Protein: An essential nutrient to support patients’ health and recovery

Proteins are essential nutrients for growth, development and health

Proteins are the main building blocks of our body. They’re key structural components of muscles, bones, hair, nails and all cells in the body. Proteins are also needed to regulate metabolic processes and immune pathways.¹ They’re important nutrients to support growth and development during infancy and childhood, as well as essential nutrients during aging, when muscle decline is common, especially for individuals with malnutrition.

Higher intakes of proteins are essential to help support recovery from illness, surgery, falls and fractures and to help support the body during the wound healing process.^2-9 This makes protein an instrumental component of medical nutrition products serving hospitalized patients and those with chronic illnesses.

High-quality proteins are key

Proteins are made up of amino acids that are joined together in long chains called peptides. There are nine essential amino acids that our bodies are unable to produce and therefore we must get them from our diet. In addition, there are six conditionally essential amino acids that are needed in some situations, such as an illness or wound healing. “High quality” proteins are recommended as they provide all the essential amino acids our body needs in a form that the body can break down, digest and absorb.

Not all proteins are created equal

Two important factors come into play when selecting a protein source: digestibility and overall quality. Digestibility assesses how well a protein is broken down and absorbed throughout the gastrointestinal (GI) tract. Proteins are often classified as “fast” or “slow,” referring to the speed at which amino acids are released. Protein quality depends on the amounts of each amino acid and how easy it is to digest. Scoring systems, such as the protein digestibility corrected amino acid score (PDCAAS) rate proteins on a scale of 0–1. The goal is to provide high-quality protein in products that have a PDCAAS of 1, the highest possible score.

Dairy proteins, including whey and casein, are high quality. They inherently provide all the essential amino acids in meaningful amounts. Nutritional adequacy can also be achieved with a thoughtful combination of plant proteins, or animal and plant proteins. Some plant proteins, such as those derived from soy also have a PDCAAS of 1 and can achieve amino acid requirements. Other proteins, like those from pea, wheat or some beans, can be lacking in certain amino acids and must be paired together with other proteins or individual amino acids to ensure no shortfalls.

A variety of protein offerings gives patients choices

Diet diversity can support human and planetary health. As dietary guidance evolves globally to meet the optimal health needs of the population, experts recognize that eating a variety of foods helps to deliver nutritional adequacy and better health outcomes.¹⁰ There’s a growing recognition that plant proteins, in addition to animal sources of protein, can deliver benefits for the individual as well as reduce the carbon footprint to drive sustainability goals. Moreover, people are also looking for food choices that align with their cultural preferences. It’s important to give patients who rely on medical nutrition a variety of protein choices to meet their daily needs as well. This includes oral nutrition supplements and tube feeding products.

Dairy proteins as the standard in medical nutrition for decades

Dairy proteins can come in the form of intact milk protein, or its individual components, whey and casein. Whey protein is a fast-acting protein, meaning it moves quickly from the stomach to the small intestine. It’s rich in essential and branched chain amino acids, like leucine, which is important to support muscle synthesis for tissue growth and repair.¹¹ Casein is a slow-acting protein that takes longer to digest and can provide a sustained release of amino acids over a long period of time.¹² This can also be beneficial to support muscle, particularly during periods of fasting or sleep when muscle breakdown can be common.

Research continues to uncover additional benefits of whey protein for hospitalized patients. It helps to facilitate gastric emptying to support tolerance and fewer GI symptoms, often a key challenge for patients adjusting to new or modified nutrition support.¹³ Whey protein is also a rich source of the amino acid cysteine, a precursor to glutathione, to protect against oxidative stress and tissue damage.^14,15 A study conducted in Brazil showed that a 100% whey peptide diet delivered via enteral feeding improved inflammatory markers and glutathione production in patients with ischemic stroke.¹⁵ Lastly, glucose control can be a challenge for acute care patients in particular. Whey peptides have an insulinotropic effect, having a positive effect on glycemic response and insulin sensitivity.¹⁶ A multi-center study showed that a very high protein (100% whey peptide; Peptamen Intense VHP), low-carbohydrate enteral feeding can facilitate glucose control and reduced insulin requirements in critically ill, mechanically ventilated overweight/obese patients in the ICU.¹⁷

Hydrolyzed whey protein is an important option for children and adults with conditions that impair digestion or absorption, such as critical illness, gastroparesis, Crohn’s disease, or short bowel syndrome.^18,19 Hydrolysis is the process of breaking proteins down into their smaller components, either peptides or amino acids, resulting in a pre-digested form of protein that’s easier to absorb. Proteins like this can be found in specialized products like Peptamen and Extensive HA infant formula.

• Peptamen is a peptide-based formula suitable for patients with GI dysfunction and malabsorption, where this unique broken-down form of protein supports better tolerance compared to intact protein formulas.
• Extensive HA is made with extensively hydrolyzed proteins for infants with cow’s milk protein allergy who need a hypoallergenic formula.

Formulas made with pea and/or soy proteins offer plant-based alternatives

As health and nutritional guidelines recommend the integration of plant-based proteins into diets, there have been many new products introduced to the market to help patients who rely on oral nutrition supplements and tube feeding products to also reap these benefits. Formulas made with soy or pea proteins provide options for patients seeking plant-based alternatives to dairy-based formulas. In some cases, additional amino acids (such as cysteine or methionine) are added to ensure a formula with PDCAAS 1 is achieved. These such formulas have demonstrated nutritional adequacy as well as improved GI tolerance (lower incidence of constipation, diarrhea, nausea and vomiting) in patients who may have an allergy or feeding intolerance to other proteins.²⁰ As a bonus, pea protein delivers other unique benefits including being rich in arginine, a conditionally essential amino acid that’s important during periods of illness, stress or trauma. These plant-based proteins are available in both intact and hydrolyzed versions, similar to animal protein options, to meet the needs of a variety of patients.

Protein blends—The best of both worlds

Knowing that there are advantages to both animal and plant proteins, carefully crafted recipes that blend both of these protein sources can bring value. At Nestlé Health Science, dietitians take great care to ensure that enteral formulas provide essential amino acids in the correct amounts to ensure optimal digestion and absorption (PDCAAS of 1). Many of these protein blends bring the added benefit of a combination of fast, medium and slow-release amino acids to help deliver the best support possible to muscles. A key example of this is Compleat Pediatric Original 1.0, which offers real food ingredients that many patients and healthcare practitioners are looking for, with a combination of high-quality animal protein via chicken and milk proteins, as well as nutritious plant protein via pea protein. This helps patients reliant on medical nutrition products achieve a variety of food sources, similar to a mixed healthy diet. And last, but certainly not least, these unique protein blends can support more environmentally sustainable nutrition solutions.