N, Van Den Berghe G. ICU-acquired weakness. Intensive Care Med. 2020;46(4):637\u201353. https:\/\/doi.org\/10.1007\/s00134-020-05944-4.","journal-title":"Intensive Care Med"},{"issue":"10","key":"1314_CR2","doi-asserted-by":"publisher","first-page":"S299","DOI":"10.1097\/CCM.0b013e3181b6ef67","volume":"37","author":"RD Stevens","year":"2009","unstructured":"Stevens RD, Marshall SA, Cornblath DR, Hoke A, Needham DM, De Jonghe B, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med. 2009;37(10):S299\u2013308.","journal-title":"Crit Care Med"},{"issue":"10","key":"1314_CR3","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1016\/S1474-4422(11)70178-8","volume":"10","author":"N Latronico","year":"2011","unstructured":"Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol. 2011;10(10):931\u201341. https:\/\/doi.org\/10.1016\/S1474-4422(11)70178-8.","journal-title":"Lancet Neurol"},{"issue":"17","key":"1314_CR4","doi-asserted-by":"publisher","first-page":"1626","DOI":"10.1056\/NEJMra1209390","volume":"370","author":"JP Kress","year":"2014","unstructured":"Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med. 2014;370(17):1626\u201335.","journal-title":"N Engl J Med"},{"issue":"1","key":"1314_CR5","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1113\/jphysiol.2007.142828","volume":"585","author":"MD De Boer","year":"2007","unstructured":"De Boer MD, Selby A, Atherton P, Smith K, Seynnes OR, Maganaris CN, et al. The temporal responses of protein synthesis, gene expression and cell signalling in human quadriceps muscle and patellar tendon to disuse. J Physiol. 2007;585(1):241\u201351. https:\/\/doi.org\/10.1113\/jphysiol.2007.142828.","journal-title":"J Physiol"},{"issue":"24","key":"1314_CR6","doi-asserted-by":"publisher","first-page":"6049","DOI":"10.1113\/jphysiol.2008.160333","volume":"586","author":"EI Glover","year":"2008","unstructured":"Glover EI, Phillips SM, Oates BR, Tang JE, Tarnopolsky MA, Selby A, et al. Immobilization induces anabolic resistance in human myofibrillar protein synthesis with low and high dose amino acid infusion: immobilization induces muscle anabolic resistance to amino acids. J Physiol. 2008;586(24):6049\u201361. https:\/\/doi.org\/10.1113\/jphysiol.2008.160333.","journal-title":"J Physiol"},{"issue":"4","key":"1314_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.12968\/hmed.2020.0045","volume":"81","author":"L Flower","year":"2020","unstructured":"Flower L, Puthucheary Z. Muscle wasting in the critically ill patient: how to minimise subsequent disability. Br J Hosp Med. 2020;81(4):1\u20139. https:\/\/doi.org\/10.12968\/hmed.2020.0045.","journal-title":"Br J Hosp Med"},{"issue":"1","key":"1314_CR8","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1097\/CCM.0b013e31822d7c18","volume":"40","author":"S Derde","year":"2012","unstructured":"Derde S, Hermans G, Derese I, G\u00fciza F, Hedstr\u00f6m Y, Wouters PJ, et al. Muscle atrophy and preferential loss of myosin in prolonged critically ill patients*. Crit Care Med. 2012;40(1):79\u201389. https:\/\/doi.org\/10.1097\/CCM.0b013e31822d7c18.","journal-title":"Crit Care Med"},{"issue":"4","key":"1314_CR9","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1152\/physrev.00031.2010","volume":"91","author":"S Schiaffino","year":"2011","unstructured":"Schiaffino S, Reggiani C. Fiber types in mammalian skeletal muscles. Physiol Rev. 2011;91(4):1447\u2013531. https:\/\/doi.org\/10.1152\/physrev.00031.2010.","journal-title":"Physiol Rev"},{"issue":"4","key":"1314_CR10","doi-asserted-by":"publisher","first-page":"E633","DOI":"10.1210\/jc.2010-2563","volume":"96","author":"I Vanhorebeek","year":"2011","unstructured":"Vanhorebeek I, Gunst J, Derde S, Derese I, Boussemaere M, G\u00fciza F, et al. Insufficient activation of autophagy allows cellular damage to accumulate in critically Ill patients. J Clin Endocrinol Metabolism. 