Nutritional effect of oral supplement enriched in beta-hydroxy-beta-methylbutyrate, glutamine and arginine on resting metabolic rate after laparoscopic gastric bypass.
BACKGROUND
Weight regain that begins 12-18 months after laparoscopic gastric bypass has been attributed to changes in resting metabolic rate (RMR), which is largely determined by lean body mass (LBM). An oral supplement containing beta-hydroxy-beta-methylbutyrate, glutamine, and arginine (HMB/Glu/Arg) has helped to restore LBM in cachexia due to cancer and in critically ill trauma patients. The objective of this study was to evaluate the effect of oral HMB/Glu/Arg on LBM and RMR following laparoscopic gastric bypass (LGB).


METHODS
Patients who underwent LGB were randomized to receive 24 g of HMB/Glu/Arg dissolved in water twice daily for 8 weeks or to receive no supplement. Weight loss, LBM, and RMR were assessed preoperatively, 2 and 8 weeks postoperatively. LBM was determined by dual emission x-ray absorptiometry (DXA) and RMR was measured by indirect calorimetry.


RESULTS
Thirty patients were enrolled: 80% white; 20% African American; 96.7% women; mean age 46.9±8.4 years; mean weight 113.4±11.6 kg; and mean body mass index (BMI) 43.3±4.1 kg/m2. The experimental and control groups included 14 and 16 patients, respectively, and there was no difference in baseline demographics and characteristics between the two groups. At 8 weeks, weight, BMI, LBM, and RMR significantly decreased by 15.7±2.5 kg, 6.0±1.0 kg/m2, 7.8±4.0 kg, and 290.6±234.9 kcal/day, respectively (P<0.0001 for each variable). However, when comparing these changes between the two groups, no statistical significance was observed.


CONCLUSIONS
There is a significant decrease in weight, BMI, LBM, and RMR in all subjects after LGB, and these changes were not affected by the use of HMB/Glu/Arg. Potential preservation of LBM as a result of HMB/Glu/Arg requires further investigation. However, its consumption (78 calories per serving) did not adversely affect weight loss in the experimental group.
Section of Surgical Sciences, Division of General Surgery, Vanderbilt University, 1161 Medical Center Drive, D5203, Nashville, TN 37232-7610, USA. Ronald.Clements@Vanderbilt.Edu
Ronald H
RH
Clements
Neha
N
Saraf
Manasi
M
Kakade
Kishore
K
Yellumahanthi
Merritt
M
White
Jo Ann
JA
Hackett
D015502:Absorptiometry, Photon; D001120:Arginine / Q000008:administration & dosage*; D050110:Bariatric Surgery; D001481:Basal Metabolism; D001823:Body Composition; D015992:Body Mass Index; D019587:Dietary Supplements; D005260:Female; D015390:Gastric Bypass; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009753:Nutritive Value; D011182:Postoperative Care; D014631:Valerates / Q000008:administration & dosage*; D015431:Weight Loss
D014631:Valerates; D005973:Glutamine; C004961:beta-hydroxyisovaleric acid; D001120:Arginine