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Kisil I, Gimelfarb Y. Long-term supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine, and glutamine for pressure ulcer in sedentary older adults: a retrospective matched case-control study. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:364-372. [PMID: 36796413 PMCID: PMC10626290 DOI: 10.12701/jyms.2022.00899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/07/2023] [Accepted: 01/12/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Growing evidence suggests that beta-hydroxy-beta-methylbutyrate (HMB), arginine (Arg), and glutamine (Gln) positively affect wound recovery. This study investigated the effects of long-term administration of HMB/Arg/Gln on pressure ulcer (PU) healing in sedentary older adults admitted to geriatric and rehabilitation care facilities. METHODS This was a pilot retrospective case (standard of care and HMB/Arg/Gln)-control (standard of care alone) clinical study. Outcome measures were relative healing rates and Pressure Ulcer Scale for Healing (PUSH) scores (calculated after 4, 8, 12, 16, and 20 weeks) and time to healing. RESULTS The study subpopulation was comprised of 14 participants (four males, 28.6%) with the median age of 85.5 years (interquartile range [IQR], 82.0-90.2 years). The control subpopulation was comprised of 31 participants (18 males, 58.1%) with the median age of 84.0 years (IQR, 78.0-90.0 years). At the beginning of follow-up, there were no statistically significant demographic (sex and age) and clinical (main diagnosis, baseline area, and PU perimeter) differences between the groups. During the study period, there were no significant differences in the relative healing rates and PUSH scores between the subpopulations. The median time to complete healing in the study and control populations was 170.0 days (95% confidence interval [CI], 85.7-254.3) and 218.0 days (95% CI, 149.2-286.7) (log-rank, chi-square=3.99; p<0.046), respectively. CONCLUSION More than 20 weeks of HMB/Arg/Gln supplementation had a positive effect on difficult PU healing in older adults with multiple comorbidities.
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Affiliation(s)
- Igor Kisil
- Medical – Care Hospital, Bat Yam, Israel
| | - Yuri Gimelfarb
- AMHC, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Bat Yam, Israel
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Jing X, Liang Y, Wang R, Fu H, Jiang J, Yang M. β-hydroxy-β-methylbutyrate-enriched nutritional supplements for obese adults during weight loss: study protocol of a randomised, double-blind, placebo-controlled clinical trial. BMJ Open 2022; 12:e055420. [PMID: 35738656 PMCID: PMC9226916 DOI: 10.1136/bmjopen-2021-055420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Obesity is a public health challenge worldwide. To maintain a healthy weight, dieting and lifestyle changes are the first-line interventions; however, these interventions are of poor compliance and may cause body composition changes, mainly skeletal muscle wasting (sarcopenia). Dietary supplements for improving body composition while inducing weight loss are therefore needed. β-hydroxy-β-methylbutyrate (HMB) has been proven to be effective for improving muscle mass and muscle strength in athletes, older adults and patients with cancer. We aim to evaluate the effectiveness and safety of HMB-enriched nutritional supplements for improving muscle mass and muscle function in obese adults during calorie restriction. METHOD AND ANALYSIS A total of 72 Chinese adults with obesity will be randomised to receive HMB-enriched nutritional supplements (65 g/day) or a placebo for 12 weeks. Participants in both groups will also receive calorie restrictions based on the individualised nutrition guidance of dietitians. Participants and investigators will be blinded to the allocations. The primary outcome will be the mean change in whole-body skeletal muscle mass (measured by bioelectrical impedance analysis). The secondary outcomes will include the mean change of appendicular skeletal muscle mass, body fat mass, basal metabolic rate, phase angle, muscle function and serum biomarkers. The enrolment will commence in December 2021 and will proceed until March 2022. ETHICS AND DISSEMINATION This protocol has been approved by the Biomedical Ethics Committee of West China Hospital (2021-771). All potential subjects will be required to sign a written informed consent. The results of this study will be reported in peer-reviewed academic journals and conferences. TRIAL REGISTRATION NUMBER NCT04953936.
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Affiliation(s)
- Xiaofan Jing
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuxiang Liang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Renjie Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongbo Fu
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaojiao Jiang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, Sichuan, China
| | - Ming Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Randomized Clinical Trial: Effects of β-Hydroxy-β-Methylbutyrate (HMB)-Enriched vs. HMB-Free Oral Nutritional Supplementation in Malnourished Cirrhotic Patients. Nutrients 2022; 14:nu14112344. [PMID: 35684144 PMCID: PMC9183090 DOI: 10.3390/nu14112344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
β-Hydroxy-β-methylbutyrate (HMB) supplementation increases muscle and strength mass in some muscle-wasting disorders. Malnutrition and sarcopenia are often present in liver cirrhosis. We aimed to investigate the effects of oral HMB supplementation on changes in body composition and liver status in patients with cirrhosis and malnutrition. In a randomized, controlled, double-blind trial, 43 individuals were randomized to receive twice a day and for 12 weeks an oral nutritional supplement (ONS) enriched with 1.5 g of calcium HMB per bottle or another supplement with similar composition devoid of HMB. Inclusion criteria were liver cirrhosis with at least one previous decompensation and clinical malnutrition. Liver function, plasma biochemistry analyses, and physical condition assessment were carried out at baseline, then after six and 12 weeks of supplementation. A total of 34 patients completed the clinical trial. An improvement in liver function and an increase in fat mass index were observed in both groups. None of the two ONS changed the fat-free mass. However, we observed an upward trend in handgrip strength and a downward trend in minimal hepatic encephalopathy in the HMB group. At the end of the trial and regardless of the supplement administered, fat mass content increased with no change in fat-free mass, while liver function scores and nutritional analytic markers also improved.
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Prado CM, Orsso CE, Pereira SL, Atherton PJ, Deutz NEP. Effects of β-hydroxy β-methylbutyrate (HMB) supplementation on muscle mass, function, and other outcomes in patients with cancer: a systematic review. J Cachexia Sarcopenia Muscle 2022; 13:1623-1641. [PMID: 35301826 PMCID: PMC9178154 DOI: 10.1002/jcsm.12952] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/01/2022] [Indexed: 12/17/2022] Open
Abstract
Low muscle mass is prevalent among patients with cancer and a predictor of adverse clinical outcomes. To counteract muscle loss, β-hydroxy β-methylbutyrate (HMB) supplementation has been proposed as a potential therapy for older adults and various diseases states. This systematic review aimed to investigate the effects and safety of HMB supplementation in relation to muscle mass and function and other clinical outcomes in patients with cancer. A systematic search of MEDLINE, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Scopus, ProQuest, and grey literature for reports published from inception to December 2021 was conducted. Included studies provided supplements containing any dose of HMB to adult patients with active cancer. A synthesis without meta-analysis was conducted using a vote-counting approach based solely on the direction of the effect (i.e. regardless of statistical significance). Risk of bias was assessed for each outcome domain, and evidence from higher-quality studies (i.e. those with either low or moderate risk of bias) was examined. Safety was evaluated using both lower-quality and higher-quality studies. Fifteen studies were included, in which six were randomized controlled trials in patients with various cancer types and treatments. Studies prescribed HMB combined with amino acids (73.3%), HMB in oral nutritional supplements (20.0%), or both supplement types (6.7%); Ca-HMB doses of 3.0 g/day were provided in 80.0% of the studies. Four studies had high risk of bias across all outcome domains. Considering the higher-quality studies, evidence of a beneficial effect of HMB supplementation was found in four of four studies for muscle mass, two of two for muscle function, three of three for hospitalization, and five of seven for survival. In contrast, no beneficial effects of HMB on quality of life or body weight was found in two of four and three of five studies, respectively. A limited number of higher-quality studies evaluating the impact of HMB on cancer therapy-related toxicity, inflammation, and tumour response were observed. No serious adverse effects directly related to the nutrition intervention were reported. Although limited, current evidence suggests that HMB supplementation has a beneficial effect on muscle mass and function in patients with cancer. Well-designed trials are needed to further explore the clinical benefit of HMB supplementation in this patient population.
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Affiliation(s)
- Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Camila E Orsso
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | | | - Philip J Atherton
- Centre of Metabolism, Ageing & Physiology (COMAP), Medical Research Council (MRC) Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), University of Nottingham, Nottingham, UK
| | - Nicolaas E P Deutz
- Center for Translational Research in Aging and Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
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Abstract
The aim of the article is to examine side effects of increased dietary intake of amino acids, which are commonly used as a dietary supplement. In addition to toxicity, mutagenicity and carcinogenicity, attention is focused on renal and gastrointestinal tract functions, ammonia production, and consequences of a competition with other amino acids for a carrier at the cell membranes and enzymes responsible for their degradation. In alphabetic order are examined arginine, β-alanine, branched-chain amino acids, carnosine, citrulline, creatine, glutamine, histidine, β-hydroxy-β-methylbutyrate, leucine, and tryptophan. In the article is shown that enhanced intake of most amino acid supplements may not be risk-free and can cause a number of detrimental side effects. Further research is necessary to elucidate effects of high doses and long-term consumption of amino acid supplements on immune system, brain function, muscle protein balance, synthesis of toxic metabolites, and tumor growth and examine their suitability under certain circumstances. These include elderly, childhood, pregnancy, nursing a baby, and medical condition, such as diabetes and liver disease. Studies are also needed to examine adaptive response to a long-term intake of any substance and consequences of discontinuation of supplementation.
