The effect of protein and essential amino acid supplementation on muscle strength and performance in patients with chronic heart failure: a systematic review

Abstract

Purpose Critically low skeletal muscle mass and strength, observed in 20% of people with chronic heart failure (CHF), reduces functional capacity, quality of life (QoL) and survival. Protein and essential amino acid (EAA) supplementation could be a viable treatment strategy to prevent declines in muscle strength and performance, and subsequently improve QoL and survival. This systematic review (PROSPERO: CRD42018103649) aimed to assess the effect of dietary protein and/or EAA supplementation on muscle strength and performance in people with CHF. Methods Searches of PubMed, MEDLINE and Embase identified studies that reported changes in strength or muscle performance following protein and/or EAA supplementation in patients with CHF. Following PRISMA guidelines and using predefined inclusion/exclusion criteria relating to participants, intervention, control, outcome and study design, two reviewers independently screened titles, abstracts and full manuscripts for eligibility. Risk of bias was assessed using Cochrane Risk of Bias Tool (RCTs) or Mixed Methods Appraisal Tool (cohort studies). Data were extracted for analysis using predefined criteria. Results Five randomised controlled trials (RCT) and one cohort study met our inclusion criteria. All RCTs had a high risk of bias. The methodological quality of the cohort study was moderate. Heterogeneity of extracted data prevented metaanalyses, qualitative synthesis was therefore performed. Data from 167 patients with CHF suggest that protein and/or EAA supplementation does not improve strength, but may increase six-minute walk test distance, muscle mass and QoL. Conclusions The limited quality of the studies makes firm conclusions difficult, however protein and/or EAA supplementation may improve important outcome measures related to sarcopenia. High-quality randomised controlled studies are needed.

Metabonomics Analysis of Myocardial Metabolic Dysfunction in Patients with Cardiac Natriuretic Peptide Resistance

“…Amino acids are either ingested or endogenously synthesized in the human body and play important physiological roles as basic metabolites and metabolic regulators. Amino acids are key substrates required for mitochondrial metabolism and are usually elevated in HF groups [ 32 , 33 ]. Glutamic acid, an amino acid, plays an important role in the creation of proteins.…”

Effects of protein supplementation on muscle wasting disorders: A brief update of the evidence

“…It was also noted that the randomised trials included in this review had a high risk of bias, and thus, more evidence is needed to elucidate the benefits of protein supplementation in heart failure patients. 62 In older adults with type 2 diabetes, previous research has shown they often experience accelerated loss in SMM and strength in comparison with age-matched, normoglycaemic controls, 63 which is related, in part, to insulin resistance impairing muscle protein synthesis. 64 Given that skeletal muscle is the largest mass of insulin-sensitive tissue and the key storage site for glucose, preserving muscle mass is important for this clinical population.…”

“…60 Another study supplementing 17 heart failure patients with l-alanyl-l-glutamine (8 g/day) and polyunsaturated fatty acid (6.5 g/day) for 3 months reported gains in lean body mass (+1.7 ± 0.3 kg) and quality of life (+13 ± 11 points) when compared to an isocaloric placebo, but no changes in hand grip or leg strength were observed. 61 A recent systematic review of 167 heart failure patients (>18 years) suggests that chronic (>4 weeks) protein and/or EAA supplementation may improve lean body mass and quality of life; 62 however, no effect on muscle strength was reported. It was also noted that the randomised trials included in this review had a high risk of bias, and thus, more evidence is needed to elucidate the benefits of protein supplementation in heart failure patients.…”

“…A recent systematic review of 167 heart failure patients (>18 years) suggests that chronic (>4 weeks) protein and/or EAA supplementation may improve lean body mass and quality of life; 62 however, no effect on muscle strength was reported. It was also noted that the randomised trials included in this review had a high risk of bias, and thus, more evidence is needed to elucidate the benefits of protein supplementation in heart failure patients 62 …”

Is branched-chain amino acid nutritional supplementation beneficial or detrimental in heart failure?

“…Nichols et al [ 19 ] performed a systematic review of the effect of amino acid supplementation in heart failure. They demonstrated that essential amino acid supplementation could improve important outcome measures related to sarcopenia.…”