Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial
Abstract Background A defining feature of prolonged critical illness is muscle wasting, leading to impaired recovery. Supplementation with a tailored blend of amino acids may bolster the innate gut defence, promote intestinal mucosa repair and limit muscle loss. Methods This was a monocentric, rando...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-022-04232-5 |
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| author | Nicholas Heming Robert Carlier Helene Prigent Ahmed Mekki Camille Jousset Frederic Lofaso Xavier Ambrosi Rania Bounab Virginie Maxime Arnaud Mansart Pascal Crenn Pierre Moine Fabien Foltzer Bernard Cuenoud Tobias Konz John Corthesy Maurice Beaumont Mickaël Hartweg Claudia Roessle Jean-Charles Preiser Denis Breuillé Djillali Annane |
| author_facet | Nicholas Heming Robert Carlier Helene Prigent Ahmed Mekki Camille Jousset Frederic Lofaso Xavier Ambrosi Rania Bounab Virginie Maxime Arnaud Mansart Pascal Crenn Pierre Moine Fabien Foltzer Bernard Cuenoud Tobias Konz John Corthesy Maurice Beaumont Mickaël Hartweg Claudia Roessle Jean-Charles Preiser Denis Breuillé Djillali Annane |
| author_sort | Nicholas Heming |
| collection | DOAJ |
| description | Abstract Background A defining feature of prolonged critical illness is muscle wasting, leading to impaired recovery. Supplementation with a tailored blend of amino acids may bolster the innate gut defence, promote intestinal mucosa repair and limit muscle loss. Methods This was a monocentric, randomized, double-blind, placebo-controlled study that included patients with sepsis or acute respiratory distress syndrome. Patients received a specific combination of five amino acids or placebo mixed with enteral feeding for 21 days. Markers of renal function, gut barrier structure and functionality were collected at baseline and 1, 2, 3 and 8 weeks after randomization. Muscle structure and function were assessed through MRI measurements of the anterior quadriceps volume and by twitch airway pressure. Data were compared between groups relative to the baseline. Results Thirty-five critically ill patients were randomized. The amino acid blend did not impair urine output, blood creatinine levels or creatinine clearance. Plasma citrulline levels increased significantly along the treatment period in the amino acid group (difference in means [95% CI] 5.86 [1.72; 10.00] nmol/mL P = 0.007). Alanine aminotransferase and alkaline phosphatase concentrations were lower in the amino acid group than in the placebo group at one week (ratio of means 0.5 [0.29; 0.86] (P = 0.015) and 0.73 [0.57; 0.94] (P = 0.015), respectively). Twitch airway pressure and volume of the anterior quadriceps were greater in the amino acid group than in the placebo group 3 weeks after randomization (difference in means 10.6 [0.99; 20.20] cmH20 (P = 0.035) and 3.12 [0.5; 5.73] cm3/kg (P = 0.022), respectively). Conclusions Amino acid supplementation increased plasma citrulline levels, reduced alanine aminotransferase and alkaline phosphatase levels, and improved twitch airway pressure and anterior quadriceps volume. Trial registration ClinicalTrials.gov, NCT02968836. Registered November 21, 2016. |
| first_indexed | 2024-04-13T09:38:54Z |
| format | Article |
| id | doaj.art-60d1a1313e5f4b1db84d5a7ef95c2a4c |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-13T09:38:54Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-60d1a1313e5f4b1db84d5a7ef95c2a4c2022-12-22T02:52:01ZengBMCCritical Care1364-85352022-11-0126111410.1186/s13054-022-04232-5Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trialNicholas Heming0Robert Carlier1Helene Prigent2Ahmed Mekki3Camille Jousset4Frederic Lofaso5Xavier Ambrosi6Rania Bounab7Virginie Maxime8Arnaud Mansart9Pascal Crenn10Pierre Moine11Fabien Foltzer12Bernard Cuenoud13Tobias Konz14John Corthesy15Maurice Beaumont16Mickaël Hartweg17Claudia Roessle18Jean-Charles Preiser19Denis Breuillé20Djillali Annane21General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris SaclayDepartment of Radiology, APHP, DMU Smart Imaging, GH Université Paris-Saclay, Hôpital Raymond PoincaréDepartment of Physiology-AP-HP, Hôpital Raymond-PoincaréDepartment of Radiology, APHP, DMU Smart Imaging, GH Université Paris-Saclay, Hôpital Raymond PoincaréDepartment of Radiology, APHP, DMU Smart Imaging, GH Université