2011;96(4):E633\u201345. https:\/\/doi.org\/10.1210\/jc.2010-2563.","journal-title":"J Clin Endocrinol Metabolism"},{"issue":"3","key":"1314_CR11","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1152\/physrev.00028.2014","volume":"95","author":"O Friedrich","year":"2015","unstructured":"Friedrich O, Reid MB, Van Den Berghe G, Vanhorebeek I, Hermans G, Rich MM, et al. The sick and the weak: neuropathies\/myopathies in the critically Ill. Physiol Rev. 2015;95(3):1025\u2013109. https:\/\/doi.org\/10.1152\/physrev.00028.2014.","journal-title":"Physiol Rev"},{"issue":"1","key":"1314_CR12","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1186\/s13054-016-1417-z","volume":"20","author":"M Llano-Diez","year":"2016","unstructured":"Llano-Diez M, Cheng AJ, Jonsson W, Ivarsson N, Westerblad H, Sun V, et al. Impaired Ca2\u2009+\u2009release contributes to muscle weakness in a rat model of critical illness myopathy. Crit Care. 2016;20(1):254. https:\/\/doi.org\/10.1186\/s13054-016-1417-z.","journal-title":"Crit Care"},{"issue":"1","key":"1314_CR13","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s13054-019-2331-y","volume":"23","author":"N Latronico","year":"2019","unstructured":"Latronico N, Friedrich O. Electrophysiological investigations of peripheral nerves and muscles: a method for looking at cell dysfunction in the critically ill patients. Crit Care. 2019;23(1):33.","journal-title":"Crit Care"},{"issue":"1","key":"1314_CR14","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1111\/apha.12532","volume":"216","author":"MS Brook","year":"2016","unstructured":"Brook MS, Wilkinson DJ, Phillips BE, Perez-Schindler J, Philp A, Smith K, et al. Skeletal muscle homeostasis and plasticity in youth and ageing: impact of nutrition and exercise. Acta Physiol. 2016;216(1):15\u201341. https:\/\/doi.org\/10.1111\/apha.12532.","journal-title":"Acta Physiol"},{"issue":"4","key":"1314_CR15","doi-asserted-by":"publisher","first-page":"S828","DOI":"10.3945\/an.115.011650","volume":"7","author":"WK Mitchell","year":"2016","unstructured":"Mitchell WK, Wilkinson DJ, Phillips BE, Lund JN, Smith K, Atherton PJ. Human skeletal muscle protein metabolism responses to amino acid nutrition. Adv Nutr. 2016;7(4):S828\u201338. https:\/\/doi.org\/10.3945\/an.115.011650.","journal-title":"Adv Nutr"},{"issue":"4","key":"1314_CR16","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1177\/0148607115624084","volume":"40","author":"LJ Hoffer","year":"2016","unstructured":"Hoffer LJ. Human protein and amino acid requirements. J Parenter Enter Nutr. 2016;40(4):460\u201374.","journal-title":"J Parenter Enter Nutr"},{"issue":"9","key":"1314_CR17","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1016\/j.clnu.2023.07.011","volume":"42","author":"P Singer","year":"2023","unstructured":"Singer P, Blaser AR, Berger MM, Calder PC, Casaer M, Hiesmayr M, et al. ESPEN practical and partially revised guideline: clinical nutrition in the intensive care unit. Clin Nutr. 2023;42(9):1671\u201389. https:\/\/doi.org\/10.1016\/j.clnu.2023.07.011.","journal-title":"Clin Nutr"},{"issue":"2","key":"1314_CR18","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1024\/0300-9831\/a000058","volume":"81","author":"L Genton","year":"2011","unstructured":"Genton L, Pichard C. Protein catabolism and requirements in severe illness. Int J Vitam Nutr Res. 2011;81(2):143.","journal-title":"Int J Vitam Nutr Res"},{"issue":"11","key":"1314_CR19","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1056\/NEJMct0806956","volume":"361","author":"TR Ziegler","year":"2009","unstructured":"Ziegler TR. Parenteral nutrition in the critically ill patient. N Engl J Med. 2009;361(11):1088\u201397.","journal-title":"N