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Affiliation(s)
- M HOLEČEK
- Department of Physiology, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
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6
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Norouzi M, Nadjarzadeh A, Maleki M, Khayyatzadeh SS, Hosseini S, Yaseri M, Fattahi H. The effects of preoperative supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine, and glutamine on inflammatory and hematological markers of patients with heart surgery: a randomized controlled trial. BMC Surg 2022; 22:51. [PMID: 35148750 PMCID: PMC8832784 DOI: 10.1186/s12893-022-01495-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cardiac surgery is associated with a widespread inflammatory response, by an additional release of free radicals. Due to the importance of these patient’s nutritional status, the present study was designed to evaluate the effectiveness of supplementation with a combination of glutamine, β-hydroxy-β-methylbutyrate (HMB) and arginine in patients undergoing to the heart surgery. Methods The experiment was performed in 1 month (30 days) before cardiac surgery. patients were asked to take 2 sachets of Heallagen® (a combination of 7 g l-arginine, 7 g l-glutamine, and 1.5 g daily HMB) or placebo with identical appearance and taste (maltodextrin) with 120 cc of water. Clinical and biochemical factors were evaluated in the baseline and end of the study. Results Totally, 60 preoperative patients (30 interventions and 30 placeboes) with a mean age of 53.13 ± 14.35 years participated in the study. Subjects in Heallagen® group had a lower serum levels of interleukin-6 (P = 0.023), erythrocyte sedimentation rate (P < 0.01), high sensitivity C-reactive protein (P < 0.01), and lymphocyte number (P = 0.007) compared to the placebo, at end of the study. Conclusion In the patients undergoing heart surgery, Heallagen® significantly improved some of the inflammatory factors and hematological parameters. These results need to be confirmed in a larger trial. Trial registration: The protocol of the study was registered in the IRCT.ir with registration no. IRCT20120913010826N31 at 13/10/2020.
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Affiliation(s)
- Mona Norouzi
- Department of Nutrition, International Campus of Shahid Sadoughi University of Medical Science, Yazd, Iran.,Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Azadeh Nadjarzadeh
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. .,Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Majid Maleki
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sayyed Saeid Khayyatzadeh
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saeid Hosseini
- Heart Valve Disease Research Center, Shahid Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Science, Tehran, Iran
| | - Hamed Fattahi
- Cardiovascular Medical and Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Wittholz K, Fetterplace K, Ali Abdelhamid Y, Presneill JJ, Beach L, Thomson B, Read D, Koopman R, Deane AM. β-Hydroxy-β-methylbutyrate (HMB) supplementation and functional outcomes in multi-trauma patients: a study protocol for a pilot randomised clinical trial (BOOST trial). Pilot Feasibility Stud 2022; 8:21. [PMID: 35101139 PMCID: PMC8802472 DOI: 10.1186/s40814-022-00990-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background There are no therapies proven to diminish the muscle wasting that occurs in patients after major trauma who are admitted to the intensive care unit (ICU). β-Hydroxy-β-methylbutyrate (HMB) is a nutrition intervention that may attenuate muscle loss and, thereby, improve recovery. The primary aim of this study is to determine the feasibility of a blinded randomised clinical trial of HMB supplementation to patients after major trauma who are admitted to the ICU. Secondary aims are to establish estimates for the impact of HMB when compared to placebo on muscle mass and nutrition-related patient outcomes. Methods This prospective, single-centre, blinded, randomised, placebo-controlled, parallel-group, feasibility trial with allocation concealment will recruit 50 participants over 18 months. After informed consent, participants will be randomised [1:1] to receive either the intervention (three grams of HMB dissolved in either 150 ml of orange juice for those allowed oral intake or 150 ml of water for those being enterally fed) or placebo (150 ml of orange juice for those allowed oral intake or 150 ml of water for those being enterally fed). The intervention will be commenced in ICU, continued after ICU discharge and ceased at hospital discharge or day 28 post randomisation, whichever occurs first. The primary outcome is the feasibility of administering the intervention. Secondary outcomes include change in muscle thickness using ultrasound and other nutritional and patient-centred outcomes. Discussion This study aims to determine the feasibility of administering HMB to critically ill multi-trauma patients throughout ICU admission until hospital discharge. Results will inform design of a larger randomised clinical trial. Trial registration The protocol is registered with Australian New Zealand Clinical Trials Registry (ANZCTR) ANZCTR: 12620001305910. UTN: U1111-1259-5534.
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Kiryukova MA, Dubtsova EA, Vinokurova LV, Malykh MV, Bordin DS. Nutritional status disorders and methods of their correction in patients with advanced pancreatic cancer. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2022:66-74. [DOI: 10.31146/1682-8658-ecg-195-11-66-74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Despite of achieved progress in advanced pancreatic cancer treatment, the disease outcomes remain far from satisfying. The peculiarity of malnutrition treatment in these patients is the result of its causes complexity and progressively growing manifestations extent. The review represents mechanisms of malnutrition and approaches to their treatment.
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Affiliation(s)
| | - E. A. Dubtsova
- Moscow Clinical Research Center named after A. S. Loginov
| | | | - M. V. Malykh
- Moscow Clinical Research Center named after A. S. Loginov
| | - D. S. Bordin
- Moscow Clinical Research Center named after A. S. Loginov; Moscow State University of Medicine and Dentistry named after A. I. Yevdokimov; Tver State Medical University
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β-Hydroxy-β-Methylbutyrate (HMB) Supplementation Prevents Bone Loss during Pregnancy-Novel Evidence from a Spiny Mouse ( Acomys cahirinus) Model. Int J Mol Sci 2021; 22:ijms22063047. [PMID: 33802646 PMCID: PMC8002460 DOI: 10.3390/ijms22063047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to determine the effects of ß-hydroxy-ß-methylbutyrate (HMB) supplementation during pregnancy on postpartum bone tissue quality by assessing changes in trabecular and compact bone as well as in hyaline and epiphyseal cartilage. The experiment was carried out on adult 6-month-old female spiny mice (Acomys cahirinus) divided into three groups: pregnant control (PregCont), pregnant HMB-treated (supplemented with 0.02 g/kg b.w of HMB during the second trimester of pregnancy, PregHMB), and non-pregnant females (NonPreg). Cross-sectional area and cortical index of the femoral mid-shaft, stiffness, and Young modulus were significantly greater in the PregHMB group. Whole-bone mineral density was similar in all groups, and HMB supplementation increased trabecular number. Growth plate cartilage was the thinnest, while the articular cartilage was the thickest in the PregHMB group. HMB supplementation increased the content of proteoglycans in the articular cartilage and the percentage of immature collagen content in metaphyseal trabeculae and compact bone. In summary, dietary HMB supplementation during the second trimester of pregnancy intensifies bone metabolic processes and prevents bone loss during pregnancy.
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10
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Host cell glutamine metabolism as a potential antiviral target. Clin Sci (Lond) 2021; 135:305-325. [PMID: 33480424 DOI: 10.1042/cs20201042] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/08/2020] [Accepted: 01/04/2021] [Indexed: 12/20/2022]
Abstract
A virus minimally contains a nucleic acid genome packaged by a protein coat. The genome and capsid together are known as the nucleocapsid, which has an envelope containing a lipid bilayer (mainly phospholipids) originating from host cell membranes. The viral envelope has transmembrane proteins that are usually glycoproteins. The proteins in the envelope bind to host cell receptors, promoting membrane fusion and viral entry into the cell. Virus-infected host cells exhibit marked increases in glutamine utilization and metabolism. Glutamine metabolism generates ATP and precursors for the synthesis of macromolecules to assemble progeny viruses. Some compounds derived from glutamine are used in the synthesis of purines and pyrimidines. These latter compounds are precursors for the synthesis of nucleotides. Inhibitors of glutamine transport and metabolism are potential candidate antiviral drugs. Glutamine is also an essential nutrient for the functions of leukocytes (lymphocyte, macrophage, and neutrophil), including those in virus-infected patients. The increased glutamine requirement for immune cell functions occurs concomitantly with the high glutamine utilization by host cells in virus-infected patients. The development of antiviral drugs that target glutamine metabolism must then be specifically directed at virus-infected host cells to avoid negative effects on immune functions. Therefore, the aim of this review was to describe the landscape of cellular glutamine metabolism to search for potential candidates to inhibit glutamine transport or glutamine metabolism.
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Rathmacher JA, Pitchford LM, Khoo P, Angus H, Lang J, Lowry K, Ruby C, Krajek AC, Fuller JC, Sharp RL. Long-term Effects of Calcium β-Hydroxy-β-Methylbutyrate and Vitamin D3 Supplementation on Muscular Function in Older Adults With and Without Resistance Training: A Randomized, Double-blind, Controlled Study. J Gerontol A Biol Sci Med Sci 2020; 75:2089-2097. [PMID: 32857128 PMCID: PMC7566440 DOI: 10.1093/gerona/glaa218] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 12/25/2022] Open
Abstract
The primary aim of this study was to determine whether supplementation with calcium β-hydroxy-β-methylbutyrate (HMB) and vitamin D3 (D) would enhance muscle function and strength in older adults. Older adults over 60 years of age with insufficient circulating 25-hydroxy-vitamin D (25OH-D) levels were enrolled in a double-blinded controlled 12-month study. Study participants were randomly assigned to treatments consisting of: (a) Control + no exercise, (b) HMB+D + no exercise, (c) Control + exercise, and (d) HMB+D + exercise. The study evaluated 117 participants via multiple measurements over the 12 months that included body composition, strength, functionality, and questionnaires. HMB+D had a significant benefit on lean body mass within the nonexercise group at 6 months (0.44 ± 0.27 kg, HMB+D vs −0.33 ± 0.28 kg, control, p < .05). In nonexercisers, improvement in knee extension peak torque (60°/s) was significantly greater in HMB+D-supplemented participants than in the nonsupplemented group (p = .04) at 3 months, 10.9 ± 5.7 Nm and −5.2 ± 5.9 Nm, respectively. A composite functional index, integrating changes in handgrip, Get Up, and Get Up and Go measurements, was developed. HMB+D + no exercise resulted in significant increases in the functional index compared with those observed in the control + no exercise group at 3 (p = .03), 6 (p = .04), and 12 months (p = .04). Supplementation with HMB+D did not further improve the functional index within the exercising group. This study demonstrated the potential of HMB and vitamin D3 supplementation to enhance muscle strength and physical functionality in older adults, even in individuals not engaged in an exercise training program.
