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Adequate energy‐protein intake is not enough to improve nutritional and metabolic status in muscle‐depleted patients with chronic heart failure
Author(s) -
Aquilani Roberto,
Opasich Cristina,
Gualco Alessandra,
Verri Manuela,
Testa Amidio,
Pasini Evasio,
Viglio Simona,
Iadarola Paolo,
Pastoris Ornella,
Dossena Maurizia,
Boschi Federica
Publication year - 2008
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2008.09.002
Subject(s) - medicine , heart failure , nitrogen balance , insulin resistance , endocrinology , body mass index , insulin , cardiology , nitrogen , physics , quantum mechanics
Background: An adequate energy‐protein intake (EPI) when combined with amino acid supplementation may have a positive impact 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). patients had adequate EPI (energy ≥ 30 kcal/kg; proteins >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 >1 kg in 80% of supplemented patients (mean 2.96 kg) and in 30% of controls (mean 2.3 kg) (interaction <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 <0.01 for both) but decreased in the supplemented group ( p <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.