ROLE OF THERAPEUTIC NUTRITION IN CRITICAL AND CLINICAL CARE: A DIETITIAN'S PERSPECTIVE ON ICU PROTEIN INTAKE, ENTERAL NUTRITION IN INFECTION RECOVERY, AND INFLAMMASOME MODULATION IN HEART FAILURE

Abstract

Therapeutic nutrition plays a pivotal role in the management of critically ill and clinically complex patients, yet optimal implementation requires integration of evolving mechanistic insights with pragmatic clinical protocols. This review synthesizes current evidence across three domains of high clinical relevance to dietitians: protein delivery in intensive care unit (ICU) settings, enteral nutrition strategies for infection and sepsis recovery, and dietary modulation of inflammasome pathways in heart failure. In ICU protein management, contemporary guidelines recommend staged escalation from low early doses to 1.2–2.0 g/kg/day after stabilization, with individualized adjustments for obesity, continuous renal replacement therapy, burns, and sepsis; however, randomized controlled trials demonstrate muscle-sparing effects without consistent mortality benefit, and delivery barriers necessitate active dietitian oversight. Enteral nutrition in infection recovery preserves gut barrier integrity, modulates the microbiome, and supports immune homeostasis, with early initiation (within 72 hours) associated with shorter ICU stays and reduced acute kidney injury, though clinical trial outcomes remain heterogeneous and immunonutrient formulas show context-dependent benefits and risks. Emerging evidence implicates the NLRP3 inflammasome in cardiac inflammation and heart failure progression; preclinical studies identify omega-3 fatty acids, polyphenols, short-chain fatty acids, and ketone bodies as inflammasome inhibitors through mitochondrial protection, redox modulation, and epigenetic mechanisms, yet clinical translation remains limited. Across all three domains, dietitians serve as essential integrators—assessing individual needs, prescribing tailored interventions, troubleshooting delivery obstacles, and bridging mechanistic science with bedside care. This review provides a structured framework for evidence-based nutrition practice in critical and clinical care, highlighting both established interventions and areas requiring further investigation.