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Affiliation(s)
- John A Rathmacher
- MTI BioTech, Inc., Iowa State University Research Park, Ames.,Department of Animal Science, Iowa State University, Ames
| | - Lisa M Pitchford
- MTI BioTech, Inc., Iowa State University Research Park, Ames.,Department of Kinesiology, Iowa State University, Ames
| | - Paul Khoo
- Department of Kinesiology, Iowa State University, Ames
| | - Hector Angus
- Department of Kinesiology, Iowa State University, Ames
| | - James Lang
- Department of Kinesiology, Iowa State University, Ames
| | - Kristin Lowry
- Department of Physical Therapy, Des Moines University
| | - Carol Ruby
- Department of Physical Therapy, Des Moines University
| | - Alex C Krajek
- Department of Physical Therapy, Des Moines University
| | | | - Rick L Sharp
- Department of Kinesiology, Iowa State University, Ames
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12
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Utilization of Hydroxyl-Methyl Butyrate, Leucine, Glutamine and Arginine Supplementation in Nutritional Management of Sarcopenia-Implications and Clinical Considerations for Type 2 Diabetes Mellitus Risk Modulation. J Pers Med 2020; 10:jpm10010019. [PMID: 32213854 PMCID: PMC7151606 DOI: 10.3390/jpm10010019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/14/2020] [Accepted: 03/19/2020] [Indexed: 01/06/2023] Open
Abstract
While onset characteristics may vary, sarcopenia gradually develops over time as a result of the aging process, leading to muscle loss, disturbance of the muscle to fat ratio, and a variety of negative symptoms undermining the wellbeing, quality of life, and lifespan in the aging population globally. There is evidence that sarcopenia may be a cause and consequence of type 2 diabetes mellitus (T2DM) in the aging population. The importance of nutritional management in the prevention and/or deceleration of sarcopenia is critical, with the main focus placed on the amount and quality of protein intake. Significant efforts are being made towards the development of medical nutrition therapies involving certain amino acids and amino compounds, as well as their combinations, for the improvement in muscle strength, muscle function and protein synthesis. This may reduce hospitalization times and hasten the recovery of patients with sarcopenia. The administration of protocols with varying dose and frequencies, as well as their efficacy, is being investigated. In the work herein, we present and evaluate data derived from human trials regarding the utilization of hydroxyl-methyl butyrate (HMB), L-leucine (Leu), L-glutamine (Gln) and L-arginine (Arg) supplementation for optimal management of sarcopenia in geriatric patients, a topic of significant clinical nutrition interest which may have important implications in T2DM status.
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13
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Erdem D, Sözen İ, Çakırca M, Örnek D, Kanyılmaz D, Akan B, Yastı AÇ. Effect of Nutritional Support Containing Arginine, Glutamine and β-hydroxy-β-methylbutyrate on the Protein Balance in Patients with Major Burns. Turk J Anaesthesiol Reanim 2019; 47:327-333. [PMID: 31380514 DOI: 10.5152/tjar.2019.40327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 09/15/2018] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the effect of a supplementary nutritional product containing arginine, glutamine and β-hydroxy-β-methylbutyrate (HMB) on the nutritional parameters of patients with major burns. Methods In a total of 40 patients with major burns treated in the Burns Unit, standard nutritional support was administered to 20 patients, and the study product was added to the standard nutritional support of the remaining 20 patients. The biochemical laboratory test results and burn severity were recorded on the first day of treatment and on Days 14 and 28. The 40 patients were divided as the study and the control group, and their results were compared. Results An increase in the albumin, prealbumin and total protein values in the group administered with the study product was found to be statistically significant compared to the control group (p=0.021, p=0.02, p<0.001, respectively). The decreases in haemoglobin and C-reactive protein (CRP) were at the levels expected in burn trauma. Conclusion The results obtained in this study demonstrated that the addition of arginine, glutamine and HMB to the nutrition of patients with burns had a positive effect on the protein balance.
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Affiliation(s)
- Deniz Erdem
- Clinic of Anaesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - İsa Sözen
- Clinic of Burn, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Müge Çakırca
- Clinic of Anaesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Dilşen Örnek
- Clinic of Anaesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Dilek Kanyılmaz
- Clinic of Anaesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Belgin Akan
- Clinic of Anaesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ahmet Çınar Yastı
- Clinic of Burn, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Holeček M, Vodeničarovová M. Effects of beta-hydroxy-beta-methylbutyrate supplementation on skeletal muscle in healthy and cirrhotic rats. Int J Exp Pathol 2019; 100:175-183. [PMID: 31321841 DOI: 10.1111/iep.12322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/11/2019] [Accepted: 05/05/2019] [Indexed: 12/23/2022] Open
Abstract
Beta-hydroxy-beta-methylbutyrate (HMB) is a leucine metabolite with protein anabolic effects. We examined the effects of an HMB-enriched diet in healthy rats and rats with liver cirrhosis induced by multiple doses of carbon tetrachloride (CCl4). HMB increased branched-chain amino acids (BCAAs; valine, leucine and isoleucine) in blood and BCAA and ATP in muscles of healthy animals. The effect on muscle mass and protein content was insignificant. In CCl4-treated animals alterations characteristic of liver cirrhosis were found with decreased ratio of the BCAA to aromatic amino acids in blood and lower muscle mass and ATP content when compared with controls. In CCl4-treated animals consuming HMB, we observed higher mortality, lower body weight, higher BCAA levels in blood plasma, higher ATP content in muscles, and lower ATP content and higher cathepsin B and L activities in the liver when compared with CCl4-treated animals without HMB. We conclude that (1) HMB supplementation has a positive effect on muscle mitochondrial function and enhances BCAA concentrations in healthy animals and (2) the effects of HMB on the course of liver cirrhosis in CCl4-treated rats are detrimental. Further studies examining the effects of HMB in other models of hepatic injury are needed to determine pros and cons of HMB in the treatment of subjects with liver cirrhosis.
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Affiliation(s)
- Milan Holeček
- Department of Physiology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Melita Vodeničarovová
- Department of Physiology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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15
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Mitchell T, Clarke L, Goldberg A, Bishop KS. Pancreatic Cancer Cachexia: The Role of Nutritional Interventions. Healthcare (Basel) 2019; 7:healthcare7030089. [PMID: 31323984 PMCID: PMC6787643 DOI: 10.3390/healthcare7030089] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 12/13/2022] Open
Abstract
Pancreatic cancer is a cancer with one of the highest mortality rates and many pancreatic cancer patients present with cachexia at diagnosis. The definition of cancer cachexia is not consistently applied in the clinic or across studies. In general, it is “defined as a multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass with or without loss of fat mass that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment.” Many regard cancer cachexia as being resistant to dietary interventions. Cachexia is associated with a negative impact on survival and quality of life. In this article, we outline some of the mechanisms of pancreatic cancer cachexia and discuss nutritional interventions to support the management of pancreatic cancer cachexia. Cachexia is driven by a combination of reduced appetite leading to reduced calorie intake, increased metabolism, and systemic inflammation driven by a combination of host cytokines and tumour derived factors. The ketogenic diet showed promising results, but these are yet to be confirmed in human clinical trials over the long-term. L-carnitine supplementation showed improved quality of life and an increase in lean body mass. As a first step towards preventing and managing pancreatic cancer cachexia, nutritional support should be provided through counselling and the provision of oral nutritional supplements to prevent and minimise loss of lean body mass.
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Affiliation(s)
- Toni Mitchell
- School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Lewis Clarke
- School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Alexandra Goldberg
- School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Karen S Bishop
- Department of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand.
- Auckland Cancer Society Research Centre, School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand.
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16
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Miyake S, Ogo A, Kubota H, Teramoto F, Hirai T. β-Hydroxy-β-methylbutyrate Suppresses NF-ĸB Activation and IL-6 Production in TE-1 Cancer Cells. In Vivo 2019; 33:353-358. [PMID: 30804112 DOI: 10.21873/invivo.11481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIM Stress reactions, especially those related to surgery, cause poor convalescence of cancer patients. β-Hydroxyβ-methylbutyrate (HMB) is known to regulate excessive inflammation in the body. The objective of this work was to investigate the capacity of HMB to suppress activation of nuclear factor-kappa B (NF-ĸB) and production of interleukin-6 (IL-6) in a human esophageal squamous cell carcinoma cell line (TE-1). MATERIALS AND METHODS Cell proliferation was measured using the water-soluble tetrazolium-1 method, while tumor necrosis factor alpha (TNFα)-induced IL-6 production was measured using an enzyme-linked immunosorbent assay (ELISA) assay. Nuclear translocation of NF-ĸB was detected by immunofluorescence staining. RESULTS HMB did not affect cell proliferation. However, HMB suppressed the TNFα-induced increase in IL-6 production in TE-1 cells by inhibiting NF-ĸB activation. CONCLUSION HMB did not influence TE-1 cell proliferation, but inhibited activation of NF-ĸB and IL-6 production. This result may be useful for improving excessive stress reactions during and after surgery.
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Affiliation(s)
- Sachi Miyake
- Department of Doctoral Program in Health Science, Graduate School of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Ayako Ogo
- Department of Doctoral Program in Health Science, Graduate School of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Hisako Kubota
- Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Fusako Teramoto
- Department of Doctoral Program in Health Science, Graduate School of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Toshihiro Hirai
- Department of Doctoral Program in Health Science, Graduate School of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Japan
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17
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Gepner Y, Varanoske AN, Boffey D, Hoffman JR. Benefits of β-hydroxy-β-methylbutyrate supplementation in trained and untrained individuals. Res Sports Med 2018; 27:204-218. [PMID: 30348016 DOI: 10.1080/15438627.2018.1533470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
β-Hydroxy-β-Methylbutyrate (HMB) is a metabolite of the branched-chain amino acid leucine and its ketoacid α-ketoisocaproate. HMB has been widely used as an ergogenic supplement to increase muscle strength, muscle hypertrophy and enhance recovery. The physiological mechanisms that underlie these benefits are related to HMB's ability to stimulate muscle protein synthesis and minimize muscle breakdown. Although evidence supporting the benefits of HMB supplementation is not conclusive, many of these studies have suffered from methodological flaws including different formulations, supplement duration and population studied. HMB in its free acid formulation is suggestive of having a greater potential for efficacy in both trained and untrained populations than its calcium-salt form. However, the evidence regarding HMB's role in limiting muscle degradation and increasing muscle protein synthesis has created an exciting interest in examining its efficacy among untrained individuals. Recent investigations examining intense training have demonstrated efficacy in maintaining muscle mass and attenuating the inflammatory response.
