HMB and leucine supplementation during critical illness and recovery

Bear, Danielle E.; Rooyackers, Olav

doi:10.1097/mco.0000000000000809

Cited by 8 publications

(10 citation statements)

References 20 publications

(32 reference statements)

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“…The branched chain amino acid leucine is one of the most potent stimulators of muscle protein synthesis and acts via stimulation of the mammalian target of rapamycin (mTOR) pathway [42 ▪ ]. Its metabolite, β-hydroxy-β-methylbutyrate (HMB), also stimulates muscle synthesis via the mTOR pathway but, in addition, attenuates proteasome pathways that lead to muscle protein catabolism.…”

Section: Whole Protein or Individual Amino Acids?mentioning

confidence: 99%

Protein supplementation in critical illness: why, when and how?

Bels

Abdelhamid

Poll

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewIn critically ill patients, optimal protein provision remains a challenge given the wide range in recommended protein delivery in international guidelines and the lack of robust, high quality evidence. As patients are confronted with poor functional outcomes after admission, often attributed to muscle wasting and persisting for multiple years, there is a pressing need for optimal nutritional strategies in the ICU, particularly including protein. This review will discuss the recent literature with regard to purpose, timing and mode of protein delivery.Recent findingsRecent studies on the effect of dose and timing of protein on clinical and functional outcomes are largely observational in nature and the protein delivery considered as “high” still often only nears the lower end of current recommendations. The majority of trials observed no effect of protein supplementation on mortality, muscle strength or function, though some report attenuation of muscle volume loss, especially when combined with muscle activation. There is no strong evidence that ICU patients should receive supplementation with any specific amino acids.SummaryThough adequate protein provision is likely important, it is difficult to come to a uniform conclusion regarding dosing and timing due to conflicting results in mostly observational studies as well as different cut-off values for high, moderate and low protein intake. This topic is currently subject to large clinical trials.

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Section: Whole Protein or Individual Amino Acids?mentioning

confidence: 99%

Protein supplementation in critical illness: why, when and how?

Bels

Abdelhamid

Poll

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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“…Experiments with transaminase inhibitors have shown that the leucine effect on protein catabolism also partially depends on its degradation into KIC; however, the exact mechanism of this KIC effect is unknown. It should be noted that HMB, derived from KIC, is also an activator of protein synthesis and an inhibitor of muscle proteolysis, which has led to its proposed use in the treatment of muscle wasting in situations such as cancer cachexia, sarcopenia of aging, or critically ill patients [ 36 ]. However, its endogenous synthesis is far too low to contribute to the effects of leucine.…”

Section: Metabolic Properties Of Bcaas/bckasmentioning

confidence: 99%

Branched-Chain Amino Acids and Insulin Resistance, from Protein Supply to Diet-Induced Obesity

2022

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For more than a decade, there has been a wide debate about the branched-chain amino acids (BCAA) leucine, valine, and isoleucine, with, on the one hand, the supporters of their anabolic effects and, on the other hand, those who suspect them of promoting insulin resistance. Indeed, the role of leucine in the postprandial activation of protein synthesis has been clearly established, even though supplementation studies aimed at taking advantage of this property are rather disappointing. Furthermore, there is ample evidence of an association between the elevation of their plasma concentrations and insulin resistance or the risk of developing type 2 diabetes, although there are many confounding factors, starting with the level of animal protein consumption. After a summary of their metabolism and anabolic properties, we analyze in this review the factors likely to increase the plasma concentrations of BCAAs, including insulin-resistance. After an analysis of supplementation or restriction studies in search of a direct role of BCAAs in insulin resistance, we discuss an indirect role through some of their metabolites: branched-chain keto acids, C3 and C5 acylcarnitines, and hydroxyisobutyrate. Overall, given the importance of insulin in the metabolism of these amino acids, it is very likely that small alterations in insulin sensitivity are responsible for a reduction in their catabolism long before the onset of impaired glucose tolerance.

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“…This finding, however, needs confirmation in prospective randomized interventional trials. During the critically ill period, supplements like leucine and its metabolite β-hydroxy-β-methylbutyrate (HMB) have also been shown to positively impact long-term outcome and recovery [31].…”

Section: Feeding Strategy and Nutritional Support In The Recovery Pha...mentioning

confidence: 99%

Nutritional issues concerning general medical ward patients: feeding patients recovering from critical illness

Gressies

Schüetz

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewICU survivors often spend long periods of time in general wards following transfer from ICU in which they are still nutritionally compromised. This brief review will focus on the feeding of patients recovering from critical illness, as no formal recommendations or guidelines on nutrition management are available for this specific situation.Recent findingsWhile feeding should start in the ICU, it is important to continue and adapt nutritional plans on the ward to support individuals recovering from critical illness. This process is highly complex – suboptimal feeding may contribute significantly to higher morbidity and mortality, and seriously hinder recovery from illness. Recently, consensus diagnostic criteria for malnutrition have been defined and large-scale trials have advanced our understanding of the pathophysiological pathways underlying malnutrition. They have also helped further develop treatment algorithms. However, we must continue to identify specific clinical parameters and blood biomarkers to further personalize therapy for malnourished patients. Better understanding of such factors may help us adapt nutritional plans more efficiently.SummaryAdequate nutrition is a vigorous component of treatment in the post-ICU period and can enhance recovery and improve clinical outcome. To better personalize nutritional treatment because not every patient benefits from support in the same manner, it is important to further investigate biomarkers with a possible prognostic value.

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HMB and leucine supplementation during critical illness and recovery

Cited by 8 publications

References 20 publications

Protein supplementation in critical illness: why, when and how?

Protein supplementation in critical illness: why, when and how?

Branched-Chain Amino Acids and Insulin Resistance, from Protein Supply to Diet-Induced Obesity

Nutritional issues concerning general medical ward patients: feeding patients recovering from critical illness

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