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George A, Holderread BM, Lambert BS, Harris JD, McCulloch PC. Post-operative protein supplementation following orthopaedic surgery: A systematic review. SPORTS MEDICINE AND HEALTH SCIENCE 2024; 6:16-24. [PMID: 38463662 PMCID: PMC10918348 DOI: 10.1016/j.smhs.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 03/12/2024] Open
Abstract
Decreased mechanical loading after orthopaedic surgery predisposes patients to develop muscle atrophy. The purpose of this review was to assess whether the evidence supports oral protein supplementation can help decrease postoperative muscle atrophy and/or improve patient outcomes following orthopaedic surgery. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). PubMed (MEDLINE), Embase, Scopus, and Web of Science were searched for randomized controlled trials that assessed protein or amino acid supplementation in patients undergoing orthopaedic surgery. Two investigators independently conducted the search using relevant Boolean operations. Primary outcomes included functional or physiologic measures of muscle atrophy or strength. Fourteen studies including 611 patients (224 males, 387 females) were analyzed. Three studies evaluated protein supplementation after ACL reconstruction (ACLR), 3 after total hip arthroplasty (THA), 5 after total knee arthroplasty (TKA), and 3 after surgical treatment of hip fracture. Protein supplementation showed beneficial effects across all types of surgery. The primary benefit was a decrease in muscle atrophy compared to placebo as measured by muscle cross sectional area. Multiple authors also demonstrated improved functional measures and quicker achievement of rehabilitation benchmarks. Protein supplementation has beneficial effects on mitigating muscle atrophy in the postoperative period following ACLR, THA, TKA, and surgical treatment of hip fracture. These effects often correlate with improved functional measures and quicker achievement of rehabilitation benchmarks. Further research is needed to evaluate long-term effects of protein supplementation and to establish standardized population-specific regimens that maximize treatment efficacy in the postoperative period.
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Affiliation(s)
- Andrew George
- Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street Suite 2300, Houston, TX, 77030, USA
| | - Brendan M. Holderread
- Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street Suite 2300, Houston, TX, 77030, USA
| | - Bradley S. Lambert
- Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street Suite 2300, Houston, TX, 77030, USA
- Houston Methodist Orthopedic Biomechanics Research Laboratory, 6670 Bertner Ave, Houston, TX, 77030, USA
| | - Joshua D. Harris
- Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street Suite 2300, Houston, TX, 77030, USA
| | - Patrick C. McCulloch
- Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street Suite 2300, Houston, TX, 77030, USA
- Houston Methodist Orthopedic Biomechanics Research Laboratory, 6670 Bertner Ave, Houston, TX, 77030, USA
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2
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Jazayeri R, Anil U, Zuckerman JD. The Role of Amino Acid Supplementation in Orthopaedic Surgery. J Am Acad Orthop Surg 2024; 32:162-168. [PMID: 38165904 DOI: 10.5435/jaaos-d-23-00300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/08/2023] [Indexed: 01/04/2024] Open
Abstract
The nutritional status of patients undergoing orthopaedic surgery has started to garner increasing attention in published literature. Notable previous evidence has demonstrated the negative effect of malnutrition on outcomes after orthopaedic procedures. Although there has been increased recognition of malnutrition as a risk factor for suboptimal outcomes, the use of nutritional supplementation to mitigate those risks is not well understood. The purpose of this review of most current literature on the topic is to introduce and elucidate the role of amino acid supplementation as a countermeasure to muscle loss and improvement of nutritional status in orthopaedic patients to improve results and outcomes after orthopaedic surgery.
