Impact of protein pulse feeding on lean mass in malnourished and at-risk hospitalized elderly patients: A randomized controlled trial
Impact of protein pulse feeding on lean mass in malnourished and at-risk hospitalized elderly patients: A randomized controlled trial
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DOI：
10.1016/j.clnu.2012.08.015
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发表时间：
2013-04-01
影响因子：
6.3
通讯作者：
Aussel, Christian
中科院分区：
文献类型：
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作者：
Bouillanne, Olivier;Curis, Emmanuel;Aussel, Christian
背景与目的：衰老与食物摄入引起的合成代谢反应迟钝有关，可能与系统可利用氨基酸(AAs)减少有关，后者可能源于内脏AA代谢增加。这种内脏隔离可以通过脉冲喂养(一顿饭中每日蛋白质摄入量的80%)达到饱和，从而增加蛋白质合成。本研究旨在评价一种名为蛋白质脉冲喂养的新营养策略的有效性。方法：这项前瞻性随机研究(ClinicalTrials.gov注册编号为NCT00135590)纳入了住院康复病房的66名老年营养不良或高危患者。所有受试者均接受为期6周的控制饮食。在分散饮食(SD)组(n=36)，饮食蛋白质分布在每天的四餐中。在脉冲饮食(PD)组(n=30)，中午一餐消耗了72%的膳食蛋白质(平均1.31g/kg体重/d)。在入院时和6周时对患者的身体组成[瘦体重(LM)、附件骨骼肌质量(ASMM)和身体细胞质量(BCM)指数，通过X射线吸收计量法结合生物电阻抗分析测量](主要结果)、握力和日常生活能力(ADL)评分进行评估。结果：蛋白质脉冲喂养在改善LM指数方面明显优于蛋白质分散喂养(PD组平均变化：较基线变化：+0.38 kg/m(2)；95%可信区间(CI)，[0；0.60]；对于SD组：-0.21 kg/m(2)；95%CI，[两组间[-0.61；0.20]；P=0.005)；ASMM指数(+0.21 kg/m(2)；95%CI，[0；0.34]和-0.11 kg/m(2)；95%CI，[-0.20；0.09]；p=0.022)，BCM指数(+0.44 kg/m(2)；95%CI，[0.08；和-0.04 kg/m(2)；95%可信区间[-0.09；0.10]；p=0.004)。结论：本研究首次证实蛋白质脉冲喂养对营养不良和高危住院老年患者的瘦体重有积极的临床意义。(C)2012年爱思唯尔有限公司和欧洲临床营养与代谢学会。版权所有。
Background & aims: Aging is associated with a blunted anabolic response to dietary intake, possibly related to a decrease in systemically available amino acids (AAs), which in turn may stem from increased splanchnic AA metabolism. This splanchnic sequestration can be saturated by pulse feeding (80% of daily protein intake in a single meal), enabling increased protein synthesis. This study aimed to evaluate the efficacy of a new nutritional strategy, termed protein pulse feeding.Methods: This prospective randomized study (ClinicalTrials.gov registration number NCT00135590) enrolled 66 elderly malnourished or at-risk patients in an inpatient rehabilitation unit. All were given a controlled diet for 6 weeks. In a spread diet (SD) group (n = 36), dietary protein was spread over the four daily meals. In a pulse diet (PD) group (n = 30), 72% of dietary protein (1.31 g/kg weight/d on average) was consumed in one meal at noon. The patients were evaluated at admission and at 6 weeks for body composition [lean mass (LM), appendicular skeletal muscle mass (ASMM), and body cell mass (BCM) indices, measured by X-ray absorptiometry combined with bioelectrical impedance analysis] (primary outcome), hand grip strength, and activities of daily living (ADL) score.Results: Protein pulse feeding was significantly more efficacious than protein spread feeding in improving LM index (mean changes from baseline for PD group: +0.38 kg/m(2); 95% confidence interval (CI), [0; 0.60]; for SD group: -0.21 kg/m(2); 95% CI, [-0.61; 0.20]; p = 0.005 between the two groups), ASMM index (+0.21 kg/m(2); 95% CI, [0; 0.34] and -0.11 kg/m(2); 95% CI, [-0.20; 0.09]; p = 0.022), BCM index (+0.44 kg/m(2); 95% CI, [0.08; 0.52] and -0.04 kg/m(2); 95% CI, [-0.09; 0.10]; p = 0.004). There was no significant effect for hand-grip strength or ADL score.Conclusions: This study demonstrates for the first time that protein pulse feeding has a positive, clinically relevant effect on lean mass in malnourished and at-risk hospitalized elderly patients. (C) 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.