{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:46:06Z","timestamp":1785843966795,"version":"3.56.0"},"reference-count":53,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Intensive Care Unit-Acquired Weakness (ICU-AW) is a secondary neuromuscular disorder diagnosed during a critical illness and related to ICU stay and intensive treatments, once other possible etiologies have been excluded. Micronutrients are essential components of human nutrition that are needed in small amounts to maintain pivotal organ functions, but their role in critical care nutrition and in prevention and treatment of ICU-AW is unclear. This narrative review aimed to provide a synthesis of the current evidence on the potential role of micronutrients in ICU-AW, with a glance at what is known in medical settings outside the ICU. Available evidence is fragmented, showing controversial results. Studies on vitamin K1 and vitamin D suggest potential benefits on handgrip strength, skeletal muscle mass and mobility, while Coenzyme Q10 may have a role in improving skeletal muscle composition. Moreover, zinc homeostasis may influence muscle degradation, whereas copper levels may represent a risk factor. Evidence on iron and carnitine showed uncertain results. Conversely, more robust evidence on muscle weakness is available for medical settings outside the ICU. Larger observational studies and RCTs are needed to further evaluate the possible efficacy of micronutrient supplementation in the critical care setting.<\/jats:p>","DOI":"10.3390\/jcm15156066","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:38:08Z","timestamp":1785839888000},"page":"6066","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Micronutrients and ICU-Acquired Weakness: A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Alberto Nicol\u00f2","family":"Galvano","sequence":"first","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artemide Maria","family":"Di Nicol\u00f2","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Cusimano","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Giarratano","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy"},{"name":"Department of Anesthesia, Analgesia, Intensive Care and Emergency, University Hospital Policlinico \u201cPaolo Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1416-9993","authenticated-orcid":false,"given":"Andrea","family":"Cortegiani","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy"},{"name":"Department of Anesthesia, Analgesia, Intensive Care and Emergency, University Hospital Policlinico \u201cPaolo Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1164\/rccm.201411-2011ST","article-title":"An official american thoracic society clinical practice guideline: The diagnosis of intensive care unit-acquired weakness in adults","volume":"190","author":"Fan","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s00134-020-05944-4","article-title":"ICU-acquired weakness","volume":"46","author":"Vanhorebeek","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_3","unstructured":"World Health Organisation (2026, May 20). Micronutrients (WHO). Available online: https:\/\/www.who.int\/health-topics\/micronutrients#tab=tab_1."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1016\/j.clnu.2020.06.005","article-title":"Monitoring and parenteral administration of micronutrients, phosphate and magnesium in critically ill patients: The VITA-TRACE survey","volume":"40","author":"Vankrunkelsven","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_5","first-page":"102848","article-title":"Prevalence of low blood vitamin levels in critically ill patients at intensive care unit admission: A cross-sectional study","volume":"71","author":"Riphagen","year":"2025","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.clnu.2025.07.021","article-title":"Nutrition therapy for physical impairment in critically ill patients: A narrative review of the latest evidence","volume":"52","author":"Yoshida","year":"2025","journal-title":"Clin. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.clnu.2018.08.037","article-title":"ESPEN guideline on clinical nutrition in the intensive care unit","volume":"38","author":"Singer","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1016\/j.clnu.2022.02.015","article-title":"ESPEN micronutrient guideline","volume":"41","author":"Berger","year":"2022","journal-title":"Clin. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1186\/s13054-020-02889-4","article-title":"Gastrointestinal dysfunction in the critically ill: A systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine","volume":"24","author":"Preiser","year":"2020","journal-title":"Crit. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3828","DOI":"10.1097\/00003246-200012000-00013","article-title":"Enteral Feeding with a Solution Enriched with Antioxidant Vitamins A, C, and E Enhances the Resistance to Oxidative Stress","volume":"28","author":"Preiser","year":"2000","journal-title":"Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/01.CCM.0000297954.45251.A9","article-title":"Early enteral supplementation with key pharmaconutrients improves Sequential Organ Failure Assessment score in critically ill patients with sepsis: Outcome of a randomized, controlled, double-blind trial","volume":"36","author":"Beale","year":"2008","journal-title":"Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1002\/jpen.2700","article-title":"What do we know about micronutrients in critically ill patients? A narrative review","volume":"49","author":"Stoppe","year":"2025","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_13","first-page":"344","article-title":"Micronutrient trials in critical illness\u2014New evidence since 2023","volume":"32","author":"Blaauw","year":"2026","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_14","first-page":"178","article-title":"Micronutrients as therapy in critical illness","volume":"30","author":"Stoppe","year":"2024","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1186\/s13054-023-04539-x","article-title":"Personalized nutrition therapy in critical care: 10 expert recommendations","volume":"27","author":"Wischmeyer","year":"2023","journal-title":"Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s13054-024-04810-9","article-title":"Improving management of ARDS: Uniting acute management and long-term recovery","volume":"28","author":"Latronico","year":"2024","journal-title":"Crit. Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1097\/CCM.0000000000005125","article-title":"ICU Survivorship\u2014The Relationship of Delirium, Sedation, Dementia, and Acquired Weakness","volume":"49","author":"Mart","year":"2021","journal-title":"Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1186\/s13054-014-0542-9","article-title":"Prevalence of iron deficiency on ICU discharge and its relation with fatigue: A multicenter prospective study","volume":"18","author":"Lasocki","year":"2014","journal-title":"Crit. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1186\/s13054-018-2253-0","article-title":"Iron deficiency diagnosed using hepcidin on critical care discharge is an independent risk factor for death and poor quality of life at one year: An observational prospective study on 1161 patients","volume":"22","author":"Lasocki","year":"2018","journal-title":"Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s13054-020-03430-3","article-title":"Impact of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: A multicenter, randomized, single-blinded trial","volume":"25","author":"Lasocki","year":"2021","journal-title":"Crit. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e70032","DOI":"10.1111\/nicc.70032","article-title":"Iron, selenium, copper and magnesium in critical care: Impact on acquired weakness risk through Mendelian randomization","volume":"30","author":"Zhang","year":"2025","journal-title":"Nurs. Crit. Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.freeradbiomed.2024.06.022","article-title":"The role of zinc and matrix metalloproteinases in myofibrillar protein degradation in critical illness myopathy","volume":"222","author":"Ribeiro","year":"2024","journal-title":"Free Radic. Biol. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.jcrc.2019.12.017","article-title":"Muscle degradation, vitamin D and systemic inflammation in hospitalized septic patients","volume":"56","author":"Borges","year":"2020","journal-title":"J. Crit. Care"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Sim\u00f3n-Frapolli, V.J., L\u00f3pez-Montalb\u00e1n, \u00c1., Vegas-Aguilar, I.M., Generoso-Pi\u00f1ar, M., Fern\u00e1ndez-Jim\u00e9nez, R., Cornejo-Pareja, I.M., S\u00e1nchez-Garc\u00eda, A.M., Mart\u00ednez-L\u00f3pez, P., Nuevo-Ortega, P., and Reina-Artacho, C. (2025). Relationship Between Vitamin D Levels with In-Hospital Complications and Morphofunctional Recovery in a Cohort of Patients After Severe COVID-19 Across Different Obesity Phenotypes. Nutrients, 17.","DOI":"10.3390\/nu17010110"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1002\/jcsm.13379","article-title":"Vitamin K1 ameliorates lipopolysaccharide-triggered skeletal muscle damage revealed by faecal bacteria transplantation","volume":"15","author":"Xiao","year":"2024","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e48","DOI":"10.1017\/jns.2021.39","article-title":"Effect of coenzyme Q10 supplementation on oxidative stress and clinical outcomes in patients with low levels of coenzyme Q10 admitted to the intensive care unit","volume":"10","author":"Zeinaly","year":"2021","journal-title":"J. Nutr. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/0026-0495(92)90146-2","article-title":"Prevalence of Carnitine Depletion in Critically III Patients with Undernutrition","volume":"41","author":"Wennberg","year":"1992","journal-title":"Metabolism"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13054-025-05746-4","article-title":"Abnormal carnitine concentrations in critical illness associated with compromised outcome","volume":"30","author":"Lauwers","year":"2026","journal-title":"Crit. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"508","DOI":"10.12688\/f1000research.17376.1","article-title":"Intensive care unit\u2013acquired weakness: Unanswered questions and targets for future research","volume":"8","author":"Piva","year":"2019","journal-title":"F1000Research"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1152\/physrev.00028.2014","article-title":"The sick and the weak: Neuropathies\/ myopathies in the critically ill","volume":"95","author":"Friedrich","year":"2015","journal-title":"Physiol. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.jcrc.2020.11.019","article-title":"Relationship between intensive care unit-acquired weakness, fatigability and fatigue: What role for the central nervous system?","volume":"62","author":"Souron","year":"2021","journal-title":"J. Crit. Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jointm.2023.07.002","article-title":"Intensive care unit-acquired weakness: Recent insights","volume":"4","author":"Chen","year":"2024","journal-title":"J. Intensive Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1007\/s00134-019-05678-y","article-title":"Micronutrient deficiency in critical illness: An invisible foe?","volume":"45","author":"Casaer","year":"2019","journal-title":"Intensive Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1186\/s13054-015-0937-2","article-title":"Impact of ICU-acquired weakness on post-ICU physical functioning: A follow-up study","volume":"19","author":"Wieske","year":"2015","journal-title":"Crit. Care."