POWER OF PROTEIN BECOMING CLEAR IN BRAZILIAN ICU NUTRITION

Interview by Meg Blogg Marquardt, Nestlé Health Science at ESPEN 2018 with two Brazilian doctors leading nutritional breakthroughs on the front line of ICU care in their Country, Dr Sergio Loss from the UTI Hospital Independência, Porto Alegre, and Doctor Armando Porto Carreiro De Souza from Rio de Janeiro.

From ESPEN 2018, Madrid September 1-4 September.

MB: I’m here with Doctor Loss from Brazil along with Doctor Porto Carreiro. We’re here at the ESPEN Congress in Madrid, in the early days of September, and I’d very much like to hear your opinions Doctors, on the key highlights, your experience here at the ESPEN meeting? Doctor Loss what have you appreciated so far?

SL: I’m enjoying a lot the congress and I think that the main issue here is protein and I like to think about these issues. I think that protein is a core part of the treatment of intensive care patients and I work with intensive care patients and we are, we can, we have a chance to understand better the amount of protein that I have to give to these patients via doses, I think that’s very important because protein is a part and you have a chance to really help this kind of patient.

MB: Do you think Doctor Loss, what you’ve learnt here will change your practice with your intensive care patients? Do you think what you have learned here you will go back to south of Rio and do some things differently?

SL: Yes. My concern about body composition, about amount of protein in that body, of that patient, is very important to understand better how many and what protein I have to do. I think that’s important to know about cachexia, sarcopenia Type one, Type two, I think that’s a very important issue regarding my speciality that is intensive care patients.

MB: I was going to ask Doctor Porto Carreiro, who is a gastrointestinal surgeon, what have been the highlights for you here? Is it the same story, is protein the key thing for your population of patients?

APC: Yes. For sure, I agree 100 percent with Doctor Loss. The main issue of this congress, wonderful congress in Madrid, a wonderful city, is protein. I think the protein is the next border, the next frontier that needs to be managed in traditional therapy because we are talking about how many calories you need to give for the patient and you get a lot of issues about that. We are discussing a long, long time about quality of lipids and now the next frontier is going to be the protein. The big issues are what kind of protein, when and how much you need to give to the patient…

SL: And what kind of patient…

APC: And what kind of patient yes. You don’t  the same kind of  recipe to patient, you have to individualise each patient to give the best care for them. And as a surgeon I love protein As a gastrointestinal  surgeon and with cancer I know that a lot of our patients we are really about nourishing  when they go to the surgery you need an opportunity before they thought to give them some special protein, some special amino acids to have a better post-operative time. So I am enjoying too much it, I feel that I’m a believer in the power of protein and I think that this congress increased my belief in the protein for the patient.

MB: Do you think there is still additional clinical studies needed or you are convinced already with the anecdotes and the observational work that you’re seen?

All the speakers said that we need more studies. 

That we have to study more.

APC: The printed data shows that if we give less calorie and more protein you are going to be better, better outcomes. But we need more studies, more numbers of patients to confirm this result and to make them strong.

SL: And to understand better our context. Because the, core word here for me is “individualise” your patient and individualise your patient in the context of his disease.

APC: Yes. Neither disease are the same, neither patient are the same. We are going to a new frontier for sure Dr Juan Ochoa said today in the Nestlé  meeting, it is a cross –border, we need to see the disease we need to see the patients, we need to individualise the treatment. We are doing cancer therapy right now, we start to do it with nutritional therapy too.

MB: So in fact the more options you have for individualisation the better off for you and for the patient because you can be more selective?

APC: For sure.

SL: For sure.

MB: So I just have one more question because you said three clear aspects were important, what type of protein, how much and which patient. And do we have the answers to these in your opinion?

APC: I think about the amount of protein we know we should give more, but I think we still need more studies about what kind of patients and how much is more? 1.3, 1.5, 1.6, 2.0? I think that we need more studies about how much…

SL: And if your patient is sarcopenic or not sarcopenic.

APC: And when?  I believe that earlier is always better.

SL: Yes I am totally with Armando. I think that you have to individualise and you have to reach your goal and your goal in this context can be reached three, four or five days but you have to go fast with moderate restriction of total calories and make the protein your main instrument to treat this patient. Mainly with a good protein and I’m convinced in this congress, Meg, I’m convinced that the whey protein is very important and the protein you should use more in this context of patient, very sick patient with gut dysfunction, I think that protein can help you. We have heard things regarding this, your glycaemic control could be better with this kind of protein.

APC: Yes this kind of  approach. And protein is the, it takes the principal role in this  whole theatre. The principal role is protein.

SL: Good protein, whey protein.

MB: Well it’s been just a pleasure to hear your points of view. It sounds like we’re on an encouraging wave, there’s more consistency in the consensus of what should be done for this group of people that need to be fed. Well thank you very much I look forward to meeting you again soon and yeah, thank you.

APC: It was a pleasure to be here with you.

SL: Our pleasure.

Thank you.