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Affiliation(s)
- Reza Jazayeri
- From the Department of Sports Medicine, Permanente Medical Group Los Angeles, Los Angeles, CA (Jazayeri), the Department of Orthopedic Surgery, NYU Langone Health (Dr. Anil, Dr. Zuckerman), New York, NY
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Ferrando AA, Wolfe RR, Hirsch KR, Church DD, Kviatkovsky SA, Roberts MD, Stout JR, Gonzalez DE, Sowinski RJ, Kreider RB, Kerksick CM, Burd NA, Pasiakos SM, Ormsbee MJ, Arent SM, Arciero PJ, Campbell BI, VanDusseldorp TA, Jager R, Willoughby DS, Kalman DS, Antonio J. International Society of Sports Nutrition Position Stand: Effects of essential amino acid supplementation on exercise and performance. J Int Soc Sports Nutr 2023; 20:2263409. [PMID: 37800468 PMCID: PMC10561576 DOI: 10.1080/15502783.2023.2263409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023] Open
Abstract
Position Statement: The International Society of Sports Nutrition (ISSN) presents this position based on a critical examination of literature surrounding the effects of essential amino acid (EAA) supplementation on skeletal muscle maintenance and performance. This position stand is intended to provide a scientific foundation to athletes, dietitians, trainers, and other practitioners as to the benefits of supplemental EAA in both healthy and resistant (aging/clinical) populations. EAAs are crucial components of protein intake in humans, as the body cannot synthesize them. The daily recommended intake (DRI) for protein was established to prevent deficiencies due to inadequate EAA consumption. The following conclusions represent the official position of the Society: 1. Initial studies on EAAs' effects on skeletal muscle highlight their primary role in stimulating muscle protein synthesis (MPS) and turnover. Protein turnover is critical for replacing degraded or damaged muscle proteins, laying the metabolic foundation for enhanced functional performance. Consequently, research has shifted to examine the effects of EAA supplementation - with and without the benefits of exercise - on skeletal muscle maintenance and performance. 2. Supplementation with free-form EAAs leads to a quick rise in peripheral EAA concentrations, which in turn stimulates MPS. 3. The safe upper limit of EAA intake (amount), without inborn metabolic disease, can easily accommodate additional supplementation. 4. At rest, stimulation of MPS occurs at relatively small dosages (1.5-3.0 g) and seems to plateau at around 15-18 g. 5. The MPS stimulation by EAAs does not require non-essential amino acids. 6. Free-form EAA ingestion stimulates MPS more than an equivalent amount of intact protein. 7. Repeated EAA-induced MPS stimulation throughout the day does not diminish the anabolic effect of meal intake. 8. Although direct comparisons of various formulas have yet to be investigated, aging requires a greater proportion of leucine to overcome the reduced muscle sensitivity known as "anabolic resistance." 9. Without exercise, EAA supplementation can enhance functional outcomes in anabolic-resistant populations. 10. EAA requirements rise in the face of caloric deficits. During caloric deficit, it's essential to meet whole-body EAA requirements to preserve anabolic sensitivity in skeletal muscle.
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Affiliation(s)
- Arny A. Ferrando
- University of Arkansas for Medical Sciences, Center for Translational Research in Aging and Longevity, Department of Geriatrics, Little Rock, AR, USA
| | - Robert R. Wolfe
- University of Arkansas for Medical Sciences, Center for Translational Research in Aging and Longevity, Department of Geriatrics, Little Rock, AR, USA
| | - Katie R. Hirsch
- University of South Carolina, Department of Exercise Science, Arnold School of Public Health, Columbia, SC, USA
| | - David D. Church
- University of Arkansas for Medical Sciences, Center for Translational Research in Aging and Longevity, Department of Geriatrics, Little Rock, AR, USA
| | - Shiloah A. Kviatkovsky
- University of Arkansas for Medical Sciences, Center for Translational Research in Aging and Longevity, Department of Geriatrics, Little Rock, AR, USA
| | | | - Jeffrey R. Stout
- University of Central Florida, School of Kinesiology and Rehabilitation Sciences, Orlando, FL, USA
| | - Drew E. Gonzalez
- Texas A&M University, Exercise & Sport Nutrition Lab, Department of Kinesiology and Sports Management, College Station, TX, USA
| | - Ryan J. Sowinski
- Texas A&M University, Exercise & Sport Nutrition Lab, Department of Kinesiology and Sports Management, College Station, TX, USA
| | - Richard B. Kreider
- Texas A&M University, Exercise & Sport Nutrition Lab, Department of Kinesiology and Sports Management, College Station, TX, USA
| | - Chad M. Kerksick
