Adequate energy‐protein intake is not enough to improve nutritional and metabolic status in muscle‐depleted patients with chronic heart failure

Abstract

Background: An adequate energy-protein intake (EPI) when combined with amino acid supplementation may have a positive impact on nutritional and metabolic status in patients with chronic heart failure (CHF). Methods and results: Thirty eight stable CHF patients (27 males, 73.5 ± 4 years; BMI 22.5 ± 1.4 kg/m 2 ), with severe depletion of muscle mass and were randomised to oral supplements of essential amino acids 8 g/day (EAA group; n = 21) or no supplements (controls; n = 17). All patients had adequate EPI (energy ≥ 30 kcal/kg; proteins N 1.1 g/kg). At baseline and 2-months after randomisation, the patients underwent metabolic (plasma lactate, pyruvate concentration; serum insulin level; estimate of insulin resistance by HOMA index), nutritional (measure of nitrogen balance), and functional (exercise test, walking test) evaluations.Body weight increased by N1 kg in 80% of supplemented patients (mean 2.96 kg) and in 30% of controls (mean 2.3 kg) (interaction b 0.05). Changes in arm muscle area, nitrogen balance, and HOMA index were similar between the two treatment groups.Plasma lactate and pyruvate levels increased in controls (p b 0.01 for both) but decreased in the supplemented group (p b 0.01 and 0.02 respectively). EAA supplemented patients but not controls improved both exercise output and peak oxygen consumption and walking test. Conclusions: Adequate EPI when combined with essential amino acid supplementation may improve nutritional and metabolic status in most muscle-depleted CHF patients.

Essential amino acid supplementation in patients with severe COPD: a step towards home rehabilitation

“…From a clinical perspective, this study confirms data obtained in previous investigations carried out in patients with COPD [8,9] or with chronic heart failure [10] who were supplemented with the same amino acid formula, at the same dose used in the present study. EAAs should not be intended as a substitute for Rehab whenever possible.…”

“…This hypothesis relies on the following considerations: firstly, EAAs, by promoting protein synthesis [7], can increase body mass (mainly the muscle portion) which plays a crucial role for the exercise performance and the perception of well-being. Secondly, preliminary studies carried out by two independent groups [8,9] have shown that EAA supplementation increases physical activity, cognition and quality of life in cachectic/sarcopenic COPD subjects, while another study found that EAAs can improve the nutritional state; the muscle metabolism, and the exercise capacity in individuals with chronic heart failure [10]. Furthermore, several studies found that EAAs work as precursors in the synthesis of brain neurotransmitters [11] which are involved in mood, behavioural motor activity, and cognition [12].…”

Preserved muscle protein metabolism in obese patients with chronic heart failure

“…Moreover, patients had to be clinically stable since at least one month [8], have had a stable body weight over the preceding 3 months, and have an adequate daily protein (≥ 1.1 g/kg) and energy (≥30 kcal/kg) intake [7]. Particular attention was paid to adequate protein intake and normal EAA intake (≥30% total amino acid intake) ( Table 1).…”

“…To be included into the study, patients should be at the best of their clinical and nutritional conditions with normal tissue insulin sensitivity (HOMA index b 2.4) [7], normal liver and renal function, and without contraindications to β-blocker use. Moreover, patients had to be clinically stable since at least one month [8], have had a stable body weight over the preceding 3 months, and have an adequate daily protein (≥ 1.1 g/kg) and energy (≥30 kcal/kg) intake [7].…”

A Novel Amino Acids Oral Supplementation in Hemodialysis Patients: a Pilot Study

“…Therefore, nitrogen supply should not be calculated as the total nitrogen content that is the sum of EAs plus NEAs, but mainly the adequacy of EAs intake. Many pathological conditions increase dramatically nitrogen daily needs, coronary heart disease, 23 chronic obstructive pulmonary disease, 24 wound healing, 25 and traumatized and critically ill patients, 26 so that nitrogen intake is impossible to be matched by normal diets.…”