Plasma beta-hydroxy-beta-methylbutyrate availability after enteral administration during critical illness after trauma: An exploratory study.
critical illness
enteral nutrition
nutrition therapy
skeletal muscle
β‐hydroxy‐β‐methylbutyrate
Journal
JPEN. Journal of parenteral and enteral nutrition
ISSN: 1941-2444
Titre abrégé: JPEN J Parenter Enteral Nutr
Pays: United States
ID NLM: 7804134
Informations de publication
Date de publication:
24 Mar 2024
24 Mar 2024
Historique:
revised:
26
02
2024
received:
07
12
2023
accepted:
28
02
2024
medline:
24
3
2024
pubmed:
24
3
2024
entrez:
24
3
2024
Statut:
aheadofprint
Résumé
During critical illness skeletal muscle wasting occurs rapidly. Although beta-hydroxy-beta-methylbutyrate (HMB) is a potential treatment to attenuate this process, the plasma appearance and muscle concentration is uncertain. This was an exploratory study nested within a blinded, parallel group, randomized clinical trial in which critically ill patients after trauma received enteral HMB (3 g daily) or placebo. Plasma samples were collected at 0, 60, and 180 min after study supplement administration on day 1. Needle biopsies of the vastus lateralis muscle were collected (baseline and day 7 of the HMB treatment intervention period). An external standard curve was used to calculate HMB concentrations in plasma and muscle. Data were available for 16 participants (male n = 12 (75%), median [interquartile range] age 50 [29-58] years) who received placebo and 18 participants (male n = 14 (78%), age 49 [34-55] years) who received HMB. Plasma HMB concentrations were similar at baseline but increased after HMB (T = 60 min: placebo 0.60 [0.44-1.31] µM; intervention 51.65 [22.76-64.72] µM). Paired muscle biopsies were collected from 11 participants (placebo n = 7, HMB n = 4). Muscle HMB concentrations were similar at baseline between groups (2.35 [2.17-2.95]; 2.07 [1.78-2.31] µM). For participants in the intervention group who had the repeat biopsy within 4 h of HMB administration, concentrations were greater (7.2 and 12.3 µM) than those who had the repeat biopsy >4 h after HMB (2.7 and 2.1 µM). In this exploratory study, enteral HMB administration increased plasma HMB availability. The small sample size limits interpretation of the muscle HMB findings.
Sections du résumé
BACKGROUND
BACKGROUND
During critical illness skeletal muscle wasting occurs rapidly. Although beta-hydroxy-beta-methylbutyrate (HMB) is a potential treatment to attenuate this process, the plasma appearance and muscle concentration is uncertain.
METHODS
METHODS
This was an exploratory study nested within a blinded, parallel group, randomized clinical trial in which critically ill patients after trauma received enteral HMB (3 g daily) or placebo. Plasma samples were collected at 0, 60, and 180 min after study supplement administration on day 1. Needle biopsies of the vastus lateralis muscle were collected (baseline and day 7 of the HMB treatment intervention period). An external standard curve was used to calculate HMB concentrations in plasma and muscle.
RESULTS
RESULTS
Data were available for 16 participants (male n = 12 (75%), median [interquartile range] age 50 [29-58] years) who received placebo and 18 participants (male n = 14 (78%), age 49 [34-55] years) who received HMB. Plasma HMB concentrations were similar at baseline but increased after HMB (T = 60 min: placebo 0.60 [0.44-1.31] µM; intervention 51.65 [22.76-64.72] µM). Paired muscle biopsies were collected from 11 participants (placebo n = 7, HMB n = 4). Muscle HMB concentrations were similar at baseline between groups (2.35 [2.17-2.95]; 2.07 [1.78-2.31] µM). For participants in the intervention group who had the repeat biopsy within 4 h of HMB administration, concentrations were greater (7.2 and 12.3 µM) than those who had the repeat biopsy >4 h after HMB (2.7 and 2.1 µM).
CONCLUSION
CONCLUSIONS
In this exploratory study, enteral HMB administration increased plasma HMB availability. The small sample size limits interpretation of the muscle HMB findings.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Adam M. Deane is supported by a National Health and Medical Research Council Investigator Grant (Leadership 1)
Informations de copyright
© 2024 The Authors. Journal of Parenteral and Enteral Nutrition published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.
Références
Puthucheary ZA, Rawal J, McPhail M, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310(15):1591‐1600.