Engl J Med"},{"issue":"2","key":"1314_CR20","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1097\/CCM.0000000000001525","volume":"44","author":"BE Taylor","year":"2016","unstructured":"Taylor BE, McClave SA, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N). Crit Care Med. 2016;44(2):390\u2013438. https:\/\/doi.org\/10.1097\/CCM.0000000000001525.","journal-title":"Crit Care Med"},{"key":"1314_CR21","doi-asserted-by":"publisher","first-page":"2531","DOI":"10.12688\/f1000research.9278.1","volume":"5","author":"LJ Hoffer","year":"2016","unstructured":"Hoffer LJ, Bistrian BR. Nutrition in critical illness: a current conundrum. F1000Res. 2016;5:2531. https:\/\/doi.org\/10.12688\/f1000research.9278.1.","journal-title":"F1000Res"},{"issue":"10","key":"1314_CR22","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1513\/AnnalsATS.201612-967PS","volume":"14","author":"M Mourtzakis","year":"2017","unstructured":"Mourtzakis M, Parry S, Connolly B, Puthucheary Z. Skeletal muscle ultrasound in critical care: a tool in need of translation. Annals ATS. 2017;14(10):1495\u2013503. https:\/\/doi.org\/10.1513\/AnnalsATS.201612-967PS.","journal-title":"Annals ATS"},{"issue":"4","key":"1314_CR23","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1097\/MCC.0000000000000511","volume":"24","author":"WGPM Looijaard","year":"2018","unstructured":"Looijaard WGPM, Molinger J, Weijs PJM. Measuring and monitoring lean body mass in critical illness. Curr Opin Crit Care. 2018;24(4):241\u20137. https:\/\/doi.org\/10.1097\/MCC.0000000000000511.","journal-title":"Curr Opin Crit Care"},{"key":"1314_CR24","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.jcrc.2016.08.001","volume":"37","author":"R Mendes","year":"2017","unstructured":"Mendes R, Policarpo S, Fortuna P, Alves M, Virella D, Heyland DK. Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients\u2014A multicenter prospective cohort study. J Crit Care. 2017;37:45\u20139. https:\/\/doi.org\/10.1016\/j.jcrc.2016.08.001.","journal-title":"J Crit Care"},{"issue":"9","key":"1314_CR25","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1007\/s00134-016-4468-3","volume":"42","author":"R Thibault","year":"2016","unstructured":"Thibault R, Makhlouf AM, Mulliez A, Cristina Gonzalez M, Kekstas G, Kozjek NR, et al. Fat-free mass at admission predicts 28-day mortality in intensive care unit patients: the international prospective observational study phase angle project. Intensive Care Med. 2016;42(9):1445\u201353.","journal-title":"Intensive Care Med"},{"issue":"7","key":"1314_CR26","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1038\/s41430-018-0167-1","volume":"72","author":"SN Stapel","year":"2018","unstructured":"Stapel SN, Looijaard WG, Dekker IM, Girbes AR, Weijs PJ, Oudemans-van Straaten HM. Bioelectrical impedance analysis-derived phase angle at admission as a predictor of 90-day mortality in intensive care patients. Eur J Clin Nutr. 2018;72(7):1019\u201325.","journal-title":"Eur J Clin Nutr"},{"key":"1314_CR27","doi-asserted-by":"publisher","unstructured":"Doiron KA, Hoffmann TC, Beller EM. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Emergency and Critical Care Group, editor. Cochrane Database Syst Rev. 2018;2018(12). https:\/\/doi.org\/10.1002\/14651858.CD010754.pub2.","DOI":"10.1002\/14651858.CD010754.pub2"},{"issue":"6","key":"1314_CR28","doi-asserted-by":"publisher","first-page":"1543","DOI":"10.1097\/CCM.0b013e31827ca637","volume":"41","author":"G Kayambu","year":"2013","unstructured":"Kayambu G, Boots R, Paratz J. Physical therapy for the critically Ill in the ICU: a systematic review and meta-analysis*. Crit Care Med. 2013;41(6):1543\u201354. https:\/\/doi.org\/10.1097\/CCM.0b013e31827ca637.","journal-title":"Crit Care