title: Fat-free mass change after nutritional rehabilitation in weight losing COPD: role of insulin, C-reactive protein and tissue hypoxia.
abstract: BACKGROUND
  Fat-free mass (FFM) depletion marks the imbalance between tissue protein synthesis and breakdown in chronic obstructive pulmonary disease (COPD). To date, the role of essential amino acid supplementation (EAAs) in FFM repletion has not been fully acknowledged. A pilot study was undertaken in patients attending pulmonary rehabilitation.
  
  
  METHODS
  28 COPD patients with dynamic weight loss > 5% over the last 6 months were randomized to receive EAAs embedded in a 12-week rehabilitation program (EAAs group n = 14), or to the same program without supplementation (C group n = 14). Primary outcome measures were changes in body weight and FFM, using dual X-ray absorptiometry (DEXA).
  
  
  RESULTS
  At the 12th week, a body weight increment occurred in 92% and 15% of patients in the EAAs and C group, respectively, with an average increase of 3.8 +/- 2.6 kg (P = 0.0002) and -0.1 +/- 1.1 kg (P = 0.81), respectively. A FFM increment occurred in 69% and 15% of EAAs and C patients, respectively, with an average increase of 1.5 +/- 2.6 kg (P = 0.05) and -0.1 +/- 2.3 kg (P = 0.94), respectively. In the EAAs group, FFM change was significantly related to fasting insulin (r(2) 0.68, P < 0.0005), C-reactive protein (C-RP) (r(2) = 0.46, P < 0.01), and oxygen extraction tension (PaO(2x)) (r(2) = 0.46, P < 0.01) at end of treatment. These three variables were highly correlated in both groups (r > 0.7, P < 0.005 in all tests).
  
  
  CONCLUSIONS
  Changes in FFM promoted by EAAs are related to cellular energy and tissue oxygen availability in depleted COPD. Insulin, C-RP, and PaO(2x) must be regarded as clinical markers of an amino acid-stimulated signaling to FFM accretion.
authors.affiliation: Department of Pneumology and Biomedical Engineering, Scientific Institute of Montescano, Salvatore Maugeri Foundation I.R.C.C.S. Pavia, Italy. simonetta.baldi@fsm.it
authors.forename: Simonetta
authors.initials: S
authors.lastname: Baldi
authors.forename: Roberto
authors.initials: R
authors.lastname: Aquilani
authors.forename: Gian Domenico
authors.initials: GD
authors.lastname: Pinna
authors.forename: Paolo
authors.initials: P
authors.lastname: Poggi
authors.forename: Angelo
authors.initials: A
authors.lastname: De Martini
authors.forename: Claudio
authors.initials: C
authors.lastname: Bruschi
mesh_terms: D015502:Absorptiometry, Photon; D000273:Adipose Tissue / Q000033:anatomy & histology; D000368:Aged; D000601:Amino Acids, Essential / Q000008:administration & dosage / Q000378:metabolism; D015415:Biomarkers; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism*; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism*; D007558:Italy; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000178:diet therapy* / Q000534:rehabilitation; D015431:Weight Loss / Q000502:physiology*
chemical_list: D000601:Amino Acids, Essential; D015415:Biomarkers; D007328:Insulin; D002097:C-Reactive Protein