Paris-Saclay, Hôpital Raymond PoincaréDepartment of Physiology-AP-HP, Hôpital Raymond-PoincaréGeneral Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris SaclayGeneral Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris SaclayGeneral Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris SaclayLaboratory of Infection and Inflammation - U1173, School of Medicine Simone Veil, INSERM, University Versailles Saint Quentin - University Paris SaclayUFR des Sciences de la Santé Simone-Veil, Université de Versailles Saint-Quentin-en-YvelinesGeneral Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris SaclayNestlé Research, Société de Produits de NestléTranslation Research, Nestlé Health ScienceNestlé Research, Société de Produits de NestléNestlé Research, Société de Produits de NestléNestlé Research, Société de Produits de NestléNestlé Research, Société de Produits de NestléTranslation Research, Nestlé Health ScienceNutrition Team, Erasme University Hospital, Université Libre de BruxellesNestlé Research, Société de Produits de NestléGeneral Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris SaclayAbstract Background A defining feature of prolonged critical illness is muscle wasting, leading to impaired recovery. Supplementation with a tailored blend of amino acids may bolster the innate gut defence, promote intestinal mucosa repair and limit muscle loss. Methods This was a monocentric, randomized, double-blind, placebo-controlled study that included patients with sepsis or acute respiratory distress syndrome. Patients received a specific combination of five amino acids or placebo mixed with enteral feeding for 21 days. Markers of renal function, gut barrier structure and functionality were collected at baseline and 1, 2, 3 and 8 weeks after randomization. Muscle structure and function were assessed through MRI measurements of the anterior quadriceps volume and by twitch airway pressure. Data were compared between groups relative to the baseline. Results Thirty-five critically ill patients were randomized. The amino acid blend did not impair urine output, blood creatinine levels or creatinine clearance. Plasma citrulline levels increased significantly along the treatment period in the amino acid group (difference in means [95% CI] 5.86 [1.72; 10.00] nmol/mL P = 0.007). Alanine aminotransferase and alkaline phosphatase concentrations were lower in the amino acid group than in the placebo group at one week (ratio of means 0.5 [0.29; 0.86] (P = 0.015) and 0.73 [0.57; 0.94] (P = 0.015), respectively). Twitch airway pressure and volume of the anterior quadriceps were greater in the amino acid group than in the placebo group 3 weeks after randomization (difference in means 10.6 [0.99; 20.20] cmH20 (P = 0.035) and 3.12 [0.5; 5.73] cm3/kg (P = 0.022), respectively). Conclusions Amino acid supplementation increased plasma citrulline levels, reduced alanine aminotransferase and alkaline phosphatase levels, and improved twitch airway pressure and anterior quadriceps volume. Trial registration ClinicalTrials.gov, NCT02968836. Registered November 21, 2016.https://doi.org/10.1186/s13054-022-04232-5SepsisCritical illnessProtein balanceIntensive care unitNutrition |
| spellingShingle | Nicholas Heming Robert Carlier Helene Prigent Ahmed Mekki Camille Jousset Frederic Lofaso Xavier Ambrosi Rania Bounab Virginie Maxime Arnaud Mansart Pascal Crenn Pierre Moine Fabien Foltzer Bernard Cuenoud Tobias Konz John Corthesy Maurice Beaumont Mickaël Hartweg Claudia Roessle Jean-Charles Preiser Denis Breuillé Djillali Annane Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial Critical Care Sepsis Critical illness Protein balance Intensive care unit Nutrition |
| title | Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial |
| title_full | Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial |
| title_fullStr | Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial |
| title_full_unstemmed | Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial |
| title_short | Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial |
| title_sort | effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients a proof of concept randomized controlled trial |
| topic | Sepsis Critical illness Protein balance Intensive care unit Nutrition |
| url | https://doi.org/10.1186/s13054-022-04232-5 |
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