Med"},{"issue":"9","key":"1314_CR29","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.1097\/CCM.0000000000003263","volume":"46","author":"CE Hickmann","year":"2018","unstructured":"Hickmann CE, Castanares-Zapatero D, Deldicque L, Van Den Bergh P, Caty G, Robert A, et al. Impact of very early physical therapy during septic shock on skeletal muscle: a randomized controlled trial. Crit Care Med. 2018;46(9):1436\u201343. https:\/\/doi.org\/10.1097\/CCM.0000000000003263.","journal-title":"Crit Care Med"},{"key":"1314_CR30","doi-asserted-by":"publisher","unstructured":"Azevedo J, Lima H, Frota P, Nogueira I, Souza S, Fernandes E. High-protein intake and early exercise in adult intensive care patients: a randomized controlled phase III study to evaluate the impact on functional outcomes. Intensive care medicine experimental. 2021; European Society of Intensive Care Medicine Annual Congress, ESICM 2021. Virtual. 9(SUPPL 1). https:\/\/doi.org\/10.1186\/s40635-021-00413-8.","DOI":"10.1186\/s40635-021-00413-8"},{"issue":"2","key":"1314_CR31","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1007\/s00134-016-4612-0","volume":"43","author":"CJ Tipping","year":"2017","unstructured":"Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med. 2017;43(2):171\u201383. https:\/\/doi.org\/10.1007\/s00134-016-4612-0.","journal-title":"Intensive Care Med"},{"issue":"7","key":"1314_CR32","doi-asserted-by":"publisher","first-page":"e027893","DOI":"10.1136\/bmjopen-2018-027893","volume":"9","author":"DK Heyland","year":"2019","unstructured":"Heyland DK, Day A, Clarke GJ, Hough C (Terri), Files DC, Mourtzakis M, et al. Nutrition and Exercise in Critical Illness Trial (NEXIS Trial): a protocol of a multicentred, randomised controlled trial of combined cycle ergometry and amino acid supplementation commenced early during critical illness. BMJ Open. 2019;9(7):e027893. https:\/\/doi.org\/10.1136\/bmjopen-2018-027893.","journal-title":"BMJ Open"},{"issue":"1","key":"1314_CR33","doi-asserted-by":"publisher","first-page":"226","DOI":"10.22237\/jmasm\/1241137140","volume":"8","author":"HA Shah","year":"2009","unstructured":"Shah HA, Kalaian SA. Which is the best parametric statistical method for analyzing Delphi data? J Mod App Stat Meth. 2009;8(1):226\u201332. https:\/\/doi.org\/10.22237\/jmasm\/1241137140.","journal-title":"J Mod App Stat Meth"},{"issue":"1","key":"1314_CR34","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/0040-1625(79)90007-6","volume":"13","author":"JS Dajani","year":"1979","unstructured":"Dajani JS, Sincoff MZ, Talley WK. Stability and agreement criteria for the termination of Delphi studies. Technol Forecast Soc Chang. 1979;13(1):83\u201390. https:\/\/doi.org\/10.1016\/0040-1625(79)90007-6.","journal-title":"Technol Forecast Soc Chang"},{"issue":"16","key":"1314_CR35","doi-asserted-by":"publisher","first-page":"2613","DOI":"10.3390\/nu17162613","volume":"17","author":"MA Mohamed","year":"2025","unstructured":"Mohamed MA, Doleman B, Phillips BE, Williams JP. The effects of protein nutrition on muscle function in critical illness: a systematic review and meta-analysis. Nutrients. 2025;17(16):2613. https:\/\/doi.org\/10.3390\/nu17162613.","journal-title":"Nutrients"},{"issue":"6","key":"1314_CR36","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1177\/0148607115618449","volume":"40","author":"S Ferrie","year":"2016","unstructured":"Ferrie S, Allman-Farinelli M, Daley M, Smith K. Protein requirements in the critically Ill: a randomized controlled trial using parenteral nutrition. J Parenter Enter Nutr. 2016;40(6):795\u2013805. https:\/\/doi.org\/10.1177\/0148607115618449.","journal-title":"J Parenter Enter Nutr"},{"issue":"6","key":"1314_CR37","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1097\/CCM.0000000000001643","volume":"44","author":"CL