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Affiliation(s)
- Yftach Gepner
- a Institute of Exercise Physiology and Wellness, Sport and Exercise Science , University of Central Florida , Orlando , FL , USA
| | - Alyssa N Varanoske
- a Institute of Exercise Physiology and Wellness, Sport and Exercise Science , University of Central Florida , Orlando , FL , USA
| | - David Boffey
- a Institute of Exercise Physiology and Wellness, Sport and Exercise Science , University of Central Florida , Orlando , FL , USA
| | - Jay R Hoffman
- a Institute of Exercise Physiology and Wellness, Sport and Exercise Science , University of Central Florida , Orlando , FL , USA
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18
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Asghari Hanjani N, Farsi F, Sepidarkish M, Omidi A, Ardehali SH, Akbari‐Fakhrabadi M, Heshmati J. Effect of supplementation with a combination of
l
‐arginine,
l
‐glutamine, and hydroxy methyl butyrate on cachexia: A systematic review. J Food Biochem 2018. [DOI: 10.1111/jfbc.12636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Nazanin Asghari Hanjani
- Nutrition Department, School of Public Health Iran University of Medical Sciences Tehran Iran
| | - Farnaz Farsi
- Nutrition Department, School of Public Health Iran University of Medical Sciences Tehran Iran
- Colorectal Research Center Iran University of Medical Sciences Tehran Iran
| | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health Royan Institute for Reproductive Biomedicine, ACECR Tehran Iran
| | | | | | | | - Javad Heshmati
- Songhor Healthcare Center Kermanshah University of Medical Science Kermanshah Iran
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19
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Holeček M, Vodeničarovová M. Effects of beta-hydroxy-beta-methylbutyrate in partially hepatectomized rats. Physiol Res 2018; 67:741-751. [PMID: 30044108 DOI: 10.33549/physiolres.933861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Beta-hydroxy-beta-methylbutyrate (HMB) is a leucine metabolite with protein anabolic effects. Since HMB is synthesized in the liver, unique effects of exogenous HMB intake may be hypothesized in subjects with liver disease, in which muscle wasting is frequently found. We studied effects of HMB on the liver and soleus (SOL) and extensor digitorum longus (EDL) muscles in partially-hepatectomized (PH) rats. HMB or saline was infused using osmotic pumps to PH or sham-operated rats for 7 days. We found lower body weight and protein content in EDL of PH rats treated with saline than in sham-operated animals. These effects were insignificant in HMB treated animals. In blood plasma of PH rats treated with HMB we found lower concentrations of creatinine and higher concentrations of urea and branched-chain amino acids (BCAA; valine, leucine, and isoleucine) than in PH animals treated with saline. HMB increased BCAA concentrations in SOL and EDL of PH animals and decreased proteolysis in EDL of both sham-operated and PH animals. In the livers of PH rats treated with HMB we found higher DNA content, DNA fragmentation, and BCAA concentrations than in saline-treated animals. The results indicate that HMB affects metabolism of BCAA and has positive influence on protein balance in muscles. Further studies are needed to clarify the effect of HMB on liver regeneration.
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Affiliation(s)
- M Holeček
- Department of Physiology, Charles University, Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic.
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20
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Modulating Metabolism to Improve Cancer-Induced Muscle Wasting. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:7153610. [PMID: 29785246 PMCID: PMC5896402 DOI: 10.1155/2018/7153610] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/25/2017] [Indexed: 12/13/2022]
Abstract
Muscle wasting is one of the main features of cancer cachexia, a multifactorial syndrome frequently occurring in oncologic patients. The onset of cachexia is associated with reduced tolerance and response to antineoplastic treatments, eventually leading to clinical conditions that are not compatible with survival. Among the mechanisms underlying cachexia, protein and energy dysmetabolism play a major role. In this regard, several potential treatments have been proposed, mainly on the basis of promising results obtained in preclinical models. However, at present, no treatment yet reached validation to be used in the clinical practice, although several drugs are currently tested in clinical trials for their ability to improve muscle metabolism in cancer patients. Along this line, the results obtained in both experimental and clinical studies clearly show that cachexia can be effectively approached by a multidirectional strategy targeting nutrition, inflammation, catabolism, and inactivity at the same time. In the present study, approaches aimed to modulate muscle metabolism in cachexia will be reviewed.
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21
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Gangadharan A, Choi SE, Hassan A, Ayoub NM, Durante G, Balwani S, Kim YH, Pecora A, Goy A, Suh KS. Protein calorie malnutrition, nutritional intervention and personalized cancer care. Oncotarget 2017; 8:24009-24030. [PMID: 28177923 PMCID: PMC5410360 DOI: 10.18632/oncotarget.15103] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/23/2017] [Indexed: 12/27/2022] Open
Abstract
Cancer patients often experience weight loss caused by protein calorie malnutrition (PCM) during the course of the disease or treatment. PCM is expressed as severe if the patient has two or more of the following characteristics: obvious significant muscle wasting, loss of subcutaneous fat; nutritional intake of <50% of recommended intake for 2 weeks or more; bedridden or otherwise significantly reduced functional capacity; weight loss of >2% in 1 week, 5% in 1 month, or 7.5% in 3 months. Cancer anorexia-cachexia syndrome (CACS) is a multifactorial condition of advanced PCM associated with underlying illness (in this case cancer) and is characterized by loss of muscle with or without loss of fat mass. Cachexia is defined as weight loss of more than 5% of body weight in 12 months or less in the presence of chronic disease. Hence with a chronic illness on board even a small amount of weight loss can open the door to cachexia. These nutritional challenges can lead to severe morbidity and mortality in cancer patients. In the clinic, the application of personalized medicine and the ability to withstand the toxic effects of anti-cancer therapies can be optimized when the patient is in nutritional homeostasis and is free of anorexia and cachexia. Routine assessment of nutritional status and appropriate intervention are essential components of the effort to alleviate effects of malnutrition on quality of life and survival of patients.
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Affiliation(s)
- Anju Gangadharan
- The Genomics and Biomarkers Program, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Sung Eun Choi
- Department of Family, Nutrition, and Exercise Sciences, Queens College, The City University of New York, Flushing, NY, USA
| | - Ahmed Hassan
- The Genomics and Biomarkers Program, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Nehad M Ayoub
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Gina Durante
- Department of Clinical Nutrition, Baystate Medical Center, Springfield, MA, USA
| | - Sakshi Balwani
- The Genomics and Biomarkers Program, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Young Hee Kim
- Department of Clinical Nutrition, Baystate Medical Center, Springfield, MA, USA
| | - Andrew Pecora
- Clinical Divisions, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Andre Goy
- Clinical Divisions, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - K Stephen Suh
- The Genomics and Biomarkers Program, JT Cancer Center, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ, USA
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22
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Holeček M. Beta-hydroxy-beta-methylbutyrate supplementation and skeletal muscle in healthy and muscle-wasting conditions. J Cachexia Sarcopenia Muscle 2017; 8:529-541. [PMID: 28493406 PMCID: PMC5566641 DOI: 10.1002/jcsm.12208] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/08/2017] [Accepted: 03/20/2017] [Indexed: 12/21/2022] Open
Abstract
Beta-hydroxy-beta-methylbutyrate (HMB) is a metabolite of the essential amino acid leucine that has been reported to have anabolic effects on protein metabolism. The aims of this article were to summarize the results of studies of the effects of HMB on skeletal muscle and to examine the evidence for the rationale to use HMB as a nutritional supplement to exert beneficial effects on muscle mass and function in various conditions of health and disease. The data presented here indicate that the beneficial effects of HMB have been well characterized in strength-power and endurance exercise. HMB attenuates exercise-induced muscle damage and enhances muscle hypertrophy and strength, aerobic performance, resistance to fatigue, and regenerative capacity. HMB is particularly effective in untrained individuals who are exposed to strenuous exercise and in trained individuals who are exposed to periods of high physical stress. The low effectiveness of HMB in strength-trained athletes could be due to the suppression of the proteolysis that is induced by the adaptation to training, which may blunt the effects of HMB. Studies performed with older people have demonstrated that HMB can attenuate the development of sarcopenia in elderly subjects and that the optimal effects of HMB on muscle growth and strength occur when it is combined with exercise. Studies performed under in vitro conditions and in various animal models suggest that HMB may be effective in treatment of muscle wasting in various forms of cachexia. However, there are few clinical reports of the effects of HMB on muscle wasting in cachexia; in addition, most of these studies evaluated the therapeutic potential of combinations of various agents. Therefore, it has not been possible to determine whether HMB was effective or if there was a synergistic effect. Although most of the endogenous HMB is produced in the liver, there are no reports regarding the levels and the effects of HMB supplementation in subjects with liver disease. Several studies have suggested that anabolic effects of HMB supplementation on skeletal muscle do not occur in healthy, non-exercising subjects. It is concluded that (i) HMB may be applied to enhance increases in the mass and strength of skeletal muscles in subjects who exercise and in the elderly and (ii) studies examining the effects of HMB administered alone are needed to obtain conclusions regarding the specific effectiveness in attenuating muscle wasting in various muscle-wasting disorders.
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Affiliation(s)
- Milan Holeček
- Department of Physiology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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23
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Rai VRH, Phang LF, Sia SF, Amir A, Veerakumaran JS, Kassim MKA, Othman R, Tah PC, Loh PS, Jailani MIO, Ong G. Effects of immunonutrition on biomarkers in traumatic brain injury patients in Malaysia: a prospective randomized controlled trial. BMC Anesthesiol 2017; 17:81. [PMID: 28619005 PMCID: PMC5472912 DOI: 10.1186/s12871-017-0369-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/31/2017] [Indexed: 11/27/2022] Open
Abstract
Background Head injury is one of the top three diagnosis leading to intensive care unit (ICU) admission in Malaysia. There has been growing interest in using immunonutrition as a mode of modulating the inflammatory response to injury or infection with the aim of improving clinical outcome. The aim of the present study was to evaluate the effect of an immunonutrition on biomarkers (IL-6, glutathione, CRP, total protein and albumin) in traumatic brain injury patients. Methods Thirty six patients with head injury admitted to neurosurgical ICU in University Malaya Medical Centre were recruited for this study, over a 6-month period from July 2014 to January 2015. Patients were randomized to receive either an immunonutrition (Group A) or a standard (Group B) enteral feed. Levels of biomarkers were measured at day 1, 5 and 7 of enteral feeding. Results Patients in Group A showed significant reduction of IL-6 at day 5 (p < 0.001) with concurrent rise in glutathione levels (p = 0.049). Patients in Group A also demonstrated a significant increase of total protein level at the end of the study (day 7). Conclusion These findings indicate the potential of immunonutrition reducing cytokines and increasing antioxidant indices in patients with TBI. However, further studies incorporating patient outcomes are needed to determine its overall clinical benefits. Trial registration National Medical Research Register (NMRR) ID: 14–1430-23,171. ClinicalTrials.gov identifier: NCT03166449.
