Effectiveness of essential amino acid supplementation in stimulating whole body net protein anabolism is comparable between COPD patients and healthy older adults

Abstract

Background The development of effective nutritional strategies in support of muscle growth for patients with chronic obstructive pulmonary disease (COPD) remains challenging. Dietary essential amino acids (EAAs) are the main driver of postprandial net protein anabolism. In agreement, EAA supplements in healthy older adults are more effective than supplements with the composition of complete proteins. In patients with COPD it is still unknown whether complete protein supplements can be substituted with only EAAs, and whether they are as effective as in healthy older adults. Methods According to a double-blind randomized crossover design, we examined in 23 patients with moderate to very severe COPD (age: 65 ± 2 y, FEV1: 40 ± 2% of predicted) and 19 healthy age-matched subjects (age: 64 ± 2 y), whether a free EAA mixture with a high proportion (40%) of leucine (EAA mixture) stimulated whole body net protein gain more than a similar mixture of balanced free EAAs and non-EAAs as present in whey protein (TAA mixture). Whole body net protein gain and splanchnic extraction of phenylalanine (PHE) were assessed by continuous IV infusion of L-[ring-2H5]-PHE and L-[ring-2H2]-tyrosine, and enteral intake of L-[15N]-PHE (added to the mixtures). Results Besides an excellent positive linear relationship between PHE intake and net protein gain in both groups (r=0.84–0.91, P<0.001), net protein gain was 42% higher in healthy controls and 49% higher in COPD patients after intake of the EAA mixture compared to the TAA mixture (P<0.0001). These findings could not be attributed to the high LEU content, as in both groups net protein gain per gram EAA intake was lower for the EAA mixture (P<0.0001). Net protein gain was higher in COPD patients for both mixtures due to a 40% lower splanchnic extraction (P<0.0001), but was similarly related to dietary PHE (i.e. EAA) plasma appearance. Conclusions In COPD patients, similarly to healthy older adults, free EAA supplements stimulate whole body protein anabolism more than free amino acid supplements with the composition of complete proteins. Therefore, free EAA supplements may aid in the prevention and treatment of muscle wasting in this patient population. Trial registry ClinicalTrials.gov; Nos.: NCT01173354 and NCT01172314; URL: www.clinicaltrials.gov

Identifying Protein–metabolite Networks Associated with COPD Phenotypes

“…Valine is a metabolite that also promotes muscle growth and overall muscle health. Jonker et al reported that an essential amino acid supplement that includes valine, could be used as a treatment for COPD to prevent muscle wasting [39].…”

Systematic review and meta-analysis of the effect of protein and amino acid supplements in older adults with acute or chronic conditions

“…These determine the AA composition, leucine concentration, protein digestibility and subsequent availability of absorbed AA for protein synthesis (12,(88)(89)(90)(91)(92)(93) . Jonker et al recently found that a high-leucine EAA mixture was superior to a similar mixture with the AA composition of complete proteins, in improving wholebody net protein gain (94) , and suggests possible benefits and effectiveness of EAA over complete protein (92) .…”

Nutrition‐related factors associated with waiting list mortality in patients with interstitial lung disease: A retrospective cohort study

“…In COPD patients, free essential amino acid supplements stimulate whole-body protein anabolism more than free amino acid supplements. 41 Nutritional supplementation also enriched with leucine, vitamin D, and omega-3 fatty acids increased inspiratory muscle strength and maintained physical activity. 42 Thus, in addition to pulmonary rehabilitation, combined supplements with free EAA, vitamin D, and polyunsaturated fatty acids may be helpful for the prevention and treatment of skeletal muscle wasting and an improvement in body composition in waiting list patients.…”

“…In COPD patients, free essential amino acid supplements stimulate whole-body protein anabolism more than free amino acid supplements 41. To increase skeletal muscle mass but not body fat mass, enough energy and sufficient supply of amino acids are needed.…”