Hodgson","year":"2016","unstructured":"Hodgson CL, Bailey M, Bellomo R, Berney S, Buhr H, Denehy L, et al. A binational multicenter pilot feasibility randomized controlled trial of early goal-directed mobilization in the ICU*. Crit Care Med. 2016;44(6):1145\u201352. https:\/\/doi.org\/10.1097\/CCM.0000000000001643.","journal-title":"Crit Care Med"},{"issue":"5","key":"1314_CR38","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1007\/s00134-015-3763-8","volume":"41","author":"G Kayambu","year":"2015","unstructured":"Kayambu G, Boots R, Paratz J. Early physical rehabilitation in intensive care patients with sepsis syndromes: a pilot randomised controlled trial. Intensive Care Med. 2015;41(5):865\u201374. https:\/\/doi.org\/10.1007\/s00134-015-3763-8.","journal-title":"Intensive Care Med"},{"issue":"2","key":"1314_CR39","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1590\/S0103-507X2012000200013","volume":"24","author":"CM Dantas","year":"2012","unstructured":"Dantas CM, Silva PFDS, de Siqueira FHT, Pinto RMF, Matias S, Maciel C, et al. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva. 2012;24(2):173\u20138. PubMed PMID: 23917766.","journal-title":"Rev Bras Ter Intensiva"},{"key":"1314_CR40","doi-asserted-by":"publisher","unstructured":"Bear DE, Rooyackers O. HMB and leucine supplementation during critical illness and recovery. Current opinion in clinical nutrition and metabolic care. 2022;25(2):88\u201392. https:\/\/doi.org\/10.1097\/MCO.0000000000000809 PubMed PMID: 34937852.","DOI":"10.1097\/MCO.0000000000000809"},{"issue":"4","key":"1314_CR41","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1111\/jhn.12238","volume":"28","author":"L Wandrag","year":"2015","unstructured":"Wandrag L, Brett SJ, Frost G, Hickson M. Impact of supplementation with amino acids or their metabolites on muscle wasting in patients with critical illness or other muscle wasting illness: a systematic review. J Hum Nutr Diet. 2015;28(4):313\u201330. https:\/\/doi.org\/10.1111\/jhn.12238.","journal-title":"J Hum Nutr Diet"},{"key":"1314_CR42","doi-asserted-by":"crossref","unstructured":"Bels JLM, Thiessen S, van Gassel RJJ, Beishuizen A, De Bie Dekker A, Fraipont V, Effect of high versus standard protein provision on functional recovery in people with critical illness (PRECISe): an investigator-initiated, double-blinded, multicentre, parallel-group, randomised controlled trial in Belgium and the Netherlands. Bels JL, van BB RJ, van der Horst IC, van Kuijk SM, van de Poll MC, van Santen S, van den Berk D, van den Hogen E, van Loon LA, van Loon LJ, Dictus MM, Fiez T, Meex I, Mesotten D, Tartaglia K, Thiessen S, Boer W, Engelen K, Vander Laenen M, Willaert X, Jonckheer J, De Waele E, Demol J, Geers J, van Malderen MC, Opdenacker G, Verhelst C, Paulus MC, van Zanten AR, Bouw Ruiter M, Kouw I, Melchers M, Osinga M, Swaen Dekkers Y, De Bie Dekker A, Harks I, Beishuizen A, Rinket M, Cornet AD, Krol T, Vermeijden W, Bormans Russell L, Scheeren C, van der Woude M, Zandijk E, Lamote S, Lagast S, Boscart I, Ledoux D, Massion P, Fraipont V, Marechal H, Demuydt F, Vloet L, Weijs PM, Puthucheary Z, Deane A et al. PRECISe study team, editors. Lancet. 2024;Comment in: Lancet. 2024;404(10453):630\u2013631. https:\/\/doi.org\/10.1016\/S0140-6736(24)01499-5. PMID: 39153799 [https:\/\/pubmed.ncbi.nlm.nih.gov\/39153799404(10453):659\u201369. Located at: Ovid MEDLINE(R)\u2009<\u20092024>. doi:10.1016\/S0140-6736(24)01304-7","DOI":"10.1016\/S0140-6736(24)01304-7"},{"issue":"1","key":"1314_CR43","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1177\/0148607115583675","volume":"40","author":"M Nicolo","year":"2016","unstructured":"Nicolo M, Heyland DK, Chittams J, Sammarco T, Compher C. Clinical outcomes related to protein delivery in a critically Ill population: a multicenter, multinational observation study. JPEN J Parenter Enter Nutr. 2016;40(1):45\u201351. https:\/\/doi.org\/10.1177\/0148607115583675.","journal-title":"JPEN J Parenter Enter Nutr"},{"issue":"6","key":"1314_CR44","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1186\/s13054-014-0701-z","volume":"18","author":"PJM Weijs","year":"2014","unstructured":"Weijs PJM, Looijaard WGPM, Beishuizen A, Girbes ARJ, Oudemans-van Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care (London England). 