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Affiliation(s)
- Vineya Rai Hakumat Rai
- School of Medicine, Taylor's University, Lakeside Campus, 47500, Subang Jaya, Malaysia.,KPJ Tawakkal Specialist Hospital, Jalan Pahang Barat, 53000, Kuala Lumpur, Malaysia
| | - Lee Fern Phang
- Department of Anaesthesiology, Hospital Umum Sarawak, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Sheau Fung Sia
- Division of Neurosurgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Amirah Amir
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Jeyaganesh S Veerakumaran
- Department of Anaesthesiology, Faculty of Medicine, University Malaya, 50603, Kuala Lumpur, Malaysia
| | | | - Rafidah Othman
- Department of Dietetics, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia
| | - Pei Chien Tah
- Department of Dietetics, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia
| | - Pui San Loh
- Department of Anaesthesiology, Faculty of Medicine, University Malaya, 50603, Kuala Lumpur, Malaysia
| | | | - Gracie Ong
- Department of Anaesthesiology, Faculty of Medicine, University Malaya, 50603, Kuala Lumpur, Malaysia
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24
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Mochamat, Cuhls H, Marinova M, Kaasa S, Stieber C, Conrad R, Radbruch L, Mücke M. A systematic review on the role of vitamins, minerals, proteins, and other supplements for the treatment of cachexia in cancer: a European Palliative Care Research Centre cachexia project. J Cachexia Sarcopenia Muscle 2017; 8:25-39. [PMID: 27897391 PMCID: PMC5326814 DOI: 10.1002/jcsm.12127] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 04/24/2016] [Accepted: 05/04/2016] [Indexed: 02/06/2023] Open
Abstract
We provide a systematic review to support the European Palliative Care Research Collaboration development of clinical guidelines for cancer patients suffering from cachexia. CENTRAL, MEDLINE, PsycINFO, ClinicalTrials.gov, and a selection of cancer journals have been searched up until 15 April 2016. The systematic literature research yielded 4214 publications with 21 of these included in the final evaluation. Regarding minerals, our search identified only one study examining the use of magnesium with no effect on weight loss. As far as vitamins are concerned, vitamin E in combination with omega-3 fatty acids displayed an effect on survival in a single study, vitamin D showed improvement of muscle weakness in prostate cancer patients, and vitamin C supplementation led to an improvement of various quality of life aspects in a sample with a variety of cancer diagnoses. For proteins, a combination therapy of β-hydroxy-β-methylbutyrate (HMB), arginine, and glutamine showed an increase in lean body mass after 4 weeks in a study of advanced solid tumour patients, whereas the same combination did not show a benefit on lean body mass in a large sample of advanced lung and other cancer patients after 8 weeks. L-carnitine led to an increase of body mass index and an increase in overall survival in advanced pancreatic cancer patients. Adverse effects of food supplementation were rare and showed mild intensity. There is not enough solid evidence for the use of minerals, vitamins, proteins, or other supplements in cancer. No serious adverse effects have been reported with dietary supplementation.
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Affiliation(s)
- Mochamat
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany.,Department of Anesthesiology and Intensive Therapy, University of Diponegoro/Kariadi Hospital, Central Java, Indonesia
| | - Henning Cuhls
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
| | - Milka Marinova
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
| | - Stein Kaasa
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Oncology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Christiane Stieber
- Department of Human Genetics, University Hospital of Bonn, Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University Hospital of Bonn, Bonn, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Bonn, Bonn, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany.,Centre for Palliative Care, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
| | - Martin Mücke
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University Hospital of Bonn, Bonn, Germany.,Department of General Practice and Family Medicine, University Hospital of Bonn, Bonn, Germany
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25
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Effects of the Oral Nutritional Supplement Containing Arginine, Glutamine, and Hydroxymethylbutyrate (Abound®) on Healing of Colonic Anastomoses in Rats. Indian J Surg 2016; 77:1242-7. [PMID: 27011545 DOI: 10.1007/s12262-015-1268-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 04/06/2015] [Indexed: 10/23/2022] Open
Abstract
We evaluated the effects of the oral nutritional supplement containing arginine, glutamine, and hydroxymethylbutyrate (Abound®) on healing of colonic anastomoses in experimental rat model. Seventy Wistar-Albino male rats were divided into seven groups. Colon transection and anastomosis were performed in all groups except for the sham group. In groups 2 and 5, rats were fed with standard rat chow after the operation. Oral nutritional supplement was added to standard nutrition for 3 days postoperatively in group 3 and 7 days in group 6 and preoperative 7 days plus postoperative 3 days in group 4 and preoperative 7 days plus postoperative 7 days in group 7. Bursting pressures were measured, adhesions were evaluated, and tissue samples were taken for measurement of tissue hydroxyproline levels and for histopathological examination. The usage of oral nutritional supplement had positive effects on bursting pressures, tissue hydroxyproline levels, and histopathological findings of anastomoses, but feeding with oral nutritional supplement both preoperatively and postoperatively had no additive effect on these parameters when compared with the groups that were fed only postoperatively. The mixture of arginine, glutamine, and hydroxymethylbutyrate may be safely used for achieving better healing results after colonic anastomoses.
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26
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Effects of amino acid derivatives on physical, mental, and physiological activities. Crit Rev Food Sci Nutr 2016; 55:1793-807. [PMID: 24279396 DOI: 10.1080/10408398.2012.708368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Nutritional ergogenic aids have been in use for a long time to enhance exercise and sports performance. Dietary components that exhibit ergogenic activity are numerous and their consumption is common and popular among athletes. They often come under scrutiny by legal authorities for their claimed benefits and safety concerns. Amino acid derivatives are propagated as being effective aids to enhance physical and mental performance in many ways, even though studies have pointed out that individuals who are deficient are more likely to benefit from dietary supplementation of amino acid derivatives than normal humans. In this review, some of the most common and widely used amino acids derivatives in sports and athletics namely creatine, tyrosine, carnitine, HMB, and taurine have been discussed for their effects on exercise performance, mental activity as well as body strength and composition. Creatine, carnitine, HMB, and taurine are reported to delay the onset of fatigue, improve exercise performance, and body strength. HMB helps in increasing fat-free mass and reduce exercise induced muscle injury. Taurine has been found to reduce oxidative stress during exercise and also act as an antihypertensive agent. Although, studies have not been able to find any favorable effect of tyrosine administration on exercise performance, it has been proved to be very effective in fighting stress, improving mood and cognitive performance particularly in sleep-deprived subjects. While available data from published studies and findings are equivocal about the efficacy of creatine, tyrosine, and HMB, more comprehensive researches on carnitine and taurine are necessary to provide evidence for the theoretical basis of their ergogenic role in nutritional modification and supplementation.
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YILDIZ SY, YAZICIOĞLU MB, TİRYAKİ Ç, ÇİFTÇİ A, BOYACIOĞLU Z, ÖZYILDIZ M, COŞKUN M, ŞUBAŞI Ö. The effect of enteral immunonutrition in upper gastrointestinalsurgery for cancer: a prospective study. Turk J Med Sci 2016; 46:393-400. [DOI: 10.3906/sag-1411-102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 07/06/2015] [Indexed: 11/03/2022] Open
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Dennis RA, Ponnappan U, Kodell RL, Garner KK, Parkes CM, Bopp MM, Padala KP, Peterson CA, Padala PR, Sullivan DH. Immune Function and Muscle Adaptations to Resistance exercise in Older Adults: Study Protocol for a Randomized Controlled Trial of a Nutritional Supplement. Trials 2015; 16:121. [PMID: 25872570 PMCID: PMC4411711 DOI: 10.1186/s13063-015-0631-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 03/04/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Immune function may influence the ability of older adults to maintain or improve muscle mass, strength, and function during aging. Thus, nutritional supplementation that supports the immune system could complement resistance exercise as an intervention for age-associated muscle loss. The current study will determine the relationship between immune function and exercise training outcomes for older adults who consume a nutritional supplement or placebo during resistance training and post-training follow-up. The supplement was chosen due to evidence suggesting its ingredients [arginine (Arg), glutamine (Gln), and β-hydroxy β-methylbutyrate (HMB)] can improve immune function, promote muscle growth, and counteract muscle loss. METHODS/DESIGN Veterans (age 60 to 80 yrs, N = 50) of the United States military will participate in a randomized double-blind placebo-controlled trial of consumption of a nutritional supplement or placebo during completion of three study objectives: 1) determine if 2 weeks of supplementation improve immune function measured as the response to vaccination and systemic and cellular responses to acute resistance exercise; 2) determine if supplementation during 36 sessions of resistance training boosts gains in muscle size, strength, and function; and 3) determine if continued supplementation for 26 weeks post-training promotes retention of training-induced gains in muscle size, strength, and function. Analyses of the results for these objectives will determine the relationship between immune function and the training outcomes. Participants will undergo nine blood draws and five muscle (vastus lateralis) biopsies so that the effects of the supplement on immune function and the systemic and cellular responses to exercise can be measured. DISCUSSION Exercise has known effects on immune function. However, the study will attempt to modulate immune function using a nutritional supplement and determine the effects on training outcomes. The study will also examine post-training benefit retention, an important issue for older adults, usually omitted from exercise studies. The study will potentially advance our understanding of the mechanisms of muscle gain and loss in older adults, but more importantly, a nutritional intervention will be evaluated as a complement to exercise for supporting muscle health during aging. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02261961, registration date 10 June 2014, recruitment active.