Fazzini B, Märkl T, Costas C, et al. The rate and assessment of muscle wasting during critical illness: a systematic review and meta‐analysis. Crit Care. 2023;27(1):2.
Mayer KP, Thompson Bastin ML, Montgomery‐Yates AA, et al. Acute skeletal muscle wasting and dysfunction predict physical disability at hospital discharge in patients with critical illness. Crit Care. 2020;24(1):637.
Deane AM, Little L, Bellomo R, et al. Outcomes six months after delivering 100% or 70% of enteral calorie requirements during critical illness (TARGET). A randomized controlled trial. Am J Respir Crit Care Med. 2020;201(7):814‐822.
Chapple LS, van Gassel RJJ, Rooyackers O. Protein metabolism in critical illness. Curr Opin Crit Care. 2022;28(4):367‐373.
Rooyackers O, Kouchek‐Zadeh R, Tjäder I, Norberg Å, Klaude M, Wernerman J. Whole body protein turnover in critically ill patients with multiple organ failure. Clin Nutr. 2015;34(1):95‐100.
Chapple LS, Kouw IWK, Summers MJ, et al. Muscle protein synthesis after protein administration in critical illness. Am J Respir Crit Care Med. 2022;206(6):740‐749.
Batt J, Herridge M, Dos Santos C. Mechanism of ICU‐acquired weakness: skeletal muscle loss in critical illness. Intensive Care Med. 2017;43(12):1844‐1846.
Gunst J, Casaer MP, Preiser JC, Reignier J, Van den Berghe G. Toward nutrition improving outcome of critically ill patients: how to interpret recent feeding RCTs? Crit Care. 2023;27(1):43.
Tagawa R, Watanabe D, Ito K, et al. Dose–response relationship between protein intake and muscle mass increase: a systematic review and meta‐analysis of randomized controlled trials. Nutr Res. 2020;79(1):66‐75.
Pennings B, Groen B, de Lange A, et al. Amino acid absorption and subsequent muscle protein accretion following graded intakes of whey protein in elderly men. Am J Physiol Endocrinol Metab. 2012;302(8):E992‐E999.
Weijs PJM, Mogensen KM, Rawn JD, Christopher KB. Protein intake, nutritional status and outcomes in ICU survivors: a single center cohort study. J Clin Med. 2019;8(1):43.
Dresen E, Weißbrich C, Fimmers R, Putensen C, Stehle P. Medical high‐protein nutrition therapy and loss of muscle mass in adult ICU patients: a randomized controlled trial. Clin Nutr. 2021;40(4):1562‐1570.
van Gassel RJJ, Bels JLM, Tartaglia K, et al. The impact of high versus standard enteral protein provision on functional recovery following intensive care admission (PRECISE trial): study protocol for a randomized controlled, quadruple blinded, multicenter, parallel group trial in mechanically ventilated patients. Trials. 2023;24(1):416.
Ali Abdelhamid Y, Cousins CE, Sim JA, et al. Effect of critical illness on triglyceride absorption. JPEN J Parenter Enteral Nutr. 2015;39(8):966‐972.
Deane AM, Rayner CK, Keeshan A, et al. The effects of critical illness on intestinal glucose sensing, transporters, and absorption. Crit Care Med. 2014;42(1):57‐65.
Heyland DK, Patel J, Compher C, et al. The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry‐based randomised trial. Lancet. 2023;401(10376):568‐576.
Wilkinson DJ, Hossain T, Hill DS, et al. Effects of leucine and its metabolite β‐hydroxy‐β‐methylbutyrate on human skeletal muscle protein metabolism. J Physiol. 2013;591(11):2911‐2923.
Bear DE, Langan A, Dimidi E, et al. β‐Hydroxy‐β‐methylbutyrate and its impact on skeletal muscle mass and physical function in clinical practice: a systematic review and meta‐analysis. Am J Clin Nutr. 2019;109(4):1119‐1132.
Wittholz K, Fetterplace K, Karahalios A, et al. Beta‐hydroxy‐beta‐methylbutyrate supplementation and functional outcomes in multitrauma patients: a pilot randomized controlled trial. JPEN J Parenter Enteral Nutr. 2023;47(8):983‐992.
Kuhls DA, Rathmacher JA, Musngi MD, et al. Beta‐hydroxy‐beta‐methylbutyrate supplementation in critically ill trauma patients. J Trauma. 2007;62(1):125‐131.
discussion 131‐132.
