Feasibility of whey protein powder supplementation in patients who are neurocritically ill: A post hoc analysis of a pilot randomized controlled trial

BACKGROUND: Hypoalbuminemia, often induced by acute stress and inflammation in patients who are neurocritically ill, is adversely associated with prognosis. This study investigates whether supplementing nutrition support with anti-inflammatory whey protein powder formulations (experimental group) can improve serum albumin levels and overall patient outcomes compared with traditional liquid intact protein formulations (control group) while monitoring for enteral feeding complications and inflammatory markers. METHODS: In a randomized controlled trial conducted at a neurointensive care unit from January 2020 to May 2022, 116 out of 597 patients who required enteral nutrition (EN) for at least 7 days were randomly assigned to receive either the formula from experimental group or control group. The primary end point was serum albumin levels at 14 days. Secondary outcomes included functional status (modified Rankin Scale [mRS]) at 90 days, EN-related complications, and changes in serum inflammatory and infectious markers. RESULTS: No significant differences were observed in serum albumin levels or mRS scores (P > 0.05). Complication rates from EN and changes in inflammatory and biochemical markers were comparable between groups. The post hoc analysis showed that the experimental group had a significantly higher median daily protein intake (1.7 g/kg/day; interquartile range [IQR]: 1.6-1.8) compared with the control group (1.5 g/kg/day; IQR: 1.3-1.7), with P ＜ 0.001. CONCLUSION: Although no significant difference was observed in serum albumin levels on day 14 between the whey protein powder supplementation group and the control group, protein supplementation with whey protein powder may be a viable strategy to meet protein requirements in patients who are neurocritically ill.