Supplementation of l-Alanyl-l-Glutamine and Fish Oil Improves Body Composition and Quality of Life in Patients With Chronic Heart Failure.
Supplementation of l-Alanyl-l-Glutamine and Fish Oil Improves Body Composition and Quality of Life in Patients With Chronic Heart Failure.
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DOI：
10.1161/circheartfailure.115.002073
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发表时间：
2015-11
期刊：
影响因子：
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通讯作者：
Schulze PC
中科院分区：
文献类型：
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作者：
Wu C;Kato TS;Ji R;Zizola C;Brunjes DL;Deng Y;Akashi H;Armstrong HF;Kennel PJ;Thomas T;Forman DE;Hall J;Chokshi A;Bartels MN;Mancini D;Seres D;Schulze PC
骨骼肌功能障碍和运动不耐受是心力衰竭（HF）患者的临床特征。这些与渐进性分解代谢状态、骨骼肌炎症和氧化代谢受损有关。先前的研究表明ω-3多不饱和脂肪酸（PUFA）和谷氨酰胺对运动表现和肌肉蛋白质平衡的有益作用。在一项随机、双盲、安慰剂对照试验中，31例HF患者随机接受L-丙氨酰-L-谷氨酰胺（8 g/d）和PUFA（6.5 g/d）或安慰剂（红花油和奶粉）治疗3个月。在基线和随访时进行心脏运动试验、双能X线吸收测定法、6分钟步行试验、握力、功能性肌肉试验、超声心动图和生活质量以及股四头肌外侧活检。在肌肉活检中分析了氧化能力和代谢基因表达。治疗组的肌肉功能、超声心动图、6分钟步行试验或握力无差异，峰值VO 2无显著性增加。活性治疗组的瘦体重增加，生活质量改善。分子生物学分析显示，肌纤维组成、纤维横截面积、代谢标志基因（PGC-1α、CPT 1、PDK 4、GLUT 4）的基因表达和骨骼肌氧化能力无差异。联合补充L-丙氨酰-L-谷氨酰胺和多不饱和脂肪酸并不能改善慢性稳定型心力衰竭患者的运动表现或肌肉功能，但能增加瘦体重和生活质量。这些发现表明高剂量营养PUFA和氨基酸替代物在慢性稳定型HF患者中具有潜在的有益作用。URL：http://www.clinicaltrials.gov。唯一标识符：NCT 01534663。
Skeletal muscle dysfunction and exercise intolerance are clinical hallmarks of patients with heart failure (HF). These have been linked to a progressive catabolic state, skeletal muscle inflammation and impaired oxidative metabolism. Prior studies suggest beneficial effects of ω-3 polyunsaturated fatty acids (PUFAs) and glutamine on exercise performance and muscle protein balance. In a randomized double-blind, placebo-controlled trial, 31 HF patients were randomized to either L-alanyl-L-glutamine (8g/d) and PUFA (6.5g/d) or placebo (safflower oil and milk powder) for 3 months. Cardiopulmonary exercise testing, dual-energy X-ray absorptiometry, 6 minute walk test, hand grip strength, functional muscle testing, echocardiography and quality of life and lateral quadriceps muscle biopsy were performed at baseline and at follow-up. Oxidative capacity and metabolic gene expression were analyzed on muscle biopsies. No differences in muscle function, echocardiography, 6 minute walk test or hand grip strength and a non-significant increase in peak VO2 in the treatment group were found. Lean body mass increased and quality-of-life improved in the active treatment group. Molecular analysis revealed no differences in muscle fiber composition, fiber cross sectional area, gene expression of metabolic marker genes (PGC-1α, CPT1, PDK4, GLUT4) and skeletal muscle oxidative capacity. The combined supplementation of L-alanyl-L-glutamine and PUFA did not improve exercise performance or muscle function but increased lean body mass and quality-of-life in patients with chronic stable HF. These findings suggest potentially beneficial effects of high dose nutritional PUFAs and amino acid supplementations in patients with chronic stable HF. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01534663.