In addition, perioperative fasting can worsen the surgical stress response, weaken gut function, and amplify protein losses. In patients with critical illness who may be also confined to bed rest, a vicious cycle is present with bed rest promoting muscle breakdown and the resultant muscle wasting and weakness preventing much needed ambulation and physical activity. It has been reported that patients in the acute care setting can lose about 2% of their muscle mass per day but with longer hospital stays, they can lose as much as 50% muscle mass. [22] Loss of muscle mass has significant consequences, including muscle weakness, fatigue, risk of pulmonary complications (e.g. longer need for a ventilator, pneumonia) , and prolonged hospitalization as a consequence of a slower recovery. How does HMB work? The effects of HMB resulting in an improvement of physical performance, stamina, or recovery are related to the inhibition of protein break-down, increased protein synthesis, stimulation of growth hormone, increase of muscle stem cells, and decreased cell death. [23]
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