title: Impact of protein pulse feeding on lean mass in malnourished and at-risk hospitalized elderly patients: a randomized controlled trial.
abstract: OBJECTIVE
  Aging is associated with a blunted anabolic response to dietary intake, possibly related to a decrease in systemically available amino acids (AAs), which in turn may stem from increased splanchnic AA metabolism. This splanchnic sequestration can be saturated by pulse feeding (80% of daily protein intake in a single meal), enabling increased protein synthesis. This study aimed to evaluate the efficacy of a new nutritional strategy, termed protein pulse feeding.
  
  
  METHODS
  This prospective randomized study (ClinicalTrials.gov registration number NCT00135590) enrolled 66 elderly malnourished or at-risk patients in an inpatient rehabilitation unit. All were given a controlled diet for 6 weeks. In a spread diet (SD) group (n = 36), dietary protein was spread over the four daily meals. In a pulse diet (PD) group (n = 30), 72% of dietary protein (1.31 g/kg weight/d on average) was consumed in one meal at noon. The patients were evaluated at admission and at 6 weeks for body composition [lean mass (LM), appendicular skeletal muscle mass (ASMM), and body cell mass (BCM) indices, measured by X-ray absorptiometry combined with bioelectrical impedance analysis] (primary outcome), hand grip strength, and activities of daily living (ADL) score.
  
  
  RESULTS
  Protein pulse feeding was significantly more efficacious than protein spread feeding in improving LM index (mean changes from baseline for PD group: +0.38 kg/m(2); 95% confidence interval (CI), [0; 0.60]; for SD group: -0.21 kg/m(2); 95% CI, [-0.61; 0.20]; p = 0.005 between the two groups), ASMM index (+0.21 kg/m(2); 95% CI, [0; 0.34] and -0.11 kg/m(2); 95% CI, [-0.20; 0.09]; p = 0.022), BCM index (+0.44 kg/m(2); 95% CI, [0.08; 0.52] and -0.04 kg/m(2); 95% CI, [-0.09; 0.10]; p = 0.004). There was no significant effect for hand-grip strength or ADL score.
  
  
  CONCLUSIONS
  This study demonstrates for the first time that protein pulse feeding has a positive, clinically relevant effect on lean mass in malnourished and at-risk hospitalized elderly patients.
authors.affiliation: Service de Gérontologie 2, AP-HP, Hôpital Émile-Roux, France. olivier.bouillanne@erx.aphp.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouillanne
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Curis
authors.forename: Brigitte
authors.initials: B
authors.lastname: Hamon-Vilcot
authors.forename: Ioannis
authors.initials: I
authors.lastname: Nicolis
authors.forename: Pascale
authors.initials: P
authors.lastname: Chrétien
authors.forename: Nathalie
authors.initials: N
authors.lastname: Schauer
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Vincent
authors.forename: Luc
authors.initials: L
authors.lastname: Cynober
authors.forename: Christian
authors.initials: C
authors.lastname: Aussel
mesh_terms: D015502:Absorptiometry, Photon; D000203:Activities of Daily Living; D000369:Aged, 80 and over; D000375:Aging; D001823:Body Composition / Q000187:drug effects; D015992:Body Mass Index; D001835:Body Weight; D004032:Diet; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000178:diet therapy*; D062407:Meals; D018482:Muscle, Skeletal / Q000187:drug effects; D015596:Nutrition Assessment; D009752:Nutritional Status; D009961:Orosomucoid / Q000032:analysis; D011228:Prealbumin / Q000032:analysis; D011446:Prospective Studies; D012709:Serum Albumin / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D004044:Dietary Proteins; D009961:Orosomucoid; D011228:Prealbumin; D012709:Serum Albumin