Abstract | BACKGROUND: Negative nitrogen balance and skeletal muscle loss are common in critically injured patients and may contribute to morbidity, mortality and resource utilization. Juven, an enteral supplement which is a combination of beta-hydroxy-beta-methylbutyrate (HMB), arginine (ARG), and glutamine (GLN) has been shown to restore muscle in cachetic acquired immunodeficiency syndrome ( AIDS) and cancer patients. More recently HMB has been shown to attenuate cancer-induced muscle loss by decreasing muscle proteolysis. The purpose of this study was to analyze whether HMB alone or in combination with ARG and GLN would have a similar effect on critically injured trauma patients. We hypothesized that nitrogen balance would be improved and muscle proteolysis decreased with HMB and HMB/ ARG/GLN supplementation. METHODS: There were 100 adult trauma patients with Injury Severity Score (ISS) >18 were enrolled in this prospective, randomized, blinded study. All patients received standard tube feeds and one of three iso-nitrogenous supplements; HMB, HMB/ ARG/ GLN, or placebo ( PLAC) for 28 days. Urine, serum, and clinical data were collected for 72 patients receiving at least 7 days of supplementation during the first 14 days of treatment. Urinary 3-methylhistidine (3-MH) was used as a proxy for muscle proteolysis. RESULTS: The three groups were similar in age, gender, mechanism, and severity of injury, with the average ISS being 31.9. Utilizing covariant (ISS) repeated measure (days 1-14) mixed model (SAS) analysis, there was a significant treatment effect (p = 0.05) on nitrogen balance (g/d). Change in nitrogen balance from the first 7 days to the last 7 days was -4.3 for the HMB and -5.6 g/d HMB/ ARG/GLN groups compared with -8.9 g/d for the PLAC group. 3-MH to creatinine ratios were not different in the PLAC group as compared with the HMB/ ARG/GLN and HMB groups (Treatment Effect, p = 0.80). CONCLUSIONS: These data suggest that supplementation with HMB alone may improve nitrogen balance in critically injured adult patients and that this effect is not a result of lowered muscle protein turnover as originally hypothesized.
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Authors | Deborah A Kuhls, John A Rathmacher, M Diana Musngi, Donald A Frisch, Jeremiah Nielson, Annabel Barber, Allan D MacIntyre, Jay E Coates, John J Fildes |
Journal | The Journal of trauma
(J Trauma)
Vol. 62
Issue 1
Pg. 125-31; discussion 131-2
(Jan 2007)
ISSN: 0022-5282 [Print] United States |
PMID | 17215743
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Biomarkers
- Methylhistidines
- Glutamine
- Arginine
- 3-methylhistidine
- Nitrogen
- 3-Hydroxybutyric Acid
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Topics |
- 3-Hydroxybutyric Acid
(therapeutic use)
- Adult
- Arginine
(therapeutic use)
- Biomarkers
(metabolism)
- Enteral Nutrition
- Female
- Glutamine
(therapeutic use)
- Humans
- Male
- Methylhistidines
(metabolism)
- Muscle, Skeletal
(metabolism)
- Muscular Atrophy
(prevention & control)
- Nitrogen
(metabolism)
- Survival Analysis
- Systemic Inflammatory Response Syndrome
(prevention & control)
- Wounds and Injuries
(therapy)
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