Back to Basics: Estimating Protein Requirements for Adult Hospital Patients. A Systematic Review of Randomised Controlled Trials

Abstract

Aim: To review the supporting evidence for protein requirements in hospitalised adults, and compare the findings with commonly-used guidelines and resources. Methods: a systematic review was conducted based on a computerised bib-liographic search of MEDLINE, EMBASE and CINAHL from 1950 to October 2011, as well as a citation review of relevant articles and guidelines. Studies were included if they were randomised clinical trials in hospitalised or chroni-cally ill adults, comparing two or more different levels of protein intake. Information about study quality, setting, and findings was extracted using standardised protocols. Due to the heterogeneity of study characteristics, no meta-analysis was undertaken. Results: 116 papers were obtained in the search and 33 of these met all inclusion criteria. Five studies could not be obtained. The remainder reported outcome measures such as nitrogen balance, anthropometric measure-ments (including body weight, BMI, and mid-arm circumference), blood electrolyte levels and serum urea, which pro-vide support for recommended protein intakes in various clinical conditions. The results were summarized and com-pared with current recommendations. Conclusion: high-level evidence to support current recommendations is lacking. The studies reviewed generally agreed with current guidelines and resources.