- Lindenwood University, Exercise and Performance Nutrition Laboratory, College of Science, Technology, and Health, St Charles, MO, USA
| | - Nicholas A. Burd
- University of Illinois Urbana-Champaign, Department of Kinesiology and Community Health, Urbana, IL, USA
| | - Stefan M. Pasiakos
- National Institutes of Health, Office of Dietary Supplements, Bethesda, MD, USA
| | - Michael J. Ormsbee
- Florida State University, Institute of Sports Sciences and Medicine, Nutrition and Integrative Physiology, Tallahassee, FL, USA
| | - Shawn M. Arent
- University of South Carolina, Department of Exercise Science, Arnold School of Public Health, Columbia, SC, USA
| | - Paul J. Arciero
- University of Pittsburgh, Department of Sports Medicine and Nutrition, Pittsburgh, PA, USA
- Skidmore College, Health and Physiological Sciences, Saratoga Springs, NY, USA
| | - Bill I. Campbell
- University of South Florida, Performance & Physique Enhancement Laboratory, Tampa, FL, USA
| | - Trisha A. VanDusseldorp
- Bonafede Health, LLC, JDS Therapeutics, Harrison, NY, USA
- Jacksonville University, Department of Health and Exercise Sciences, Jacksonville, FL, USA
| | | | - Darryn S. Willoughby
- University of Mary Hardin-Baylor, Human Performance Lab, School of Exercise and Sport Science, Belton, TX, USA
| | - Douglas S. Kalman
- Nova Southeastern University, Dr. Kiran C Patel College of Osteopathic Medicine, Department of Nutrition, Davie, FL, USA
| | - Jose Antonio
- Nova Southeastern University, Department of Health and Human Performance, Davie, FL, USA
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Reider L, Owen EC, Dreyer HC, Fitton LS, Willey MC. Loss of Muscle Mass and Strength After Hip Fracture: an Intervention Target for Nutrition Supplementation. Curr Osteoporos Rep 2023; 21:710-718. [PMID: 38019345 DOI: 10.1007/s11914-023-00836-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 11/30/2023]
Abstract
PURPOSEOF REVIEW To summarize what is known about the deleterious effect of hip fracture on muscle mass and strength as well as the scientific evidence for post-surgical nutrition supplementation to maintain muscle and improve function. RECENT FINDINGS This review provides a discussion of the relationship between muscle mass, strength, and physical function following hip fracture, briefly describes the approaches to measuring lean mass, discusses prevalence of sarcopenia and malnutrition among older men and women with hip fracture, and reviews the effects of essential amino acids on muscle. Loss of muscle mass and strength following hip fracture is substantial with consequences for recovery of functional independence. EAA-based nutrition supplementation, which directly effects muscle, has potential to improve outcomes.
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Affiliation(s)
- Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Street, Room 648, Baltimore, MD, 21205, USA.
| | | | - Hans C Dreyer
- Department of Human Physiology, University of Oregon, Eugene, OR, 97403, USA
| | - Lori S Fitton
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael C Willey
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Flore G, Deledda A, Fosci M, Lombardo M, Moroni E, Pintus S, Velluzzi F, Fantola G. Perioperative Nutritional Management in Enhanced Recovery after Bariatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6899. [PMID: 37835169 PMCID: PMC10573058 DOI: 10.3390/ijerph20196899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
Obesity is a crucial health problem because it leads to several chronic diseases with an increased risk of mortality and it is very hard to reverse with conventional treatment including changes in lifestyle and pharmacotherapy. Bariatric surgery (BS), comprising a range of various surgical procedures that modify the digestive tract favouring weight loss, is considered the most effective medical intervention to counteract severe obesity, especially in the presence of metabolic comorbidities. The Enhanced Recovery After Bariatric Surgery (ERABS) protocols include a set of recommendations that can be applied before and after BS. The primary aim of ERABS protocols is to facilitate and expedite the recovery process while enhancing the overall effectiveness of bariatric procedures. ERABS protocols include indications about preoperative fasting as well as on how to feed the patient on the day of the intervention, and how to nourish and hydrate in the days after BS. This narrative review examines the application, the feasibility and the efficacy of ERABS protocols applied to the field of nutrition. We found that ERABS protocols, in particular not fasting the patient before the surgery, are often not correctly applied for reasons that are not evidence-based. Furthermore, we identified some gaps in the research about some practises that could be implemented in the presence of additional evidence.