2014;18(6):701. https:\/\/doi.org\/10.1186\/s13054-014-0701-z.","journal-title":"Crit Care (London England)"},{"issue":"4","key":"1314_CR45","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1001\/jama.2025.9110","volume":"334","author":"MJ Summers","year":"2025","unstructured":"Summers MJ, Chapple L, anne S, Karahalios A, Bellomo R, Chapman MJ, Ferrie S, et al. Augmented enteral protein during critical illness: the TARGET protein randomized clinical trial. JAMA. 2025;334(4):319. https:\/\/doi.org\/10.1001\/jama.2025.9110.","journal-title":"JAMA"},{"issue":"10376","key":"1314_CR46","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1016\/S0140-6736(22)02469-2","volume":"401","author":"DK Heyland","year":"2023","unstructured":"Heyland DK, Patel J, Compher C, Rice TW, Bear DE, Lee ZY, et al. The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial. Lancet. 2023;401(10376):568\u201376. https:\/\/doi.org\/10.1016\/S0140-6736(22)02469-2.","journal-title":"Lancet"},{"issue":"8","key":"1314_CR47","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1001\/jama.2012.137","volume":"307","author":"TW Rice","year":"2012","unstructured":"The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, et al. Initial Trophic vs Full Enteral Feeding in Patients With Acute Lung Injury: The EDEN Randomized Trial. JAMA: J Am Med Association. 2012;307(8):795\u2013803. https:\/\/doi.org\/10.1001\/jama.2012.137.","journal-title":"JAMA: J Am Med Association"},{"key":"1314_CR48","doi-asserted-by":"publisher","unstructured":"Matsushima S, Yoshida M, Yokoyama H, Watanabe Y, Onodera H, Wakatake H, et al. Effects on physical performance of high protein intake for critically ill adult patients admitted to the intensive care unit: a retrospective propensity-matched analysis. Nutrition. 2021;91\u20132. https:\/\/doi.org\/10.1016\/j.nut.2021.111407.","DOI":"10.1016\/j.nut.2021.111407"},{"issue":"3","key":"1314_CR49","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1177\/0148607109335234","volume":"33","author":"SA McClave","year":"2009","unstructured":"McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient:: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N). JPEN J Parenter Enter Nutr. 2009;33(3):277\u2013316. https:\/\/doi.org\/10.1177\/0148607109335234.","journal-title":"JPEN J Parenter Enter Nutr"},{"issue":"5","key":"1314_CR50","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1007\/s00063-018-0427-9","volume":"113","author":"W Druml","year":"2018","unstructured":"Druml W, Joannidis M, John S, J\u00f6rres A, Schmitz M, Kielstein J, et al. Metabolische F\u00fchrung und Ern\u00e4hrung von Intensivpatienten mit renaler Dysfunktion: Empfehlungen der Sektionen Niere der DGIIN, \u00d6GIAIN und DIVI. Med Klin Intensivmed Notfmed. 