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1177\/0148607108328470","article-title":"Micronutrient supplementation in adult nutrition therapy: Practical considerations","volume":"33","author":"Sriram","year":"2009","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1056\/NEJMra070553","article-title":"Vitamin D deficiency","volume":"357","author":"Holick","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1007\/s13668-024-00552-w","article-title":"Managing Micronutrient Deficiencies in High-Risk Patients: No Small Feat!","volume":"13","author":"Steele","year":"2024","journal-title":"Curr. Nutr. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1016\/S0140-6736(11)61452-9","article-title":"Selenium and human health","volume":"379","author":"Rayman","year":"2012","journal-title":"Lancet"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.abb.2016.08.003","article-title":"Selenium and redox signaling","volume":"617","year":"2017","journal-title":"Arch. Biochem. Biophys."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.nut.2016.09.012","article-title":"Massive copper and selenium losses cause life-threatening deficiencies during prolonged continuous renal replacement","volume":"34","author":"Voirol","year":"2017","journal-title":"Nutrition"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1093\/ajcn\/85.5.1293","article-title":"Trace Element Supplementation after Major Burns Modulates Antioxidant Status and Clinical Course by Way of Increased Tissue Trace Element Concentrations","volume":"85","author":"Berger","year":"2007","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.1053\/j.gastro.2009.07.071","article-title":"Selenium in Intravenous Nutrition","volume":"137","author":"Shenkin","year":"2009","journal-title":"Gastroenterology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1093\/ajcn\/86.2.347","article-title":"Association of Low Plasma Selenium Concentrations with Poor Muscle Strength in Older Community-Dwelling Adults: The InCHIANTI Study","volume":"86","author":"Lauretani","year":"2007","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1007\/s12603-015-0509-9","article-title":"Improved Health-Related Quality of Life, and More Days out of Hospital with Supplementation with Selenium and Coenzyme Q10 Combined. Results from a Double Blind, Placebo-Controlled Prospective Study","volume":"19","author":"Johansson","year":"2015","journal-title":"J. Nutr. Health Aging"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"6847","DOI":"10.1007\/s11356-023-31599-x","article-title":"Association between serum copper levels and muscle mass: Results from NHANES 2011\u20132016","volume":"31","author":"Chen","year":"2024","journal-title":"Environ. Sci. Pollut. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.jamda.2015.12.015","article-title":"Differences in Nutrient Intake and Biochemical Nutrient Status Between Sarcopenic and Nonsarcopenic Older Adults-Results from the Maastricht Sarcopenia Study","volume":"17","author":"Mijnarends","year":"2016","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"3239","DOI":"10.3892\/etm.2017.4879","article-title":"Dietary vitamin B6 modulates the gene expression of myokines, Nrf2-related factors, myogenin and HSP60 in the skeletal muscle of rats","volume":"14","author":"Suidasari","year":"2017","journal-title":"Exp. Ther. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.clnu.2015.11.013","article-title":"Nutritional status, body composition, and quality of life in community-dwelling sarcopenic and non-sarcopenic older adults: A case-control study","volume":"36","author":"Verlaan","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.exger.2017.05.017","article-title":"Vitamin B12 deficiency might be related to sarcopenia in older adults","volume":"95","author":"Bulut","year":"2017","journal-title":"Exp. Gerontol."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Ganapathy, A., and Nieves, J.W. (2020). Nutrition and sarcopenia\u2014What do we know?. Nutrients, 12.","DOI":"10.3390\/nu12061755"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1007\/s11657-018-0553-2","article-title":"Vitamin D supplementation and muscle strength in pre-sarcopenic elderly Lebanese people: A randomized controlled trial","volume":"14","author":"Fares","year":"2019","journal-title":"Arch. Osteoporos."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2413","DOI":"10.1007\/s00198-015-3151-9","article-title":"Effect of vitamin D supplementation alone on muscle function in postmenopausal women: A randomized, double-blind, placebo-controlled clinical trial","volume":"26","author":"Cangussu","year":"2015","journal-title":"Osteoporos. Int."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"102532","DOI":"10.1016\/j.arr.2024.102532","article-title":"Nutritional factors and physical frailty: Highlighting the role of functional nutrients in the prevention and treatment","volume":"101","author":"Ziaei","year":"2024","journal-title":"Ageing Res. Rev."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6066\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:18:40Z","timestamp":1785842320000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6066"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":53,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15156066"],"URL":"https:\/\/doi.org\/10.3390\/jcm15156066","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}