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Affiliation(s)
- Giovanna Flore
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Andrea Deledda
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Michele Fosci
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Via di Val Cannuta, 247, 00166 Rome, Italy;
| | - Enrico Moroni
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
| | - Stefano Pintus
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
| | - Fernanda Velluzzi
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Giovanni Fantola
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
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Hirsch KR, Wolfe RR, Ferrando AA. Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery. Nutrients 2021; 13:nu13051675. [PMID: 34063333 PMCID: PMC8156786 DOI: 10.3390/nu13051675] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022] Open
Abstract
Nutritional status is a strong predictor of postoperative outcomes and is recognized as an important component of surgical recovery programs. Adequate nutritional consumption is essential for addressing the surgical stress response and mitigating the loss of muscle mass, strength, and functionality. Especially in older patients, inadequate protein can lead to significant muscle atrophy, leading to a loss of independence and increased mortality risk. Current nutritional recommendations for surgery primarily focus on screening and prevention of malnutrition, pre-surgical fasting protocols, and combating post-surgical insulin resistance, while recommendations regarding macronutrient composition and timing around surgery are less established. The goal of this review is to highlight oral nutrition strategies that can be implemented leading up to and following major surgery to minimize atrophy and the resultant loss of functionality. The role of carbohydrate and especially protein/essential amino acids in combating the surgical stress cascade and supporting recovery are discussed. Practical considerations for nutrient timing to maximize oral nutritional intake, especially during the immediate pre- and post- surgical periods, are also be discussed.
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7
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Food for Special Medical Purposes and Nutraceuticals for Pain: A Narrative Review. Pain Ther 2021; 10:225-242. [PMID: 33594594 PMCID: PMC8119521 DOI: 10.1007/s40122-021-00239-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/30/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction The present paper focuses on the possible contribution of food compounds to alleviate symptomatic pains. Chronic pain can more easily be linked to anticipatory signals such as thirst and hunger than it is to sensory perceptions as its chronicity makes it fall under the behavioural category rather than it does senses. In fact, pain often negatively affects one’s normal feeding behavioural patterns, both directly and indirectly, as it is associated with pain or because of its prostrating effects. Nutritional Compounds for Pain Several nutraceuticals and Foods for Special Medical Purposes (FSMPs) are reported to have significant pain relief efficacy with multiple antioxidant and anti-inflammatory properties. Apart from the aforementioned properties, amino acids, fatty acids, trace elements and vitamins may have a role in the modulation of pain signals to and within the nervous system. Conclusion In our opinion, this review could be of great interest to clinicians, as it offers a complementary perspective in the management of pain. Trials with well-defined patient and symptoms selection and a robust pharmacological design are pivotal points to let these promising compounds become better accepted by the medical community.
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Greif DN, Emerson CP, Allegra P, Arizpe A, Mansour KL, Cade WH, Baraga MG. Supplement Use in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2020; 36:2537-2549. [PMID: 32438028 DOI: 10.1016/j.arthro.2020.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/25/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess whether a standardized dietary supplementation can help to decrease postoperative muscle atrophy and/or improve rehabilitation outcomes in patients who underwent anterior cruciate ligament reconstruction (ACLR). METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). MEDLINE, Scopus, and Cochrane Library databases were searched, and articles that examined protein or amino acid, vitamin, or any other type of supplementation in ACLR were reviewed. Two independent reviewers conducted the search using pertinent Boolean operations. RESULTS A total of 1818 articles were found after our database search. Ten studies fulfilled our inclusion criteria and only assessed patients undergoing ACLR. Four studies assessed protein-based supplementation. One study assessed creatine as a supplement. Four studies assessed vitamin-based supplementation. One study assessed testosterone supplementation. Protein and amino acid supplementation showed potential benefits; multiple authors demonstrated a combination of improved achievement of rehabilitation benchmarks, graft maturation, muscular hypertrophic response, and peak dynamic muscle strength. When we examined creatine, vitamin, or hormone-based protocols, none demonstrated results, suggesting these factors may attenuate muscle atrophy after surgery. Vitamin C and E demonstrated potentially increased local inflammation in skeletal muscle, which runs contrary to the belief that antioxidant vitamin-based supplementation may decrease the inflammatory response that plays a role in the post injury/operative period. CONCLUSIONS Protein-based supplementation may play a role in mitigating muscle atrophy associated with ACLR, as multiple authors demonstrated a combination of improved achievement of rehabilitation benchmarks, thigh hypertrophic response, and peak dynamic muscle strength. However, based on current literature, it is not possible to recommend a specific protein-based supplementation protocol at this time for patients undergoing ACLR. Limited evidence suggests no benefit for creatine, vitamin, or hormone-based protocols. LEVEL OF EVIDENCE II, a systematic review of level I-II studies.