2018;113(5):393\u2013400. https:\/\/doi.org\/10.1007\/s00063-018-0427-9.","journal-title":"Med Klin Intensivmed Notfmed"},{"issue":"7","key":"1314_CR51","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1007\/s00134-019-05615-z","volume":"45","author":"M Ostermann","year":"2019","unstructured":"Ostermann M, Macedo E, Oudemans-van Straaten H. How to feed a patient with acute kidney injury. Intensive Care Med. 2019;45(7):1006\u20138. https:\/\/doi.org\/10.1007\/s00134-019-05615-z.","journal-title":"Intensive Care Med"},{"issue":"1","key":"1314_CR52","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1186\/s13054-023-04663-8","volume":"27","author":"C Stoppe","year":"2023","unstructured":"Stoppe C, Patel JJ, Zarbock A, Lee ZY, Rice TW, Mafrici B, et al. The impact of higher protein dosing on outcomes in critically ill patients with acute kidney injury: a post hoc analysis of the EFFORT protein trial. Crit Care. 2023;27(1):399.","journal-title":"Crit Care"},{"issue":"1","key":"1314_CR53","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1186\/s13054-021-03693-4","volume":"25","author":"ZY Lee","year":"2021","unstructured":"Lee ZY, Yap CSL, Hasan MS, Engkasan JP, Barakatun-Nisak MY, Day AG, et al. The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2021;25(1):260. https:\/\/doi.org\/10.1186\/s13054-021-03693-4.","journal-title":"Crit Care"},{"issue":"2","key":"1314_CR54","doi-asserted-by":"publisher","first-page":"395","DOI":"10.3390\/nu12020395","volume":"12","author":"E De Waele","year":"2020","unstructured":"De Waele E, Malbrain MLNG, Spapen H. Nutrition in Sepsis: A Bench-to-Bedside Review. Nutrients. 2020;12(2):395. https:\/\/doi.org\/10.3390\/nu12020395.","journal-title":"Nutrients"},{"key":"1314_CR55","doi-asserted-by":"publisher","unstructured":"Elke G, Wang M, Weiler N, Day AG, Heyland DK. Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database. Critical care (London, England). 2014;Comment in: Crit Care. 2014;18(2):126 PMID: 25029264 https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2502926418(1):R29. https:\/\/doi.org\/10.1186\/cc13720","DOI":"10.1186\/cc13720"},{"issue":"6","key":"1314_CR56","first-page":"533","volume":"72","author":"G Iapichino","year":"2006","unstructured":"Iapichino G, Radrizzani D, Armani S, Noto A, Spanu P, Mistraletti G. Metabolic treatment of critically ill patients: energy balance and substrate disposal. Minerva Anestesiol. 2006;72(6):533\u201342.","journal-title":"Minerva Anestesiol"},{"issue":"3","key":"1314_CR57","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1177\/0148607109335234","volume":"33","author":"SA McClave","year":"2009","unstructured":"McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). J Parenter Enter Nutr. 2009;33(3):277\u2013316.","journal-title":"J Parenter Enter Nutr"},{"issue":"2","key":"1314_CR58","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1097\/aln.0000000000002436","volume":"130","author":"DA Story","year":"2019","unstructured":"Story DA, Tait AR, Survey Research. Anesthesiology. 2019;130(2):192\u2013202. https:\/\/doi.org\/10.1097\/aln.0000000000002436.","journal-title":"Anesthesiology"}],"container-title":["BMC Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40795-026-01314-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40795-026-01314-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40795-026-01314-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:21:06Z","timestamp":1781648466000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40795-026-01314-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,18]]},"references-count":58,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1314"],"URL":"https:\/\/doi.org\/10.1186\/s40795-026-01314-3","relation":{},"ISSN":["2055-0928"],"issn-type":[{"value":"2055-0928","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,18]]},"assertion":[{"value":"26 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was granted by the University of Nottingham Faculty of Medicine and Health Sciences Research Ethics Committee (FMHS 193\u20130524) and the study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent detailing the nature of the study and the specific role expected of panel members was obtained from all participants prior to participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"101"}}