Supplementation of Essential Amino Acids May Reduce the Occurrence of Infections in Rehabilitation Patients With Brain Injury

Boselli, Mirella; Aquilani, Roberto; Baiardi, Paola; Dioguardi, Francesco Saverio; Guarnaschelli, C.; Achilli, M; Arrigoni, N.; Iadarola, Paolo; Verri, Manuela; Viglio, Simona; Barbieri, Annalisa; Boschi, Federica

doi:10.1177/0884533611431068

Cited by 25 publications

(22 citation statements)

References 68 publications

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“…The lower infection rate that occurred in EAA compared to placebo patients confirms the findings of our previous studies [35,54] and may be due to the fact that EAAs play an important role in improving immunological defences by inducing protein synthesis of immune cells [35]. The proimmunologic EAA activity may explain why infection did not preclude the improvements of Alb and Hb over time.…”

Section: Discussionsupporting

confidence: 84%

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Despite Inflammation, Supplemented Essential Amino Acids May Improve Circulating Levels of Albumin and Haemoglobin in Patients after Hip Fractures

Aquilani

Zuccarelli²,

Condino

et al. 2017

Nutrients

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Essential amino acids (EAAs) are nutritional substrates that promote body protein synthesis; thus we hypothesised that their supplementation may improve circulating albumin (Alb) and haemoglobin (Hb) in rehabilitative elderly patients following hip fractures (HF). Out of the 145 HF patients originally enrolled in our study, 112 completed the protocol. These subjects were divided into two randomised groups, each containing 56 patients. For a period of two months, one group (age 81.4 ± 8.1 years; male/female 27/29) received a placebo, and the other (age 83.1 ± 7.5 years; male/female 25/31) received 4 + 4 g/day oral EAAs. At admission, the prevalence of both hypoAlb (<3.5 g/dL) and hypoHb (<13 g/dL male, <12 g/dL female) was similar in the placebo group (64.3% hypoAlb, 66% hypoHb) and the treated group of patients (73.2% hypoAlb, 67.8% hypoHb). At discharge, however, the prevalence of hypoAlb had reduced more in EAAs than in placebo subjects (31.7% in EAAs vs. 77.8% in placebo; p < 0.001). There was a 34.2% reduction of anaemia in hypoHb in EAA subjects and 18.9% in placebo subjects, but the difference was not statistically significant. Oral supplementation of EAAs improves hypoAlb and, to a lesser extent, Hb in elderly rehabilitative subjects with hip fractures. Anaemia was reduced in more than one third of patients, which, despite not being statistically significant, may be clinically relevant.

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Section: Discussionsupporting

confidence: 84%

“…Indeed, in the liver, tryptophan stimulates the ribosomal re-aggregation leading to enhanced Alb production in a fasting state or in conditions of inadequate protein intake [54]. It is unlikely that diet played a role in improving Alb, given that nutritional intake was similar at admission to and discharge from our institute.…”

Section: Discussionmentioning

confidence: 99%

Despite Inflammation, Supplemented Essential Amino Acids May Improve Circulating Levels of Albumin and Haemoglobin in Patients after Hip Fractures

Aquilani

Zuccarelli²,

Condino

et al. 2017

Nutrients

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“…Reduced protein intake leading to low blood EAA levels can contribute to a dramatic increase of MH. The amount of supplemented EAAs (8 g/d) is insufficient to enhance brain function recovery, given that the neurofunctional recovery was similar between both groups confirming the finding of a previous study [90]. …”

Section: Discussionsupporting

confidence: 85%

“…In addition, maltodextrin and EAAs share common immunological activity [87–89]. On the other hand, infection complications frequently follow acute strokes [90]. …”

Section: Discussionmentioning

confidence: 99%

Unaffected Arm Muscle Hypercatabolism in Dysphagic Subacute Stroke Patients: The Effects of Essential Amino Acid Supplementation

