EFFECTS OF BRANCHED AMINO ACIDS SUPPLEMENTATION IN MALNOURISHED ELDERLY WITH CATABOLIC STATUS

Background: Among various nutrients branched amino acids (BCAAS) have been shown to be the most responsible for the stimulation of protein synthesis in various situations including catabolic states. Objectives: We evaluated the effect of a small amount of proteins enriched with BCAAs (0.4g/kg/day and 0.2g/kg/day BCAAs) on body weight and composition; nitrogen balance, energy intake and inflammation after 2 weeks of supplementation in acute elderly with catabolic status. Design: Two weeks randomized controlled trial. Setting: Geriatric department of teaching hospital. Subjects: Thirty patients with malnutrition and inflammatory process (MNA < 24, albumin < 30 g/l and CRP ≥ 20 mg/l) who agreed to participate in the study were consecutively included. Methods: Body composition was determined by labelled water dilution method; resting energy expenditure (REE) was determined by indirect calorimetry; energy intake was calculated for a 3 days period at D1 and D12. Nutritional and inflammatory proteins and cytokines (IL-6 and TNF) were measured at day 1 and 14. Results: No difference was observed at day 14 between supplemented (S) and control (C) group for weight (S: 58.0 ± 11.8 kg and C: 60.0 ± 15.9 kg); fat free mass (S: 40.7 ± 8.3 kg and C: 40 ± 8.2 kg); nitrogen balance (S: 1.34 ± 2.21 g/day and C: 0.59 ± 4.47 g/day); and energy intake (S: 20 ± 3.6 kcal/day and C: 20.5 ± 8.6 kcal/day). Energy intake was at similar level than REE and clearly less than energy requirement in C and S. A significant decrease was observed for orosomucoid and Prognostic Inflammatory and Nutritional Index (PINI) in S. Conclusion: Our results do not confirm improvement of nutritional status with enriched BCAAs supplementation as suggested in the literature. Persistence of inflammatory condition may be an explanation despite an improvement of inflammatory status was observed in the supplemented group. Those results show clearly that energy requirements are not covered in acute hospitalized elderly people. The fact that not only energy intake but also REE are decreased brings a new insight on catabolic situations