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Affiliation(s)
- Richard A Dennis
- Geriatric Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, 170/3 J, North Little Rock, AR, 72114, USA. .,Donald W Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
| | - Usha Ponnappan
- Department of Microbiology and Immunology, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
| | - Ralph L Kodell
- Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
| | - Kimberly K Garner
- Geriatric Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, 170/3 J, North Little Rock, AR, 72114, USA. .,Donald W Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
| | - Christopher M Parkes
- Geriatric Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, 170/3 J, North Little Rock, AR, 72114, USA.
| | - Melinda M Bopp
- Geriatric Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, 170/3 J, North Little Rock, AR, 72114, USA.
| | - Kalpana P Padala
- Geriatric Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, 170/3 J, North Little Rock, AR, 72114, USA. .,Donald W Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
| | - Charlotte A Peterson
- College of Health Sciences, University of Kentucky, 900 South Limestone Street, Lexington, KY, 40536, USA.
| | - Prasad R Padala
- Geriatric Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, 170/3 J, North Little Rock, AR, 72114, USA. .,Donald W Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA. .,Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
| | - Dennis H Sullivan
- Geriatric Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, 170/3 J, North Little Rock, AR, 72114, USA. .,Donald W Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
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Helms ER, Aragon AA, Fitschen PJ. Evidence-based recommendations for natural bodybuilding contest preparation: nutrition and supplementation. J Int Soc Sports Nutr 2014; 11:20. [PMID: 24864135 PMCID: PMC4033492 DOI: 10.1186/1550-2783-11-20] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 04/29/2014] [Indexed: 12/19/2022] Open
Abstract
The popularity of natural bodybuilding is increasing; however, evidence-based recommendations for it are lacking. This paper reviewed the scientific literature relevant to competition preparation on nutrition and supplementation, resulting in the following recommendations. Caloric intake should be set at a level that results in bodyweight losses of approximately 0.5 to 1%/wk to maximize muscle retention. Within this caloric intake, most but not all bodybuilders will respond best to consuming 2.3-3.1 g/kg of lean body mass per day of protein, 15-30% of calories from fat, and the reminder of calories from carbohydrate. Eating three to six meals per day with a meal containing 0.4-0.5 g/kg bodyweight of protein prior and subsequent to resistance training likely maximizes any theoretical benefits of nutrient timing and frequency. However, alterations in nutrient timing and frequency appear to have little effect on fat loss or lean mass retention. Among popular supplements, creatine monohydrate, caffeine and beta-alanine appear to have beneficial effects relevant to contest preparation, however others do not or warrant further study. The practice of dehydration and electrolyte manipulation in the final days and hours prior to competition can be dangerous, and may not improve appearance. Increasing carbohydrate intake at the end of preparation has a theoretical rationale to improve appearance, however it is understudied. Thus, if carbohydrate loading is pursued it should be practiced prior to competition and its benefit assessed individually. Finally, competitors should be aware of the increased risk of developing eating and body image disorders in aesthetic sport and therefore should have access to the appropriate mental health professionals.
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Affiliation(s)
- Eric R Helms
- Sport Performance Research in New Zealand (SPRINZ) at AUT Millennium Institute, AUT University, 17 Antares Place, Mairangi Bay, Auckland 0632, New Zealand
| | | | - Peter J Fitschen
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, USA
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Fuller JC, Arp LH, Diehl LM, Landin KL, Baier SM, Rathmacher JA. Subchronic toxicity study of β-hydroxy-β-methylbutyric free acid in Sprague–Dawley rats. Food Chem Toxicol 2014; 67:145-53. [DOI: 10.1016/j.fct.2014.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/04/2014] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
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β-hydroxy-β-methylbutyrate (HMB) prevents sepsis-induced diaphragm dysfunction in mice. Respir Physiol Neurobiol 2014; 196:63-8. [PMID: 24632527 DOI: 10.1016/j.resp.2014.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 02/26/2014] [Accepted: 02/27/2014] [Indexed: 01/30/2023]
Abstract
Infections induce severe respiratory muscle weakness. Currently there are no treatments for this important clinical problem. We tested the hypothesis that β-hydroxy-β-methylbutyrate (HMB) would prevent sepsis-induced diaphragm weakness. Four groups of adult male mice were studied: controls (saline-injected), sepsis (intraperitoneal lipopolysaccharide), sepsis+HMB (injected intravenously), and HMB. Diaphragm force generation and indices of caspase 3, calpain, 20S proteasomal subunit, and double-stranded RNA-dependent protein kinase (PKR) activation were assessed after 24h. Sepsis elicited large reductions in diaphragm specific force generation at all stimulation frequencies. Endotoxin also activated caspase 3, calpain, the 20S proteasomal subunit and PKR in the diaphragm. HMB blocked sepsis-induced caspase 3, 20S proteasomal and PKR activation, but did not prevent calpain activation. Most importantly, HMB administration significantly attenuated sepsis-induced diaphragm weakness, preserving muscle force generation at all stimulation frequencies (p<0.01). We speculate that HMB may prove to be an important therapy in infected patients, with the potential to increase diaphragm strength, to reduce the duration of mechanical ventilation and to decrease mortality in this patient population.
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Nunes EA, Gonçalves-Neto LM, Ferreira FB, dos Santos C, Fernandes LC, Boschero AC, Calder PC, Rafacho A. Glucose intolerance induced by glucocorticoid excess is further impaired by co-administration with β-hydroxy-β-methylbutyrate in rats. Appl Physiol Nutr Metab 2013; 38:1137-46. [DOI: 10.1139/apnm-2012-0456] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Glucocorticoid (GC) excess alters glucose homeostasis and promotes modifications in murinometric and anthropometric parameters in rodents and humans, respectively. β-hydroxy-β-methylbutyrate (HMB), a leucine metabolite, has been proposed as a nutritional strategy for preventing muscle wasting, but few data regarding its effects on glucose homeostasis are available. Here, we analyzed whether the effects of GC excess on glucose homeostasis may be attenuated or exacerbated by the concomitant ingestion of HMB. Adult Wistar rats (90-days-old) were assigned to four groups: (1) vehicle treated (Ctl), (2) dexamethasone (DEX) treated (Dex), (3) HMB treated (Hmb), and (4) DEX plus HMB treated (DexHmb). Dex groups received DEX (1 mg·kg body weight (BW)−1, intraperitoneal) for 5 consecutive days. HMB groups ingested HMB (320 mg·kg BW−1, oral gavage) for the same 5 days. HMB ingestion did not attenuate the effects of DEX on food intake and body weight loss, changes in masses of several organs, insulin resistance, and glucose intolerance (p > 0.05). In fact, in DexHmb rats, there was increased fasting glycemia and exacerbated glucose intolerance with the main effect attributed to DEX treatment (p < 0.05). HMB exerted no attenuating effect on plasma triacylglycerol levels from DexHmb rats, but it seems to attenuate the lipolysis induced by β-adrenergic stimulation (20 μmol·L−1isoproterenol) in fragments of retroperitoneal adipose tissue from DexHmb rats. Therefore, HMB does not attenuate the diabetogenic characteristics of GC excess. In fact, the data suggest that HMB may exacerbate GC-induced glucose intolerance.
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Affiliation(s)
- Everson A. Nunes
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Luiz M. Gonçalves-Neto
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Francielle B.D. Ferreira
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Cristiane dos Santos
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Luiz C. Fernandes
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Paraná, Curitiba, Brazil
| | - Antonio C. Boschero
- Department of Functional and Structural Biology, Institute of Biology, State University of Campinas, Campinas, Brazil
| | - Philip C. Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Alex Rafacho
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
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Beta-hydroxy-beta-methylbutyrate supplementation in health and disease: a systematic review of randomized trials. Amino Acids 2013; 45:1273-92. [PMID: 24057808 DOI: 10.1007/s00726-013-1592-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/05/2013] [Indexed: 12/13/2022]
Abstract
Beta-hydroxy-beta-methylbutyrate (HMB), a metabolite of the branched-chain amino acid leucine, is extensively used by athletes and bodybuilders in order to increase strength, muscle mass and exercise performance. We performed a systematic review of the clinical literature on the effectiveness of HMB supplementation in healthy and pathological conditions (i.e. training programs, aging, acute and chronic diseases, and after bariatric surgery). We reviewed all clinical trials indexed in Medline that tested HMB supplementation as well as all the experimental data regarding HMB intracellular mechanisms of action. Search terms included: randomized controlled trials, controlled clinical trials, single- and double-blind method, HMB, proteolytic pathways, muscle atrophy, cachexia, and training. We found out 13 studies testing HMB in healthy young trained subjects, 11 in healthy young untrained subjects, 9 in patients affected by chronic diseases (i.e. cancer, HIV, chronic obstructive pulmonary disease), and 6 in elderly subjects. The indexed studies support that HMB is effective in preventing exercise-related muscle damage in healthy trained and untrained individuals as well as muscle loss during chronic diseases. Most of the selected studies showed the effectiveness of HMB in preventing exercise-related muscle damage in healthy trained and untrained individuals as well as muscle loss during chronic diseases. The usual dose of 3 g/day may be routinely recommended to maintain or improve muscle mass and function in health and disease. The safety profile of HMB is unequivocal. Further, well-designed clinical studies are needed to confirm effectiveness and mode of action of HMB, particularly in pathological conditions.
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Wilson JM, Fitschen PJ, Campbell B, Wilson GJ, Zanchi N, Taylor L, Wilborn C, Kalman DS, Stout JR, Hoffman JR, Ziegenfuss TN, Lopez HL, Kreider RB, Smith-Ryan AE, Antonio J. International Society of Sports Nutrition Position Stand: beta-hydroxy-beta-methylbutyrate (HMB). J Int Soc Sports Nutr 2013; 10:6. [PMID: 23374455 PMCID: PMC3568064 DOI: 10.1186/1550-2783-10-6] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 01/31/2013] [Indexed: 12/12/2022] Open
Abstract
Position Statement: The International Society of Sports Nutrition (ISSN) bases the following position stand on a critical analysis of the literature on the use of beta-hydroxy-beta-methylbutyrate (HMB) as a nutritional supplement. The ISSN has concluded the following. 1. HMB can be used to enhance recovery by attenuating exercise induced skeletal muscle damage in trained and untrained populations. 2. If consuming HMB, an athlete will benefit from consuming the supplement in close proximity to their workout. 3. HMB appears to be most effective when consumed for 2 weeks prior to an exercise bout. 4. Thirty-eight mg·kg·BM-1 daily of HMB has been demonstrated to enhance skeletal muscle hypertrophy, strength, and power in untrained and trained populations when the appropriate exercise prescription is utilized. 5. Currently, two forms of HMB have been used: Calcium HMB (HMB-Ca) and a free acid form of HMB (HMB-FA). HMB-FA may increase plasma absorption and retention of HMB to a greater extent than HMB-CA. However, research with HMB-FA is in its infancy, and there is not enough research to support whether one form is superior. 6. HMB has been demonstrated to increase LBM and functionality in elderly, sedentary populations. 7. HMB ingestion in conjunction with a structured exercise program may result in greater declines in fat mass (FM). 8. HMB's mechanisms of action include an inhibition and increase of proteolysis and protein synthesis, respectively. 9. Chronic consumption of HMB is safe in both young and old populations.
