The effect of oral supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine and glutamine on wound healing: a retrospective analysis of diabetic haemodialysis patients

Sipahi, Savaş; Güngör, Özkan; Gündüz, Mehmet; Cilci, Mehmet; Demirci, Mustafaa Cahit; Tamer, Ali

doi:10.1186/1471-2369-14-8

Cited by 40 publications

(43 citation statements)

References 15 publications

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“…75 Others have demonstrated improved healing in diabetic foot ulcers with supplementation of the diet with arginine. 76 Similar results were found with stasis ulcers. 77 In a randomized controlled trial, Debats et al did not find improved healing with skin graft donor sites in patients who received intravenous supplementation with arginine.…”

Section: Arginine and Glutamine In Wound Healingsupporting

confidence: 73%

Nutrition and Chronic Wounds: Improving Clinical Outcomes

Molnár

Vlad

Gumus

2016

Plastic &Amp; Reconstructive Surgery

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Significance: Nutrition is one of the most basic of medical issues and is often ignored as a problem in the management of our chronic wound patients. Unfortunately, malnutrition is widespread in our geriatric patients even in nursing homes in developed countries. Attention to basic nutrition and providing appropriate supplements may assist in the healing of our chronic wounds. Recent Advances: Recent research has revealed the epidemiology of malnutrition in developed countries, the similarities to malnutrition in developing countries, and some of the physiologic and sociologic causes for this problem. More information is now available on the biochemical effects of nutrient deficiency and supplementation with macronutrients and micronutrients. In some cases, administration of isolated nutrients beyond recommended amounts for healthy individuals may have a pharmacologic effect to help wounds heal. Critical Issues: Much of the knowledge of the nutritional support of chronic wounds is based on information that has been obtained from trauma management. Due to the demographic differences of the patients and differences in the physiology of acute and chronic wounds, it is not logical to assume that all aspects of nutritional support are identical in these patient groups. Before providing specific nutritional supplements, appropriate assessments of patient general nutritional status and the reasons for malnutrition must be obtained or specific nutrient supplementation will not be utilized. Future Directions: Future research must concentrate on the biochemical and physiologic differences of the acute and chronic wounds and the interaction with specific supplements, such as antioxidants, vitamin A, and vitamin D. SCOPE AND SIGNIFICANCEThis review discusses the current knowledge of nutrition as related to the patient with chronic wounds. We describe the demographic and physiologic differences between acute and chronic wound patients and define the problem of malnutrition in developed countries. A basic understanding of the need for macronutrients and micronutrients and the value of specific supplementation is provided. TRANSLATIONAL RELEVANCEMuch of the current knowledge of nutrition in relation to wound healing is inferred from the management of acute wounds and may not be relevant to the patient with chronic wounds. This review describes the current state of available research on the topic and demonstrates the limitations of this information to guide future research. Additional studies that evaluate the supplementation with specific nutrients in patients with chronic wounds will translate into improved patient care. CLINICAL RELEVANCEThis review provides the clinician with knowledge of basic nutrition, the epidemiology of malnutrition in the chronic wound patient, and how to screen these patients for malnutrition. The reader will recognize that even an obese patient may have specific nutrient deficiencies. The literature is reviewed regarding the value of macronutrient and micronutrient supplementation. Recommendations f...

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Section: Arginine and Glutamine In Wound Healingsupporting

confidence: 73%

Nutrition and Chronic Wounds: Improving Clinical Outcomes

Molnár

Vlad

Gumus

2016

Plastic &Amp; Reconstructive Surgery

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“…The mixture of arginine, glutamine, and HMB has been studied for its influence on wound healing in 3 different trials 8 , 9 . These 3 studies reported that this mixture increased collagen accumulation in elderly subjects and also enhanced the healing of diabetic foot ulcers 8 , 9 , 13 . Supplementation with this amino acid mixture for 2 weeks resulted in an increase in hydroxyproline accumulation in subcutaneously placed polytetraflouroethylene tubes in healthy elderly volunteers in one of these studies 8 .…”

Section: Discussionmentioning

confidence: 97%

Pilot Experimental Study on the Effect of Arginine, Glutamine, and β‐Hydroxy β‐Methylbutyrate on Secondary Wound Healing

Bozkırlı

Gündoğdu

Ersoy

et al. 2014

J Parenter Enteral Nutr

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“…One was a retrospective review of 11 diabetic patients with foot ulcers who were given supplementation with arginine, glutamine, and HMB. In those 11 patients who were evaluated, degeneration was not identified in any wounds assessed with standardized scoring systems for wound depth and wound appearance [6], but on the contrary, statistically significant improvements in scores for wound depth and wound appearance were identified. This implies a decrease in diabetic wound catabolism leading to diminished wound degeneration.…”

Section: Literature Review: Pilot Data In Contextmentioning

confidence: 86%

“…These particular MeSH search terms identified only two sources as investigating dietary amino acid supplementation in patients with diabetic foot ulcers [6,7].…”

Section: Methodsmentioning

confidence: 99%

Targeted Amino Acid Supplementation in Diabetic Foot Wounds: Pilot Data and a Review of the Literature

Jones

Rivera

Puccinelli

et al. 2014

Surgical Infections

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Background: Diabetic foot wounds are a highly morbid and costly complication of diabetes mellitus. Targeted amino acid supplementation, by increasing tissue hydroxyproline concentrations, has been implicated in improved wound outcomes in surgical incisions and chronic wounds, and after radiation injury. A major component of collagen, hydroxyproline is a surrogate marker used commonly for tissue collagen concentrations. This paper reviews the literature pertaining to amino acid supplementation and wound healing, and also evaluates our pilot data relating to supplementation with arginine, glutamine, and beta-hydroxy-beta-methylbutyrate (HMB) in the treatment of diabetic foot ulcers. Methods: For the pilot study, nine patients scheduled to undergo wound debridement for diabetic foot ulcers were randomized prospectively to be a part of either a placebo group or a treatment group that received supplementation twice daily for 2 wks. Tissue samples were collected both before and after 2 wk of supplementation. The results of assay of the samples for hydroyproline were then analyzed via a one tailed Student t-test to evaluate tissue concentrations of hydroxyproline. For the literature review in the study, the MEDLINE/ PubMed database was reviewed, using search terms contained in the Medical Subject Headings (MeSH). Results: The treatment group in the study exhibited a significantly greater hydroxyproline concentration after supplementation than before it (p = 0.03). The mean percent change in the tissue hydroxyproline concentration for arginine, glutamine, and HMB group was + 67.8%, with a standard deviation (SD) of 129.89. The mean percent change for the corresponding amino acids in the placebo group was -78.4%, with an SD of 20.55. The review of the MEDLINE/PubMed literature revealed only two human studies of amino acid supplementation in patients with diabetic foot wounds, one of which found a significant improvement in wound-depth and woundappearance scores. Conclusions: Given the results of our pilot study, and on the basis of a review of the literature, the administration of a simple amino acid supplement may improve the healing of diabetic foot wounds via increased collagen production.

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The effect of oral supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine and glutamine on wound healing: a retrospective analysis of diabetic haemodialysis patients

Cited by 40 publications

References 15 publications

Nutrition and Chronic Wounds: Improving Clinical Outcomes

Nutrition and Chronic Wounds: Improving Clinical Outcomes

Pilot Experimental Study on the Effect of Arginine, Glutamine, and β‐Hydroxy β‐Methylbutyrate on Secondary Wound Healing

Targeted Amino Acid Supplementation in Diabetic Foot Wounds: Pilot Data and a Review of the Literature

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