Dietary treatment of rheumatoid cachexia with beta-hydroxy-beta-methylbutyrate, glutamine and arginine: a randomised controlled trial.

Abstract

BACKGROUND & AIMS:

Rheumatoid arthritis (RA) is complicated by cytokine-driven alterations in protein and energy metabolism and consequent muscle wasting (cachexia). The aim of this randomised controlled trial was to investigate the efficacy of a mixture of beta-hydroxy-beta-methylbutyrate, glutamine and arginine (HMB/GLN/ARG) as nutritional treatment for rheumatoid cachexia.

METHODS:

Forty RA patients supplemented their diet with either HMB/GLN/ARG or a nitrogen (7.19 g/day) and calorie (180 kcal/day) balanced mixture of alanine, glutamic acid, glycine, and serine (placebo) for 12 weeks. Body composition and other outcomes were assessed at baseline and follow-up, and analysed by mixed ANOVA.

RESULTS:

Dietary supplementation with HMB/GLN/ARG was not superior to placebo in the treatment of rheumatoid cachexia (groupxtime interactions P>0.05 for all outcomes). Both amino acid mixtures significantly increased (main effect of time) fat-free mass (727+/-1186 g, P<0.01), total body protein (719+/-1703 g, P=0.02), arms (112+/-183 g, P<0.01) and legs (283+/-534 g, P<0.01) lean mass, and some measures of physical function. No significant adverse event occurred during the study, but patients in the HMB/GLN/ARG group reported fewer gastrointestinal complaints compared to placebo.

CONCLUSIONS:

Dietary supplementation with HMB/GLN/ARG is better tolerated but not more effective in reversing cachexia in RA patients compared to the mixture of other non-essential amino acids used as placebo. Further controlled studies are necessary to confirm the beneficial anabolic and functional effects of increased nitrogen intake in this population.

• Authors: Samuele Marcora, Andrew Lemmey, Peter Maddison
• Journal: Clinical nutrition (Edinburgh, Scotland) (Clin Nutr) Vol. 24 Issue 3 Pg. 442-54 (Jun 2005) ISSN: 0261-5614 [Print] England
• PMID: 15896432 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Valerates
• Glutamine
• beta-hydroxyisovaleric acid
• Arginine

Topics

• Arginine (administration & dosage)
• Arthritis, Rheumatoid (complications, metabolism, psychology)
• Body Composition (physiology)
• Body Mass Index
• Cachexia (diet therapy, etiology, psychology)
• Dietary Supplements
• Double-Blind Method
• Female
• Glutamine (administration & dosage)
• Hand Strength (physiology)
• Humans
• Male
• Middle Aged
• Surveys and Questionnaires
• Valerates (administration & dosage)