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Affiliation(s)
- Jacob M Wilson
- Department of Health Sciences and Human Performance, University of Tampa, Tampa, FL, USA
| | - Peter J Fitschen
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, USA
| | - Bill Campbell
- Exercise and Performance Nutrition Laboratory, Dept. of Physical Education and Exercise Science, University of South Florida, 4202 E. Fowler Avenue, PED 214, Tampa, FL, 33620, USA
| | - Gabriel J Wilson
- Department of Nutritional Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Nelo Zanchi
- Laboratory of Applied Nutrition and Metabolism, Physical Education and School of Sports, University of São Paulo, São Paulo, Brazil
| | - Lem Taylor
- Human Performance Laboratory, Exercise & Sport Science Department, University of Mary Hardin-Baylor, Belton, TX, 76513, USA
| | - Colin Wilborn
- Human Performance Laboratory, Exercise & Sport Science Department, University of Mary Hardin-Baylor, Belton, TX, 76513, USA
| | - Douglas S Kalman
- Miami Research Associates, Endocrinology & Nutrition Department, 6141 Sunset Drive - Suite 301, Miami, FL, 33143, USA
| | - Jeffrey R Stout
- Institute of Exercise Physiology and Wellness, University of Central Florida, Orlando, FL, 32816, USA
| | - Jay R Hoffman
- Institute of Exercise Physiology and Wellness, University of Central Florida, Orlando, FL, 32816, USA
| | | | - Hector L Lopez
- The Center for Applied Health Sciences, Stow, OH, 44224, USA.,Supplement Safety Solutions, Bedford, MA, USA
| | - Richard B Kreider
- Exercise & Sport Nutrition Lab, Department of Health & Kinesiology, Texas A&M University, College Station, TX, USA
| | - Abbie E Smith-Ryan
- Applied Physiology Laboratory, Department of Exercise and Sport Science, University of North Carolina Chapel Hill, Chapel Hill, NC, 27599-8605, USA
| | - Jose Antonio
- Exercise and Sports Science, Nova Southeastern University, Davie, FL, 33314, USA
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Efficacy of β-hydroxy-β-methylbutyrate supplementation in elderly and clinical populations. Nutrition 2013; 29:29-36. [DOI: 10.1016/j.nut.2012.05.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/01/2012] [Accepted: 05/06/2012] [Indexed: 12/25/2022]
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Worthington ML, Cresci G. Immune-modulating formulas: who wins the meta-analysis race? Nutr Clin Pract 2012; 26:650-5. [PMID: 22205552 DOI: 10.1177/0884533611425799] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Most agree that enteral nutrition is the ideal way to feed critically ill patients who have a functional gastrointestinal tract, but selecting the appropriate enteral formula can be difficult. Specifically, the use of immune-modulating diets has brought much excitement as well as debate. Literature to date presents both positive and potential adverse effects. To aid the clinician in the decision-making process, this article reviews the current research and recommendations regarding the use of immune-modulating diets.
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Wong AW, Magnuson BA, Nakagawa K, Bursey RG. Oral subchronic and genotoxicity studies conducted with the amino acid, l-glutamine. Food Chem Toxicol 2011; 49:2096-102. [DOI: 10.1016/j.fct.2011.05.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 05/20/2011] [Accepted: 05/22/2011] [Indexed: 11/28/2022]
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Open phase II study on efficacy and safety of an oral amino acid functional cluster supplementation in cancer cachexia. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2010. [DOI: 10.1007/s12349-010-0016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Weitzel LRB, Sandoval PA, Mayles WJ, Wischmeyer PE. Performance-enhancing sports supplements: role in critical care. Crit Care Med 2010; 37:S400-9. [PMID: 20046127 DOI: 10.1097/ccm.0b013e3181b6f2e6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many performance-enhancing supplements and/or drugs are increasing in popularity among professional and amateur athletes alike. Although the uncontrolled use of these agents can pose health risks in the general population, their clearly demonstrated benefits could prove helpful to the critically ill population in whom preservation and restoration of lean body mass and neuromuscular function are crucial. Post-intensive care unit weakness not only impairs post-intensive care unit quality of life but also correlates with intensive care unit mortality. This review covers a number of the agents known to enhance athletic performance, and their possible role in preservation of muscle function and prevention/treatment of post-intensive care unit weakness in critically ill patients. These agents include testosterone analogues, growth hormone, branched chain amino acid, glutamine, arginine, creatine, and beta-hydryoxy-beta-methylbutyrate. Three of the safest and most effective agents in enhancing athletic performance in this group are creatine, branched-chain amino acid, and beta-hydryoxy-beta-methylbutyrate. However, these agents have received very little study in the recovering critically ill patient suffering from post-intensive care unit weakness. More placebo-controlled studies are needed in this area to determine efficacy and optimal dosing. It is very possible that, under the supervision of a physician, many of these agents may prove beneficial in the prevention and treatment of post-intensive care unit weakness.
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Affiliation(s)
- Lindsay-Rae B Weitzel
- Department of Anesthesiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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Abstract
OBJECTIVE : To evaluate the evidence for dietary recommendations in older adult athletes. DESIGN : Interpretive review of the literature. RESULTS : Regarding resistance training, a protein intake of slightly more than 0.8 g/kg/d is required to optimize gains in muscle strength. The early provision of protein and carbohydrate following a weight training session can enhance resultant strength and fat-free mass gains. Supplementation with creatine monohydrate (approximately 5 g/d) can potentiate some of the gains in strength and fat free mass attained through resistance exercise training. Regarding endurance exercise training, there are no studies evaluating carbohydrate loading, during-event, or postexercise carbohydrate/nutritional replacement in older adults. CONCLUSIONS : The amount and timing of dietary protein is important to maximize strength and gains in fat-free mass during resistance exercise training. Creatine monohydrate supplementation can potentiate some of these gains during the first 4 to 6 months of training. Older adults should consume adequate carbohydrates during endurance training (6-8 g/kg/d) and may benefit from the provision of carbohydrate and protein in the early recovery phase following endurance exercise to maximize glycogen re-synthesis for a subsequent exercise bout. There is no scientific reason to assume that older athletes will respond differently to the pre- and during-race fluid and carbohydrate replacement strategies suggested for younger athletes. The consensus guidelines outlined by the American College of Sports Medicine should therefore be followed for all athletes, regardless of their age.
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Baier S, Johannsen D, Abumrad N, Rathmacher JA, Nissen S, Flakoll P. Year-long Changes in Protein Metabolism in Elderly Men and Women Supplemented With a Nutrition Cocktail of β-Hydroxy-β-methylbutyrate (HMB), L-Arginine, and L-Lysine. JPEN J Parenter Enteral Nutr 2008; 33:71-82. [DOI: 10.1177/0148607108322403] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Shawn Baier
- From the Department of Food Science and Human Nutrition, Iowa State University, Ames; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Animal Science, Iowa State University, Ames, IA; and Metabolic Technologies, Iowa State University Research Park, Ames, IA
| | - Darcy Johannsen
- From the Department of Food Science and Human Nutrition, Iowa State University, Ames; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Animal Science, Iowa State University, Ames, IA; and Metabolic Technologies, Iowa State University Research Park, Ames, IA
| | - Naji Abumrad
- From the Department of Food Science and Human Nutrition, Iowa State University, Ames; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Animal Science, Iowa State University, Ames, IA; and Metabolic Technologies, Iowa State University Research Park, Ames, IA
| | - John A. Rathmacher
- From the Department of Food Science and Human Nutrition, Iowa State University, Ames; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Animal Science, Iowa State University, Ames, IA; and Metabolic Technologies, Iowa State University Research Park, Ames, IA
| | - Steven Nissen
- From the Department of Food Science and Human Nutrition, Iowa State University, Ames; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Animal Science, Iowa State University, Ames, IA; and Metabolic Technologies, Iowa State University Research Park, Ames, IA
| | - Paul Flakoll
- From the Department of Food Science and Human Nutrition, Iowa State University, Ames; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Animal Science, Iowa State University, Ames, IA; and Metabolic Technologies, Iowa State University Research Park, Ames, IA
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Shao A, Hathcock JN. Risk assessment for the amino acids taurine, L-glutamine and L-arginine. Regul Toxicol Pharmacol 2008; 50:376-99. [PMID: 18325648 DOI: 10.1016/j.yrtph.2008.01.004] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 12/19/2007] [Accepted: 01/09/2008] [Indexed: 12/18/2022]
Abstract
Taurine, glutamine and arginine are examples of amino acids which have become increasingly popular as ingredients in dietary supplements and functional foods and beverages. Animal and human clinical research suggests that oral supplementation of these amino acids provides additional health and/or performance benefits beyond those observed from normal intake of dietary protein. The increased consumer awareness and use of these amino acids as ingredients in dietary supplements and functional foods warrant a comprehensive review of their safety through quantitative risk assessment, and identification of a potential safe upper level of intake. The absence of a systematic pattern of adverse effects in humans in response to orally administered taurine (Tau), l-glutamine (Gln) and l-arginine (Arg) precluded the selection of a no observed adverse effect level (NOAEL) or lowest observed adverse effect level (LOAEL). Therefore, by definition, the usual approach to risk assessment for identification of a tolerable upper level of intake (UL) could not be used. Instead, the newer method described as the Observed Safe Level (OSL) or Highest Observed Intake (HOI) was utilized. The OSL risk assessments indicate that based on the available published human clinical trial data, the evidence for the absence of adverse effects is strong for Tau at supplemental intakes up to 3 g/d, Gln at intakes up to 14 g/d and Arg at intakes up to 20 g/d, and these levels are identified as the respective OSLs for normal healthy adults. Although much higher levels of each of these amino acids have been tested without adverse effects and may be safe, the data for intakes above these levels are not sufficient for a confident conclusion of long-term safety, and therefore these values are not selected as the OSLs.
