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One of the most important ICU rehabilitation trials in years just challenged a belief many of us have held for decades…🚨 Is more protein, combined with early exercise, actually better during critical illness? For years, many of us believed that if some protein and exercise were good in the ICU, more must be better. The new NEXIS Trial challenges that assumption. Researchers tested: ✅ Early in-bed cycling ✅ Intravenous amino acids targeting ~2.0–2.5 g/kg/day of protein The result? No significant improvement in post-ICU physical function compared with usual care. But this doesn’t mean protein or rehabilitation aren’t important. Recent randomized trials suggest the optimal protein dose during acute critical illness may actually be lower than many thought. 📌 PRECISe Trial (Lancet): ~1.2 g/kg/day was associated with better post-ICU physical function than higher protein doses. 📌 Our randomized trial (PMID: 39018085): Patients receiving 1.2–1.5 g/kg/day had the best post-ICU physical function, outperforming those receiving ~2.0 g/kg/day. The emerging message: ➡️ More protein isn’t automatically better. ➡️ More exercise isn’t automatically better. ➡️ Precision and personalization are the future. Our NIH R01- and SCCM-funded REMM-HIIT Trial (NCT04664101) is testing CPET VO₂peak-guided rehabilitation in post-ICU/hospital patients. We’ve shown that CPET VO₂peak testing is feasible in ICU survivors, and our pilot data demonstrate 25–50% improvements in VO₂peak within 4–12 weeks, even in very debilitated patients using home-based, real-time tele-rehabilitation. The future isn’t about giving every patient the highest protein dose. It’s about giving the right nutrition and exercise, to the right patient, at the right time. That means targeting protein needs (potentially with BIA) and personalizing exercise using CPET VO₂peak. Negative trials don’t close the book—they help us ask better questions and move toward precision nutrition and rehabilitation. ❓Should ICU protein targets shift toward ~1.2–1.5 g/kg/day during acute critical illness based on NEXIS, PRECISe, and these newer data? I’d love to hear your thoughts in comments 👇

New ESPEN Fact Sheet Released! Honored to share a major step forward for the clinical nutrition community: New ESPEN Fact Sheet on The ICD-11 Code for Adult Undernutrition is now published and available in English and Spanish. This new fact sheet highlights the global recognition of undernutrition and supports improved diagnosis and care worldwide. Download now and share with your network: https://t.co/gKSK6Wi6lT #ICD11 #Malnutrition #GLIM #ESPEN #NutritionMatters #factsheet #MAW