Nakamura K, Kihata A, Naraba H, et al. β‐hydroxy‐β‐methylbutyrate, arginine, and glutamine complex on muscle volume loss in critically ill patients: a randomized control trial. JPEN J Parenter Enteral Nutr. 2020;44(2):205‐212.
Viana MV, Becce F, Pantet O, et al. Impact of β−hydroxy‐β−methylbutyrate (HMB) on muscle loss and protein metabolism in critically ill patients: a RCT. Clin Nutr. 2021;40(8):4878‐4887.
Supinski GS, Netzel PF, Westgate PM, Schroder EA, Wang L, Callahan LA. A randomized controlled trial to determine whether beta‐hydroxy‐beta‐methylbutyrate and/or eicosapentaenoic acid improves diaphragm and quadriceps strength in critically Ill mechanically ventilated patients. Crit Care. 2021;25(1):308.
Wernerman J, Christopher KB, Annane D, et al. Metabolic support in the critically ill: a consensus of 19. Crit Care. 2019;23(1):318.
Wittholz K, Fetterplace K, Ali Abdelhamid Y, et al. β‐Hydroxy‐β‐methylbutyrate (HMB) supplementation and functional outcomes in multi‐trauma patients: a study protocol for a pilot randomised clinical trial (BOOST trial). Pilot Feasibility Stud. 2022;8(1):21.
Bergström J. Percutaneous needle biopsy of skeletal muscle in physiological and clinical research. Scand J Clin Lab Invest. 1975;35(7):609‐616.
Evans WJ, Phinney SD, Young VR. Suction applied to a muscle biopsy maximizes sample size. Med Sci Sports Exerc. 1982;14(1):100.
Yaddanapudi L. The American Statistical Association statement on P‐values explained. J Anaesthesiol Clin Pharmacol. 2016;32(4):421‐423.
Greenland S, Senn SJ, Rothman KJ, et al. Statistical tests, P values, confidence intervals, and power: a guide to misinterpretations. Eur J Epidemiol. 2016;31(4):337‐350.
Goelen N, Janssen P, Tack J, et al. Continuous assessment of gastric motility and its relation to gastric emptying in adult critically ill patients. JPEN J Parenter Enteral Nutr. 2021;45(8):1779‐1784.
Reintam Blaser A, Bachmann KF, Deane AM. Gastrointestinal function in critically ill patients. Curr Opin Clin Nutr Metab Care. 2023;26(5):463‐469.
van Gassel RJJ, van de Poll MCG, Schaap FG, Plummer M, Deane A, Olde Damink SWM. Postprandial rise of essential amino acids is impaired during critical illness and unrelated to small‐intestinal function. JPEN J Parenter Enteral Nutr. 2022;46(1):114‐122.
Fuller Jr. JC, Sharp RL, Angus HF, Baier SM, Rathmacher JA. Free acid gel form of β‐hydroxy‐β‐methylbutyrate (HMB) improves HMB clearance from plasma in human subjects compared with the calcium HMB salt. Br J Nutr. 2011;105(3):367‐372.
McNelly AS, Bear DE, Connolly BA, et al. Effect of intermittent or continuous feed on muscle wasting in critical illness. Chest. 2020;158(1):183‐194.
Granholm A, Alhazzani W, Derde LPG, et al. Randomised clinical trials in critical care: past, present and future. Intensive Care Med. 2022;48(2):164‐178.
Bear DE, Wandrag L, Merriweather JL, Connolly B, Hart N, Grocott MPW. The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review. Crit Care. 2017;21(1):226.
Slingerland‐Boot R, van der Heijden I, Schouten N, et al. Prospective observational cohort study of reached protein and energy targets in general wards during the post‐intensive care period: the PROSPECT‐I study. Clin Nutr. 2022;41(10):2124‐2134.
Fadeur M, Preiser JC, Verbrugge AM, Misset B, Rousseau AF. Oral nutrition during and after critical illness: SPICES for quality of care! Nutrients. 2020;12(11):3509.
Wischmeyer PE, Bear DE, Berger MM, et al. Personalized nutrition therapy in critical care: 10 expert recommendations. Crit Care. 2023;27(1):261.
Fetterplace K, Ridley EJ, Beach L, et al. Quantifying response to nutrition therapy during critical illness: implications for clinical practice and research? A narrative review. JPEN J Parenter Enteral Nutr. 2021;45(2):251‐266.