1.
From mitochondria to healthy aging: The role of branched-chain amino acids treatment: MATeR a randomized study.
Buondonno, I, Sassi, F, Carignano, G, Dutto, F, Ferreri, C, Pili, FG, Massaia, M, Nisoli, E, Ruocco, C, Porrino, P, et al
Clinical nutrition (Edinburgh, Scotland). 2020;39(7):2080-2091
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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.
Abstract
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.
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Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection.
Carr, CS, Ling, KD, Boulos, P, Singer, M
BMJ (Clinical research ed.). 1996;312(7035):869-71
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Malnutrition predisposes patients to postoperative complications such as infection and a prolonged hospital stay. Postoperative gastric stasis causes nausea and vomiting thus inhibiting oral intake, but it has been shown that small bowel function continues. This randomised trial of 28 patients assessed the safely and efficacy of immediate post-operative enteral feeding in patients who had undergone gastrointestinal resection, compared to conventional intravenous fluids. The study found that the average caloric intake was significantly higher in enterally fed patients compared to those on intravenous fluids. Urinary nitrogen balance, a marker of nutritional status, was negative on the first postoperative day in those on intravenous fluids but positive in all 14 enterally fed patients. There was no change in gut mucosal permeability in the enterally fed group (assessed by lactulose:mannitol absorption ratio) but a significant increase from the test ratios seen before the operation in those on intravenous fluids. There were also fewer postoperative complications in the enterally fed group. Immediate postoperative enteral feeding in patients undergoing intestinal resection seems to be safe, prevents an increase in gut mucosal permeability, and produces a positive nitrogen balance. Postoperative enteral feeding may reduce the need for total parenteral nutrition and reduce expenditure and complications.
Abstract
OBJECTIVES To assess whether immediate post-operative enteral feeding in patients who have undergone gastrointestinal resection is safe and effective. DESIGN Randomised trial of immediate post-operative enteral feeding through a nasojejunal tube v conventional postoperative intravenous fluids until the reintroduction of normal diet. SETTING Teaching hospitals in London. SUBJECTS 30 patients under the care of the participating consultant surgeon who were undergoing elective laparotomies with a view to gastrointestinal resection for quiescent, chronic gastrointestinal disease. Two patients did not proceed to resection. MAIN OUTCOME MEASURES Nutritional state, nutritional intake and nitrogen balance, gut mucosal permeability measured by lactulose-mannitol differential sugar absorption test, complications, and outcome. RESULTS Successful immediate enteral feeding was established in all 14 patients with a mean (SD) daily intake of 6.78 (1.57)MJ (1622 (375) kcal before reintroduction of oral diet compared with 1.58 (0.14) MJ (377 (34) kcal) for those on intravenous fluids (P < 0.0001). Urinary nitrogen balance on the first postoperative day was negative in those on intravenous fluids but positive in all 14 enterally fed patients (mean (SD) - 13.2 (11.6) g v 5.3 (2.7) g; P < 0.005). There was no difference by day 5. There was no change in gut mucosal permeability in the enterally fed group but a significant increase from the test ratios seen before the operation in those on intravenous fluids (0.11(0.06) v 0.15 (0.12); P < 0.005). There were also fewer postoperative complications in the enterally fed group (P < 0.005). CONCLUSIONS Immediate postoperative enteral feeding in patients undergoing intestinal resection seems to be safe, prevents an increase in gut mucosal permeability, and produces a positive nitrogen balance.