1. BACKGROUND & OBJECTIVES:
EVALUATION OF EARLY ENTERAL NUTRITION WITH WHEY PROTEIN COMPARED WITH CASEIN PROTEIN IN MECHANICALLY VENTILATED PATIENTS WITH MEDICAL SEPSIS IN INTENSIVE CARE UNIT
PR120
Vineya Rai* 1, Yew Yen Sarn1, M.Shahnaz Hasan1, Mohd Fadhil Hadi Jamaluddin1, Loh Pui San1, Amirah Amir2, 1Anesthesiology, 2Parasitology, UNIVERSITY OF MALAYA, KUALA LUMPUR, Kuala Lumpur, Malaysia
BACKGROUND & OBJECTIVES:
Sepsis is a major cause of morbidity and mortality in hospitals worldwide. Whey in particular is not only a good source of nutritional protein, but contains bioactive components which may alter disease course. High concentrations of essential amino acids Leucine and Cysteine promotes tissue growth and repair . Anti-inflammatory effects are exerted by the proteins α/β-lactalbumin and lactoferrin via inhibition of interleukin formation. Lactoferrin is also a non-enzymatic anti-oxidant which stimulates immune systems. This pilot study compares whey based protein milk to casein based protein milk as enteral nutrition, and measures the outcome by looking into how they affect the inflammatory and anti-oxidative status of the patients.
RESULTS
21 patients were randomized into whey group, while 17 patients into casein group. Results showed a reduction in all IL-6 levels for both groups, but were statistically insignificant, while Glutathione levels, an anti-oxidant showed a significant reduction in the casein protein group (p=0.027) and not whey protein group. As for CRP, both groups also showed reduction in levels, but casein group was significant (p=0.044).
Figure 1: Mean Comparison of Interleukin-6 (IL-6) between Whey and Casein Group
Figure 2: Mean Comparison of Glutathione (GSH) between Whey and Casein Group
Table 1: Comparing Interleukin-6 (IL-6) by Two Types of Feed
Table 2: Comparing Glutathione (GSH) by Two Types of Feed
Figure 3: Median Difference of C-Reactive Protein (CRP) between Whey and Casein Group
MATERIALS & METHODS
Adult critically ill patients due to sepsis whom were admitted to General Intensive Care Unit were recruited into this study. Patients were randomly assigned to receive either enteral formula containing whey protein or a casein-based formula. Blood samples were taken for measurement of plasma Interleukin-6 (IL-6), Glutathione and C-reactive Protein (CRP) levels at Day 1 and Day 5.
Table 3: Comparing C-Reactive Protein (CRP) by Two Types of Feed
CONCLUSION
Whey protein seems to have better ability in retaining body’s anti-oxidant status in times of severe stress as compared to casein from the preliminary results. However both have no significant effect on reducing inflammation. Nevertheless, a larger sample size is needed for sufficient power to determine more objectively the results of whey vs casein in terms of such outcome measurement.