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


RESULTS
Thirty eight stable CHF patients (27 males, 73.5+/-4 years; BMI 22.5+/-1.4 kg/m2), 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> or =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.
Aquilani
Roberto
R
Servizio di Fisiopatologia Metabolico-Nutrizionale e Nutrizione Clinica, Fondazione S. Maugeri, IRCCS, Istituto Scientifico di Montescano, Montescano-Pavia, Italy.
Opasich
Cristina
C
Gualco
Alessandra
A
Verri
Manuela
M
Testa
Amidio
A
Pasini
Evasio
E
Viglio
Simona
S
Iadarola
Paolo
P
Pastoris
Ornella
O
Dossena
Maurizia
M
Boschi
Federica
F
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000601:Amino Acids, Essential / Q000008:administration & dosage*; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D002908:Chronic Disease; D004044:Dietary Proteins / Q000008:administration & dosage*; D004734:Energy Metabolism / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000178:diet therapy* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D007328:Insulin / Q000097:blood; D007773:Lactates / Q000097:blood; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000502:physiology*; D011773:Pyruvates / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome
D000601:Amino Acids, Essential; D004044:Dietary Proteins; D007328:Insulin; D007773:Lactates; D011773:Pyruvates