Background
Protein energy wasting is associated with negative outcome in patients under chronic haemodialysis (HD). Branchedâchain amino acids (BCAAs) may increase the muscle mass. This post hoc analysis of a controlled doubleâblind randomized crossover study assessed the impact of BCAAs on nutritional status, physical function, and quality of life.
Methods
We included 36 chronic HD patient features of protein energy wasting as plasma albumin <38Â g/L, and dietary intakes <30Â kcal/kg/day and <1Â g protein/kg/day. Patients received either oral BCAA (2Â ĂÂ 7Â g/day) or glycine (2Â ĂÂ 7Â g/day) for 4Â months (Period 1), followed by a washout period of 1Â month, and then received the opposite supplement (Period 2). The outcomes were lean body mass measured by dualâenergy Xâray absorptiometry, fatâfree mass index measured by bioelectrical impedance, resting energy expenditure, dietary intake and appetite rating, physical activity and function, quality of life, and blood parameters. Analyses were performed by multiple mixed linear regressions including type of supplementation, months, period, sex, and age as fixed effects and subjects as random intercepts.
Results
Twentyâseven patients (61.2 ± 13.7 years, 41% women) were compliant to the supplementations (consumption >80% of packs) and completed the study. BCAA did not affect lean body mass index and body weight, but significantly decreased fatâfree mass index, as compared with glycine (coeff â0.27, 95% confidence interval â0.43 to â0.10, P = 0.002, respectively). BCAA and glycine intake had no effect on the other clinical parameters, blood chemistry tests, or plasma amino acids.
Conclusions
Branchedâchain amino acid did not improve lean body mass as compared with glycine. Unexpectedly, glycine improved fatâfree mass index in HD patients, as compared with BCAA. Whether longâterm supplementation with glycine improves the clinical outcome remains to be demonstrated.