Effects of preoperative beta-hydroxy-beta-methylbutyrate, arginine, and glutamine supplementation on cardiac surgery: A randomized controlled trial

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS Clinical nutrition Pub Date : 2025-02-01 Epub Date: 2024-12-31 DOI:10.1016/j.clnu.2024.12.030

Masato Ogawa , Seimi Satomi-Kobayashi , Naofumi Yoshida , Kodai Komaki , Takumi Hirabayashi , Kumiko Wakida , Saori Saitoh , Takeshi Inoue , Tomoya Yamashita , Yoshitada Sakai , Michiko Takahashi , Kenji Okada , Ken-ichi Hirata

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Abstract

Background & aims

In older patients undergoing cardiac surgery, physical function is a critical determinant of postoperative outcomes. Beta-hydroxy−beta-methylbutyrate (HMB) supplementation has been shown to promote muscle protein anabolism and inhibit catabolism, thereby preventing muscle weakness. However, its efficacy in older patients undergoing cardiac surgery remains unknown. This study aimed to examine the effects of preoperative HMB supplementation on postoperative physical function and complications in this population.

Methods

In this single-center, open-label, randomized controlled trial, patients aged ≥65 years scheduled for cardiac surgery were randomized to receive HMB supplementation or no nutritional intervention. The HMB group received HMB 1200 mg, l-glutamine 7000 mg, and l-arginine 7000 mg, once or twice daily, for at least 2 weeks before surgery. Evaluations were performed at baseline and before and after surgery. The primary outcome was the 6-min walking distance (6MWD) before and after surgery. Secondary outcomes included the incidence of complications, muscle mass and strength, physical performance, and length of hospital stay.

Results

Forty-four patients with a mean age of 72.5 years (women, 38 %) were randomized to the HMB (n = 22) or control (n = 22) group. Compared with the control group, the HMB group demonstrated a statistically significant improvement in the 6MWD both at the pre-surgery (448.0 ± 73.5 m vs. 375.5 ± 58.8 m; P = 0.01) and post-surgery time points (428.9 ± 76.4 m vs. 304.5 ± 52.3 m; P = 0.001). Muscle strength and physical performance also showed significant improvements in the HMB group. However, no significant difference in muscle mass was observed between the groups at any time point. The HMB group had a shorter hospital length of stay compared with that of the control group (16.1 ± 3.8 days vs. 20.4 ± 7.6 days, P = 0.03), and no adverse events were observed with the intervention.

Conclusions

Preoperative HMB supplementation in older adults undergoing cardiac surgery resulted in significant improvements in postoperative exercise capacity and physical function, along with a reduction in the length of hospital stay, without affecting muscle mass.

Registration number of Clinical Trial

UMIN000030490 (UMINhttps://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034773).

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术前补充β -羟基- β -甲基丁酸、精氨酸和谷氨酰胺对心脏手术的影响：一项随机对照试验

背景,目的在接受心脏手术的老年患者中，身体功能是术后预后的关键决定因素。补充β -羟基- β -甲基丁酸盐（HMB）已被证明可以促进肌肉蛋白质合成代谢并抑制分解代谢，从而防止肌肉无力。然而，它对接受心脏手术的老年患者的疗效尚不清楚。本研究旨在研究术前补充HMB对该人群术后身体功能和并发症的影响。方法在这项单中心、开放标签、随机对照试验中，年龄≥65岁的心脏手术患者随机接受HMB补充或不进行营养干预。HMB组给予HMB 1200 mg， l-谷氨酰胺7000 mg， l-精氨酸7000 mg，每日1 - 2次，至少在手术前2周。在基线和手术前后进行评估。主要终点为手术前后6分钟步行距离（6MWD）。次要结局包括并发症发生率、肌肉质量和力量、身体表现和住院时间。结果44例患者（女性，38%）平均年龄72.5岁，随机分为HMB组（n = 22）和对照组（n = 22）。与对照组相比，HMB组术前6MWD均有统计学显著改善(448.0±73.5 m vs 375.5±58.8 m；P = 0.01)和术后时间点(428.9±76.4 m∶304.5±52.3 m；p = 0.001)。肌肉力量和体能表现在HMB组也有显著改善。然而，在任何时间点，两组之间的肌肉质量均无显著差异。HMB组患者住院时间（16.1±3.8天）短于对照组（20.4±7.6天，P = 0.03），且未见不良事件发生。结论：老年心脏手术患者术后补充HMB可显著改善术后运动能力和身体功能，缩短住院时间，且不影响肌肉质量。Clinical TrialUMIN000030490 （UMINhttps://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034773）的注册号。

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来源期刊

Clinical nutrition 医学-营养学

CiteScore

14.10

自引率

6.30%

发文量

356

审稿时长

28 days

期刊介绍： Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.