Ilaria Buondonno, Francesca Sassi, Giulia Carignano, Francesca Dutto, Cinzia Ferreri, Fausto G Pili, Massimiliano Massaia, Enzo Nisoli, Chiara Ruocco, Paola Porrino, Claudia Ravetta, Chiara Riganti, Giovanni C Isaia, Patrizia D'Amelio
Journal: Clinical nutrition (Edinburgh, Scotland) 2021;39(7):2080-2091
PMID: 31672329
Despite the increase in life expectancy, there is no corresponding increase in healthy life expectancy. Lifestyle changes appear to be fundamental in increasing healthy life expectancy, and adequate nutrition is enormously important, given that malnutrition (i.e., undernutrition), particularly as protein-energy deficit is very common amongst the elderly population. It has been suggested that the aging process significantly affects protein metabolism and enhances the muscle wastage that accompanies undernutrition and sarcopenia. The aim of this study was to evaluate the efficacy of a specific branched-chain amino acids enriched mixtures (BCAAem) compared to diet advice to promote mitochondrial function and improve clinical outcomes, particularly muscle and cognitive performance, in malnourished elderly community-dwelling subjects. This study is a parallel, randomised, controlled, open-label trial. One hundred and fifty-five malnourished elderly patients were enrolled. The participants were randomly assigned to one of the two groups: diet advice, summarised in an easy-to-use brochure for lay persons or BCAAem supplements. Results show that amelioration of nutritional status is associated with improvement in general health status, muscle and cognitive performances in old, malnourished patients. In fact, the diagnosis of malnutrition and its treatment, albeit using different approaches, is fundamental in improving the patients’ general health and nutritional status. Authors conclude that BCAAem treatment in old, malnourished patients may be a good strategy to ameliorate the bioenergetic capacity of peripheral blood mononuclear cells.
RATIONALE
Malnutrition often affects elderly patients and significantly contributes to the reduction in healthy life expectancy, causing high morbidity and mortality. In particular, protein malnutrition is one of the determinants of frailty and sarcopenia in elderly people.
METHODS
To investigate the role of amino acid supplementation in senior patients we performed an open-label randomized trial and administered a particular branched-chain amino acid enriched mixture (BCAAem) or provided diet advice in 155 elderly malnourished patients. They were followed for 2 months, assessing cognitive performance by Mini Mental State Examination (MMSE), muscle mass measured by anthropometry, strength measure by hand grip and performance measured by the Timed Up and Go (TUG) test, the 30 s Chair Sit to Stand (30-s CST) test and the 4 m gait speed test. Moreover we measured oxidative stress in plasma and mitochondrial production of ATP and electron flux in peripheral blood mononuclear cells.
RESULTS
Both groups improved in nutritional status, general health and muscle mass, strength and performance; treatment with BCAAem supplementation was more effective than simple diet advice in increasing MMSE (1.2 increase versus 0.2, p = 0.0171), ATP production (0.43 increase versus -0.1, p = 0.0001), electron flux (0.50 increase versus 0.01, p < 0.0001) and in maintaining low oxidative stress. The amelioration of clinical parameters as MMSE, balance, four meter walking test were associated to increased mitochondrial function.
CONCLUSIONS
Overall, our findings show that sustaining nutritional support might be clinically relevant in increasing physical performance in elderly malnourished patients and that the use of specific BCAAem might ameliorate also cognitive performance thanks to an amelioration of mitochondria bioenergetics.
Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
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