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Affiliation(s)
- Andrew Shao
- Council for Responsible Nutrition, 1828 L Street, NW, Suite 900, Washington, DC 20036-5114, USA.
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Yeh SS, Lovitt S, Schuster MW. Pharmacological Treatment of Geriatric Cachexia: Evidence and Safety in Perspective. J Am Med Dir Assoc 2007; 8:363-77. [PMID: 17619035 DOI: 10.1016/j.jamda.2007.05.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Revised: 04/16/2007] [Indexed: 01/12/2023]
Abstract
Anticachexic or antisarcopenic medications are prescribed worldwide for geriatric patients with poor appetite and associated weight loss. They represent a valuable treatment option for managing cachexia. However, the well-publicized adverse reports about these medications in acquired immunodeficiency syndrome (AIDS) and in the cancer population has led to some concern and much subsequent discussion over the safety of these medications being used in geriatric population. This review looks at the evidence in relation to the benefits and risks of these medications and discusses what we know about their use in the geriatric population.
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Affiliation(s)
- Shing-Shing Yeh
- Northport VAMC, Geriatric division, Northport, NY 11768, USA.
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Lynch GS, Schertzer JD, Ryall JG. Therapeutic approaches for muscle wasting disorders. Pharmacol Ther 2007; 113:461-87. [PMID: 17258813 DOI: 10.1016/j.pharmthera.2006.11.004] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 11/10/2006] [Accepted: 11/10/2006] [Indexed: 12/12/2022]
Abstract
Muscle wasting and weakness are common in many disease states and conditions including aging, cancer cachexia, sepsis, denervation, disuse, inactivity, burns, HIV-acquired immunodeficiency syndrome (AIDS), chronic kidney or heart failure, unloading/microgravity, and muscular dystrophies. Although the maintenance of muscle mass is generally regarded as a simple balance between protein synthesis and protein degradation, these mechanisms are not strictly independent, but in fact they are coordinated by a number of different and sometimes complementary signaling pathways. Clearer details are now emerging about these different molecular pathways and the extent to which these pathways contribute to the etiology of various muscle wasting disorders. Therapeutic strategies for attenuating muscle wasting and improving muscle function vary in efficacy. Exercise and nutritional interventions have merit for slowing the rate of muscle atrophy in some muscle wasting conditions, but in most cases they cannot halt or reverse the wasting process. Hormonal and/or other drug strategies that can target key steps in the molecular pathways that regulate protein synthesis and protein degradation are needed. This review describes the signaling pathways that maintain muscle mass and provides an overview of some of the major conditions where muscle wasting and weakness are indicated. The review provides details on some therapeutic strategies that could potentially attenuate muscle atrophy, promote muscle growth, and ultimately improve muscle function. The emphasis is on therapies that can increase muscle mass and improve functional outcomes that will ultimately lead to improvement in the quality of life for affected patients.
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Affiliation(s)
- Gordon S Lynch
- Basic and Clinical Myology Laboratory, Department of Physiology, The University of Melbourne, Victoria 3010, Australia.
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Castellanos VH, Litchford MD, Campbell WW. Modular protein supplements and their application to long-term care. Nutr Clin Pract 2007; 21:485-504. [PMID: 16998147 DOI: 10.1177/0115426506021005485] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Modular protein supplements are added to either the diet or enteral formula to increase the protein or amino acid intakes of people who are nutritionally compromised. Protein supplements are aggressively marketed to long-term care clinicians because protein energy malnutrition and wounds are a common problem in this care setting. It can be challenging for clinicians to distinguish one product from another and to determine the best product for a specific application or nutrition care goal. Modular protein products can be sorted into 4 categories: (1) protein concentrates derived from a complete protein such as milk, soy, or eggs; (2) protein concentrates derived from collagen, either alone or in combination with a complete protein; (3) doses of 1 or more dispensable (nonessential) amino acids; and (4) hybrids of the complete or collagen-based proteins and amino acid dose. Modular protein supplements are generally provided either as a substrate for protein synthesis or as a source of 1 or more amino acids that may be conditionally indispensable (conditionally essential) under certain disease conditions. This review provides guidelines for the use of modular protein supplements according to their intended physiologic function and the assessment and nutrition care goals of the long-term care resident.
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Camps C, Iranzo V, Bremnes RM, Sirera R. Anorexia–Cachexia syndrome in cancer: implications of the ubiquitin–proteasome pathway. Support Care Cancer 2006; 14:1173-83. [PMID: 16819628 DOI: 10.1007/s00520-006-0097-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 05/31/2006] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Malnutrition is a common problem in cancer patients. Its incidence varies according to disease stage (between 15 and 90%) and is considered a possible prognostic factor for therapeutic response and survival. It is also one of the causes contributing to the increase in morbidity and mortality in patients. Tumor cachexia is defined as a nutritional defect caused by tumor growth in the patient and presents as a significant weight loss. This weight loss is mainly caused by a degradation of skeletal muscle proteins. CONCLUSION The ubiquitin-proteasome system is the most important pathway of protein degradation. As a regulatory system governing protein half-life, it is involved in the regulation of the cell cycle, signal transmission, immune system response, apoptosis, and oncogenesis. Knowledge of the molecular pathways involved in the induction of cancer-associated cachexia will favor a more rational approach to its treatment as well as possible quality of life and survival benefit for the patient.
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Affiliation(s)
- Carlos Camps
- Servicio de Oncología Médica, Consorcio Hospital General Universitario de Valencia, Av. Tres Cruces s/n, 46014, Valencia, Spain.
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Faintuch J, Soeters PB, Osmo HG. Nutritional and metabolic abnormalities in pre-AIDS HIV infection. Nutrition 2006; 22:683-90. [PMID: 16704957 DOI: 10.1016/j.nut.2006.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Accepted: 03/16/2006] [Indexed: 01/23/2023]
Abstract
Since the earliest reports of human immunodeficiency virus (HIV) disease, undernutrition has been associated with HIV infection, typically with the late stages of the disease (namely acquired immunodeficiency syndrome), and may advance to severe wasting and cachexia. Specific micronutrient deficiencies are also recognized to occur with HIV infection, but their actual effect on the clinical course of the disease is hard to assess. The studies reviewed provide more insight into the complex interface between undernutrition and, in some cases, obesity and HIV/acquired immunodeficiency syndrome and highlight the possibility of alleviating or curing undernutrition by means of simple and comparatively inexpensive dietary adjustments.
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Affiliation(s)
- Joel Faintuch
- Nutrition and Obesity Group, Hospital das Clínicas, São Paulo University Medical School, São Paulo, São Paulo, Brazil.
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Abstract
Nutritional supplements are widely used by patients and athletes around the world for many different reasons. Many companies are thriving on this billion-dollar industry with little proof that these substances do what they are reported or suggested to do. Beta-hydroxy-beta-methylbutyrate (HMB) is a relatively new supplement on the ergogenic landscape. Studies of HMB supplementation have shown minimal gains in strength and lean body mass in specific populations, mainly untrained athletes and patients with wasting syndromes. HMB use in those athletes involved in regular high-intensity exercise has not been proven to be beneficial when multiple variables are evaluated. Unlike other ergogenics, with HMB no adverse events have been reported in association with short-term use. Despite these findings, HMB cannot be recommended as an ergogenic until further studies in larger groups reproduce early data. This review summarizes current literature on HMB, and provides the reader with information to better educate and treat patients and athletes.
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Affiliation(s)
- Tenley Palisin
- Department of Family and Sports Medicine, University of South Carolina, 3209 Colonial Drive, Columbia, SC 29223, USA
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Smith HJ, Mukerji P, Tisdale MJ. Attenuation of Proteasome-Induced Proteolysis in Skeletal Muscle by β-Hydroxy-β-Methylbutyrate in Cancer-Induced Muscle Loss. Cancer Res 2005. [DOI: 10.1158/0008-5472.277.65.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Loss of skeletal muscle is an important determinant of survival in patients with cancer-induced weight loss. The effect of the leucine metabolite β-hydroxy-β-methylbutyrate (HMB) on the reduction of body weight loss and protein degradation in the MAC16 model of cancer-induced weight loss has been compared with that of eicosapentaenoic acid (EPA), a recognized inhibitor of protein degradation. HMB was found to attenuate the development of weight loss at a dose greater than 0.125 g/kg accompanied by a small reduction in tumor growth rate. When EPA was used at a suboptimal dose level (0.6 g/kg) the combination with HMB seemed to enhance the anticachectic effect. Both treatments caused an increase in the wet weight of soleus muscle and a reduction in protein degradation, although there did not seem to be a synergistic effect of the combination. Proteasome activity, determined by the “chymotrypsin-like” enzyme activity, was attenuated by both HMB and EPA. Protein expression of the 20S α or β subunits was reduced by at least 50%, as were the ATPase subunits MSS1 and p42 of the 19S proteasome regulatory subunit. This was accompanied by a reduction in the expression of E214k ubiquitin-conjugating enzyme. The combination of EPA and HMB was at least as effective or more effective than either treatment alone. Attenuation of proteasome expression was reflected as a reduction in protein degradation in gastrocnemius muscle of cachectic mice treated with HMB. In addition, HMB produced a significant stimulation of protein synthesis in skeletal muscle. These results suggest that HMB preserves lean body mass and attenuates protein degradation through down-regulation of the increased expression of key regulatory components of the ubiquitin-proteasome proteolytic pathway, together with stimulation of protein synthesis.
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Affiliation(s)
- Helen J. Smith
- 1Pharmaceutical Sciences Research Institute, Aston University, Birmingham, United Kingdom and
| | - Pradip Mukerji
- 2Ross Products Division, Abbott Laboratories, Columbus, Ohio, USA
| | - Michael J. Tisdale
- 1Pharmaceutical Sciences Research Institute, Aston University, Birmingham, United Kingdom and
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