© 2008 European Society of Cardiology
Adequate energy-protein intake is not enough to improve nutritional and metabolic status in muscle-depleted patients with chronic heart failure
a Servizio di Fisiopatologia Metabolico-Nutrizionale e Nutrizione Clinica, Fondazione S. Maugeri, IRCCS, Istituto Scientifico di Montescano Montescano-Pavia, Italy
b Divisione di Cardiologia, Fondazione S. Maugeri, IRCCS, Istituto Scientifico di Pavia Italy
c Dipartimento di Scienze Fisio-Farmacologiche, Sezione di Farmacologia, Università degli Studi di Pavia Pavia, Italy
d Centro Riabilitativo "E. Spalenza, Fondazione Don Gnocchi" Rovato (BS), Italy
e Divisione di Cardiologia. Fondazione S. Maugeri, IRCCS, Istituto Scientifico di Lumezzane Brescia, Italy
f Dipartimento di Biochimica "A.Castellani", Università degli Studi di Pavia Italy
g Dipartimento di Farmacologica Sperimentale ed Applicata, Università degli Studi di Pavia Pavia, Italy
* Corresponding author. Dipartimento di Scienze Fisiologiche-Farmacologiche Cellulari-Molecolari, Sezione di Farmacologia e Biotecnologie Farmacologiche, Facoltà di Scienze MM.FF.NN. Università degli Studi di Pavia, Piazza Botta, 11, 27100 Pavia, Italy. Tel.: +39 0382 986423; fax: +39 0382 986385. E-mail address: labmio{at}unipv.it (O. Pastoris)
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Abstract |
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Background: An adequate energy-protein intake (EPI) when combined with amino acid supplementation may have a positive impact nutritional and metabolic status in patients with chronic heart failure (CHF).
Methods and results: Thirty eight stable CHF patients (27 males, 73.5±4 years; BMI 22.5±1.4 kg/m2), with severe depletion of muscle mass and were randomised to oral supplements of essential amino acids 8 g/day (EAA group; n=21) or no supplements (controls; n=17). patients had adequate EPI (energy 
30 kcal/kg; proteins >1.1 g/kg). At baseline and 2-months after randomisation, the patients underwent metabolic (plasma lactate, pyruvate concentration; serum insulin level; estimate of insulin resistance by HOMA index), nutritional (measure of nitrogen balance), and functional (exercise test, walking test) evaluations.
Body weight increased by >1 kg in 80% of supplemented patients (mean 2.96 kg) and in 30% of controls (mean 2.3 kg) (interaction <0.05). Changes in arm muscle area, nitrogen balance, and HOMA index were similar between the two treatment groups.
Plasma lactate and pyruvate levels increased in controls (p<0.01 for both) but decreased in the supplemented group (p<0.01 and 0.02 respectively). EAA supplemented patients but not controls improved both exercise output and peak oxygen consumption and walking test.
Conclusions: Adequate EPI when combined with essential amino acid supplementation may improve nutritional and metabolic status in most muscle-depleted CHF patients.
Key Words: Energy-protein intake • Essential amino acids • Chronic heart failure
Received February 4, 2008; Revised May 30, 2008; Accepted September 8, 2008
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