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Randomized Controlled Trial
. 2010 Feb 18:5:29-39.
doi: 10.2147/copd.s7739.

Fat-free mass change after nutritional rehabilitation in weight losing COPD: role of insulin, C-reactive protein and tissue hypoxia

Simonetta Baldi  1 , Roberto Aquilani, Gian Domenico Pinna, Paolo Poggi, Angelo De Martini, Claudio Bruschi
Affiliations
Randomized Controlled Trial

Fat-free mass change after nutritional rehabilitation in weight losing COPD: role of insulin, C-reactive protein and tissue hypoxia

Simonetta Baldi et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: Fat-free mass (FFM) depletion marks the imbalance between tissue protein synthesis and breakdown in chronic obstructive pulmonary disease (COPD). To date, the role of essential amino acid supplementation (EAAs) in FFM repletion has not been fully acknowledged. A pilot study was undertaken in patients attending pulmonary rehabilitation.

Methods: 28 COPD patients with dynamic weight loss > 5% over the last 6 months were randomized to receive EAAs embedded in a 12-week rehabilitation program (EAAs group n = 14), or to the same program without supplementation (C group n = 14). Primary outcome measures were changes in body weight and FFM, using dual X-ray absorptiometry (DEXA).

Results: At the 12th week, a body weight increment occurred in 92% and 15% of patients in the EAAs and C group, respectively, with an average increase of 3.8 +/- 2.6 kg (P = 0.0002) and -0.1 +/- 1.1 kg (P = 0.81), respectively. A FFM increment occurred in 69% and 15% of EAAs and C patients, respectively, with an average increase of 1.5 +/- 2.6 kg (P = 0.05) and -0.1 +/- 2.3 kg (P = 0.94), respectively. In the EAAs group, FFM change was significantly related to fasting insulin (r(2) 0.68, P < 0.0005), C-reactive protein (C-RP) (r(2) = 0.46, P < 0.01), and oxygen extraction tension (PaO(2x)) (r(2) = 0.46, P < 0.01) at end of treatment. These three variables were highly correlated in both groups (r > 0.7, P < 0.005 in all tests).

Conclusions: Changes in FFM promoted by EAAs are related to cellular energy and tissue oxygen availability in depleted COPD. Insulin, C-RP, and PaO(2x) must be regarded as clinical markers of an amino acid-stimulated signaling to FFM accretion.

Keywords: COPD; branched chain amino acids; insulin; pulmonary rehabilitation; systemic inflammation.

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Figures

Figure 1
Figure 1
The flow diagram for patients’ allocation to EAAs + rehabilitation and rehabilitation interventions. §Number of patients who did not exercise on a regular basis and/or spontaneously reduced the dose of EAA to 4 g daily. Abbreviation: EAAs, essential amino acid supplementation.
Figure 2
Figure 2
Panel A: 12th-week change FFM, as assessed by DEXA, plotted against 12th-week insulin plasma levels, μUI/mL. Panel B: 12th-week change FFM, plotted against 12th-week C-RP, mg/L. Panel C: 12th-week change FFM, plotted against 12th-week PaO2x, mmHg in 13 patients allocated to EAAs group. Panel D: 12th-week change FFM, plotted against 12th-week glucose plasma levels, mmol/L. Abbreviations: C-RP, C-reactive protein; DEXA, dual X-ray absorptiometry EAAs, essential amino acid supplementation; FFM, fat-free mass; PaO2x, oxygen extraction tension.
Figure 3
Figure 3
Panel A: 12th-week change FFM, as assessed by DEXA, plotted against 12th-week insulin plasma levels, μUI/mL. Panel B: 12th-week change FFM, plotted against 12th-week C-RP, mg/L. Panel C: 12th-week change FFM, plotted against 12th-week PaO2x, mmHg 13 patients allocated to C Group. Panel D: 12th-week change FFM, plotted against 12th-week glucose plasma levels, mmol/L. P > 0.38 in all tests. Abbreviations: DEXA, dual X-ray absorptiometry EAAs, essential amino acid supplementation; FFM, fat-free mass; PaO2x, oxygen extraction tension.
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