Research Article| Volume 36, ISSUE 4, P604-616, October 1950

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Protein metabolism in chronic illness: Effect of protein supplementation on nitrogen balance, hemoglobin, serum proteins, and weight in the malnourished and the effect of the nutritional status on nitrogen storage

  • S.O. Waife
    From the Nutrition Project (Dr. M. G. Wohl, Chief) and the Department of Medicine, Philadelphia General Hospital, Philadelphia, Pa., USA
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  • Michael G. Wohl
    From the Nutrition Project (Dr. M. G. Wohl, Chief) and the Department of Medicine, Philadelphia General Hospital, Philadelphia, Pa., USA
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  • John G. Reinhold
    From the Nutrition Project (Dr. M. G. Wohl, Chief) and the Department of Medicine, Philadelphia General Hospital, Philadelphia, Pa., USA
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  • Author Footnotes
    ∗ Assistant Director, in charge of medical education, Philadelphia General Hospital; Instructor in Medicine, University of Pennsylvania School of Medicine.
    † Chief, Nutrition Clinic, Philadelphia General Hospital; Associate Professor of Medicine, Temple University Medical School.
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      Twelve chronically ill, “protein-depleted” subjects were studied by nitrogen balance methods for an average of fifty days (range 22 to 124 days).
      When their protein intake was supplemented by an oral casein concentrate preparation, large amounts of nitrogen were stored. This avidity for protein reached high proportions in certain individuals even after months of presumably adequate protein intake.
      In six subjects, the nitrogen balance rose to approximately the same extent as did the nitrogen intake. Four other patients studied showed only a moderately increased nitrogen balance in response to increased intake of protein. This was probably because their protein stores were almost completely replenished. Clinically, this group is indistinguishable from the former except that (among diabetics) they require significantly less insulin. Further work is needed to distinguish this group in order to avoid useless and indiscriminate protein supplementation.
      No over-all correlation was found between the amount of nitrogen stored or the rate at which it was stored on one hand and albumin, globulin, or weight changes on the other. None of the usual determinants helped in predicting who would store large or small amounts of nitrogen or which protein fraction would change.
      Patients in the anabolic phase of protein metabolism gained somewhat more weight when compared with those believed to be near complete protein repletion. This latter group showed a statistically significant greater rise in hemoglobin levels.
      Protein metabolism in chronic illness differs significantly from that in acute illness in previously well subjects. The position along the kinetic course of protein repletion determined the choice and degree of protein fraction which would be altered on supplementation.
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