The use of anabolic agents in catabolic states.

OBJECTIVE: We plan to review the current problem of lean mass erosion in catabolic states, caused by injury and critical illness. This protein loss is driven by the hormonal imbalance and excess inflammation referred to as the "stress response to injury." We then plan to provide the current concepts on the use of available anabolic agents to attenuate the excess catabolism. DATA SOURCE: The available published literature on the pathogenesis of acute catabolic states and the use of anabolic and anticatabolic agents, their indications, mechanism of action, and potential complications was reviewed. DATA EXTRACTION: The current understanding and experience of the available anabolic and anticatabolic agents as well as the rationale for the use of each anabolic agent are described. CONCLUSION: We conclude that the preservation of lean body mass (body protein) is extremely important in the management of critical care populations, as lean mass loss leads to severe morbidity and increased mortality. Essentially, all of the available anabolic agents stimulate protein synthesis and decrease protein breakdown, but all have different mechanisms of action. Adequate nutrition, especially protein intake, is essential for any anabolism to occur. Combined anabolic therapy also appears to be advantageous. Although controlling the inflammatory response would also be of major benefit in further controlling protein loss, effective and safe anti-inflammatory agents have not yet become clinically available for this purpose.