Aquilani¹,

Boselli²,

D’Antona

et al. 2014

BioMed Research International

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Alterations in muscle protein turnover of the unaffected side of stroke patients could contribute to physical disability. We investigated whether hypercatabolic activity occurred in unaffected arm muscle and whether supplemented essential amino acids (EAAs) could limit muscle hypercatabolism (MH). Thirty-eight dysphagic subacute stroke subjects (<3 months after acute event) (29 males + 9 females; 69.7 ± 11.4 yrs) were enrolled and randomized to receive 8 g/day EAAs (n = 19; EAA group) or isocaloric placebo (maltodextrin; n = 19, Plac group). Before randomization, all patients had their arterial (A) and venous (V) amino acids measured and muscle (A − V) differences calculated in the unaffected arm. Eight matched and healthy subjects served as controls. When compared to healthy controls, the entire stroke population showed significant muscle release (= negative value A − V) of the amino acid phenylalanine (phenyl-) indicating a prevalence of MH. Moreover, randomized EAA and Plac groups had similar rates of MH. After 38 days from the start of the protocol, the EAA group but not the Plac group had MH converted to balanced protein turnover or anabolic activity. We concluded that muscle protein metabolism of the unaffected arm of dysphagic subacute stroke individuals could be characterized by MH which can be corrected by supplemented EAAs.

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“…Twelve weeks of EAA supplementation was able to improve muscle mass and function in healthy young (38) and older adults (39), and in glucose-intolerant subjects (36). Patients with severe COPD were able to improve the daily-life performance, quality of life, nutritional and cognitive status, and muscle strength after chronic EAA intervention (40), and rehabilitation patients with brain injury reduced the occurrence of nosocomial infections (41). Although dietary EAA are very effective in inducing protein anabolism in CF, incorporation of free EAA mixtures in long term nutritional care in CF is challenging due to the bad taste of free amino acids.…”

Section: Introductionmentioning

confidence: 99%

Protein is an important but undervalued macronutrient in the nutritional care of patients with cystic fibrosis

Engelen

Com

Deutz

2014

Current Opinion in Clinical Nutrition and Metabolic Care

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Purpose of review Achieving an optimal nutritional status in patients with Cystic Fibrosis (CF) is important to maintain better pulmonary function, physical performance and to prolong survival. So far nutrition care in CF has mainly focused on fat intake and achieving energy balance but there is increasing information on the clinical importance of muscle maintenance and protein intake in CF. Recent findings Low muscle mass is consistently associated with pulmonary decline, bone mineral loss and poor survival in CF. High energy and fat intake contributes to an increased prevalence of overweight and obesity in CF. Obesity per se is not related to better lung function in CF, and has negative metabolic and clinical consequences particularly when muscle wasting is present. Protein digestion capacity is severely impaired in CF but high protein intake is needed and essential amino acid mixtures appear highly anabolic even in those with severe muscle loss. Summary Body composition assessment and achieving protein balance in the routine care in CF is important to prevent muscle loss and further improve clinical and overall outcome of these patients. New approaches are needed to optimize the interaction between high essential amino acid rich protein intake and pancreatic enzyme regimen in CF. The optimal level of protein intake needs to be assessed in clinically stable CF patients as well as those recovering from an acute exacerbation.

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Supplementation of Essential Amino Acids May Reduce the Occurrence of Infections in Rehabilitation Patients With Brain Injury

Abstract: Supplementary EAAs may reduce the occurrence of nosocomial infections in rehabilitation patients with BI. Prealbumin and CRP are the best predictors of future infections.

Cited by 25 publications

References 68 publications

Despite Inflammation, Supplemented Essential Amino Acids May Improve Circulating Levels of Albumin and Haemoglobin in Patients after Hip Fractures

Despite Inflammation, Supplemented Essential Amino Acids May Improve Circulating Levels of Albumin and Haemoglobin in Patients after Hip Fractures

Unaffected Arm Muscle Hypercatabolism in Dysphagic Subacute Stroke Patients: The Effects of Essential Amino Acid Supplementation

Protein is an important but undervalued macronutrient in the nutritional care of patients with cystic fibrosis

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