{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T23:26:09Z","timestamp":1793921169946,"version":"4.8.0"},"reference-count":27,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T00:00:00Z","timestamp":1755993600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002322","name":"Coordination for the Improvement of Higher Education Personnel (CAPES), the Ministry of Education (MEC) of Brazil","doi-asserted-by":"publisher","award":["88887.713853\/2022-00"],"award-info":[{"award-number":["88887.713853\/2022-00"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: The optimal protein dose for critically ill cancer patients, especially for muscle mass preservation and survival, remains unclear. This study evaluated whether a higher protein intake, compared to usual intake, was associated with improved clinical outcomes in this population. Methods: This was a prospective analysis of critically ill adult cancer patients admitted to an oncological intensive care unit (ICU). Patients were initially assigned to receive protein prescriptions of either 1.5 or 2.0 g per kilogram per day (g\/kg\/day), but due to common limitations in achieving prescribed targets in this setting, a prespecified per-protocol analysis was conducted. After three days of exclusive nutritional therapy, patients were reclassified into two groups based on actual protein intake: &gt;1.5 g\/kg\/day (higher intake group, IG) and \u22641.5 g\/kg\/day (usual intake group, CG). The primary outcome was muscle mass preservation, measured by quadriceps muscle thickness (QMT) via ultrasound on days 1, 7, and 14. Secondary outcomes included ICU survival, hospital and ICU length of stay, mechanical ventilation duration, dialysis requirement, and 60-day survival. Results: From June 2019 to September 2023, 117 patients were included. Following the planned interim analysis, the study was stopped after meeting the Pocock criterion for ICU survival (p = 0.0013). After reclassification, 68.4% (n = 80) were in the IG and 31.6% (n = 37) in the CG. ICU stay was similar (both medians 13 days), but the IG had shorter hospital stays [21.0 vs. 27.5 days, p = 0.020], less QMT loss, and improved ICU (HR = 0.31, 95% CI 0.15\u20130.64), hospital (HR = 0.43, CI 0.23\u20130.80), and 60-day survival (HR = 0.43, CI 0.23\u20130.80), along with shorter ventilation duration (HR = 0.54, CI 0.30\u20130.99). Conclusions: Higher protein intake (&gt;1.5 g\/kg\/day) was associated with better muscle mass preservation and improved clinical outcomes in critically ill cancer patients.<\/jats:p>","DOI":"10.3390\/nu17172742","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:09:32Z","timestamp":1756080572000},"page":"2742","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Effects of Higher Protein Intake on Muscle Mass and Clinical Outcomes in Critically Ill Cancer Patients: A Prespecified Per-Protocol Analysis"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4943-4670","authenticated-orcid":false,"given":"Jerusa Marcia","family":"Toloi","sequence":"first","affiliation":[{"name":"Division of Anesthesiology, Postgraduate Program of Anesthesiology, Surgical Sciences and Perioperative Medicine, Faculty of Medicine, University of S\u00e3o Paulo, Av. Dr. Arnaldo 455, Sao Paulo 05403-000, Brazil"},{"name":"Department of Nutrition, Barretos Cancer Hospital, R. Antenor Duarte Vilela 1331, Barretos 14784-400, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1343-3011","authenticated-orcid":false,"given":"Ana Carolina Gallo","family":"Laranja","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Barretos Cancer Hospital, R. Antenor Duarte Vilela 1331, Barretos 14784-400, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diogo Oliveira","family":"Toledo","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627\/701, Sao Paulo 05652-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo Esper","family":"Treml","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Palo Alto, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3261-5603","authenticated-orcid":false,"given":"Luiz Marcelo S.","family":"Malbouisson","sequence":"additional","affiliation":[{"name":"Division of Anesthesiology, Postgraduate Program of Anesthesiology, Surgical Sciences and Perioperative Medicine, Faculty of Medicine, University of S\u00e3o Paulo, Av. Dr. Arnaldo 455, Sao Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Manzanares","sequence":"additional","affiliation":[{"name":"Department of Critical Care, University Hospital of Universidad de la Republica (UDELAR), Av. Italia, Montevideo 11.600, Uruguay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1494-0784","authenticated-orcid":false,"given":"Jo\u00e3o Manoel","family":"Silva-Jr","sequence":"additional","affiliation":[{"name":"Division of Anesthesiology, Postgraduate Program of Anesthesiology, Surgical Sciences and Perioperative Medicine, Faculty of Medicine, University of S\u00e3o Paulo, Av. Dr. Arnaldo 455, Sao Paulo 05403-000, Brazil"},{"name":"Department of Nutrition, Barretos Cancer Hospital, R. Antenor Duarte Vilela 1331, Barretos 14784-400, Brazil"},{"name":"Division of Critical Care, Department of Surgery, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Av. Bandeirantes, 3900, Ribeirao Preto 14040-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3639","DOI":"10.1245\/s10434-024-15152-9","article-title":"Impact of the COVID-19 Pandemic on the Outcomes of Patients Undergoing Oncological Surgeries: CORONAL Study","volume":"31","author":"Vianna","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/CCM.0b013e3181c0349e","article-title":"Characteristics and outcomes of patients with cancer requiring admission to intensive care units: A prospective multicenter study","volume":"38","author":"Soares","year":"2010","journal-title":"Crit. 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