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Effectiveness of nutritional supplementation on sarcopenia and recovery in hip fracture patients. A multi-centre randomized trial.
Malafarina, V, Uriz-Otano, F, Malafarina, C, Martinez, JA, Zulet, MA
Maturitas. 2017;:42-50
Abstract
BACKGROUND AND OBJECTIVES Functional deterioration and reduced mobility in elderly patients with a hip fracture are associated with a loss of both muscle mass and function (sarcopenia). The aim of this study was to assess whether oral nutritional supplementation (ONS) improves muscle mass and nutritional markers (BMI, proteins) in elderly patients with hip fracture. METHODS Patients aged 65 years and over with hip fractures admitted to either of two rehabilitation facilities were included. Patients with diabetes, with Barthel index scores <40 prior to the fracture or with pathological fractures were excluded. A random-numbers generator was used to randomly allocate patients to the intervention group (IG) or the control group (CG). Those in the IG received a standard diet plus ONS in the form of two bottles a day of β-hydroxy-β-methylbutyrate (HMB), while those in the CG received a standard diet only. The intervention was not blinded. In order to assess changes in body mass index (BMI), anthropometric parameters were recorded at both admission and discharge. Patients' functional situation was evaluated using the Barthel index (BI) and the Functional Ambulation Categories (FAC) score. Muscle mass was assessed using bioelectrical impedance analysis, which allowed us to calculate appendicular lean mass (aLM). The outcome variable was the difference between aLM upon discharge, minus aLM upon admission (Δ-aLM). RESULTS Of the 107 randomised patients (IG n55, CG n52), 49 finished the study in the IG and 43 in the CG. BMI and aLM were stable in IG patients, whilst these parametres decreased in the CG. A significant difference was observed between the two groups (p<0.001, and p=0.020 respectively). The predictive factors for Δ-aLM were ONS (p=0.006), FAC prior to fracture (p<0.001) and BI prior to fracture (p=0.007). The concentration of proteins (p=0.007) and vitamin D (p.001) had increased more in the IG than in the CG. CONCLUSION A diet enriched in HMB improves muscle mass, prevents the onset of sarcopenia and is associated with functional improvement in elderly patients with hip fractures. Orally administered nutritional supplements can help to prevent the onset of sarcopenic obesity. TRIAL REGISTRATION www.clinicaltrials.gov identifier: NCT01404195, registered 22 July 2011, HYPERPROT-GER Study.
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Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers: a prospective randomized controlled trial.
Armstrong, DG, Hanft, JR, Driver, VR, Smith, AP, Lazaro-Martinez, JL, Reyzelman, AM, Furst, GJ, Vayser, DJ, Cervantes, HL, Snyder, RJ, et al
Diabetic medicine : a journal of the British Diabetic Association. 2014;(9):1069-77
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Abstract
AIMS: Among people with diabetes, 10-25% will experience a foot ulcer. Research has shown that supplementation with arginine, glutamine and β-hydroxy-β-methylbutyrate may improve wound repair. This study tested whether such supplementation would improve healing of foot ulcers in persons with diabetes. METHODS Along with standard of care, 270 subjects received, in a double-blinded fashion, (twice per day) either arginine, glutamine and β-hydroxy-β-methylbutyrate or a control drink for 16 weeks. The proportion of subjects with total wound closure and time to complete healing was assessed. In a post-hoc analysis, the interaction of serum albumin or limb perfusion, as measured by ankle-brachial index, and supplementation on healing was investigated. RESULTS Overall, there were no group differences in wound closure or time to wound healing at week 16. However, in subjects with an albumin level of ≤ 40 g/l and/or an ankle-brachial index of < 1.0, a significantly greater proportion of subjects in the arginine, glutamine and β-hydroxy-β-methylbutyrate group healed at week 16 compared with control subjects (P = 0.03 and 0.008, respectively). Those with low albumin or decreased limb perfusion in the supplementation group were 1.70 (95% CI 1.04-2.79) and 1.66 (95% CI 1.15-2.38) times more likely to heal. CONCLUSIONS While no differences in healing were identified with supplementation in non-ischaemic patients or those with normal albumin, addition of arginine, glutamine and β-hydroxy-β-methylbutyrate as an adjunct to standard of care may improve healing of diabetic foot ulcers in patients with risk of poor limb perfusion and/or low albumin levels. Further investigation involving arginine, glutamine and β-hydroxy-β-methylbutyrate in these high-risk subgroups might prove clinically valuable.
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Effect of beta-hydroxy-beta-methylbutyrate on protein metabolism in bed-ridden elderly receiving tube feeding.
Hsieh, LC, Chow, CJ, Chang, WC, Liu, TH, Chang, CK
Asia Pacific journal of clinical nutrition. 2010;(2):200-8
Abstract
Malnutrition and muscle loss are common in bed-ridden elderly nursing home residents. Supplementation of beta-hydroxy-beta-methylbutyrate (HMB) has been shown to prevent muscle loss in several catabolic conditions. The aim of this study was to investigate the effect of HMB supplementation on body composition and protein metabolism in bed-ridden elderly nursing home residents receiving tube feeding. The subjects were randomly assigned to HMB (n=39, 2 g/d) or control group (n=40). Anthropometry measurements, blood sampling, and 24-hr urine collection were performed on the day before and 14 days after the start of the study. A subgroup of subjects (HMB: n=19, control: n=20) continued the study for another 14 days. Changes in body weight and BMI were not significantly different between the groups after 14 or 28 days after controlling for baseline BMI. Blood urea nitrogen significantly decreased in the HMB group, while it remained unchanged in the control group after 14 days. Urinary urea nitrogen excretion significantly decreased in the HMB group, while it showed a trend of increase in the control group after 14 and 28 days, respectively. Changes in blood urea nitrogen and urinary urea nitrogen excretion were significantly different between the groups after controlling for baseline BMI. This study suggested that HMB supplementation for 2-4 weeks could reduce muscle breakdown in bed-ridden elderly nursing home residents receiving tube feeding.