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Affiliation(s)
- Dylan N Greif
- University of Miami Sports Medicine Institute, Coral Gables, Florida, U.S.A..
| | | | - Paul Allegra
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Azael Arizpe
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Kailey L Mansour
- University of Miami Sports Medicine Institute, Coral Gables, Florida, U.S.A
| | - William H Cade
- University of Miami Sports Medicine Institute, Coral Gables, Florida, U.S.A
| | - Michael G Baraga
- University of Miami Sports Medicine Institute, Coral Gables, Florida, U.S.A.; Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
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Liao CD, Wu YT, Tsauo JY, Chen PR, Tu YK, Chen HC, Liou TH. Effects of Protein Supplementation Combined with Exercise Training on Muscle Mass and Function in Older Adults with Lower-Extremity Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients 2020; 12:nu12082422. [PMID: 32806718 PMCID: PMC7468926 DOI: 10.3390/nu12082422] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Aging and osteoarthritis (OA) are associated with a high risk of muscle mass loss, which can lead to physical disability. This study investigated the effectiveness of protein supplementation combined with exercise training (PS + ET) in improving muscle mass and functional outcomes in older adults with lower-limb OA. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) on the effectiveness of PS + ET in older adults with hip or knee OA. Meta-analysis and risk of bias assessment of the included RCTs were conducted. Six RCTs were included in this systemic review; they had a median (range/total) Physiotherapy Evidence Database (PEDro) score of 7 (6-9) out of 10, respectively. Five RCTs that enrolled patients who underwent total joint replacement were included in this meta-analysis. The PS + ET group exhibited significant improvements in muscle mass (standard mean difference [SMD] = 1.13, p < 0.00001), pain (SMD = 1.36, p < 0.00001), and muscle strength (SMD = 0.44, p = 0.04). Our findings suggest that PS + ET improves muscle mass, muscle strength, and functional outcomes and reduces pain in older adults with lower-limb OA, particularly in those who have undergone total joint replacement.
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Affiliation(s)
- Chun-De Liao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 100025, Taiwan; (C.-D.L.); (Y.-T.W.); (J.-Y.T.)
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan;
| | - Yen-Tzu Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 100025, Taiwan; (C.-D.L.); (Y.-T.W.); (J.-Y.T.)
- Physical Therapy Center, National Taiwan University Hospital, Taipei 100229, Taiwan
| | - Jau-Yih Tsauo
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 100025, Taiwan; (C.-D.L.); (Y.-T.W.); (J.-Y.T.)
| | - Pey-Rong Chen
- Department of Dietetics, National Taiwan University Hospital, Taipei 100225, Taiwan;
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110301, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100025, Taiwan;
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan;
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan;
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Correspondence: ; Tel.: +886-2-2249-0088 (ext. 1600); Fax: +886-2-2248-0577
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Aquilani R, Zuccarelli Ginetto C, Rutili C, Pisano P, Pasini E, Baldissarro E, Verri M, Boschi F. Supplemented amino acids may enhance the walking recovery of elderly subjects after hip fracture surgery. Aging Clin Exp Res 2019; 31:157-160. [PMID: 29667153 DOI: 10.1007/s40520-018-0941-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/27/2018] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to investigate whether supplemented essential amino acids (EAAs) could enhance rehabilitation therapy (Rehab) for recovery of walking capacity in subjects after hip fracture surgery (HFS). Eighty-three elderly subjects with HFS (20 ± 11 days after acute trauma) were eligible for the study and randomized to receive Rehab only (Rehab; n = 27), Rehab + placebo (RP; n = 28) or Rehab + EAAs (RE 8 g/day; n = 28). The patients' walking capacity (m) was measured by 6-min walking distance (6MWD) at admission and at discharge (median 66 days after admission). All patient groups were treated with the same Rehab (2 sessions/day × 5 days/week). The results showed that the gain in 6MWD was higher in RE than in Rehab and RP (p = 0.034; p = 0.024). The study shows that EAA supplementation can enhance walking recovery rate in subjects with HFS.
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Affiliation(s)
- Roberto Aquilani
- Dipartimento di Biologia e Biotecnologie Università degli Studi di Pavia, Via Ferrata, 1, 27100, Pavia, Italy
| | - Carlo Zuccarelli Ginetto
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3, 20090, Vimodrone, Milano, Italy
| | - Carla Rutili
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3, 20090, Vimodrone, Milano, Italy
| | - Pietro Pisano
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3, 20090, Vimodrone, Milano, Italy
| | - Evasio Pasini
- Divisione di Riabilitazione Cardiologica, Centro Medico di Lumezzane, Istituti Clinici Scientifici "Maugeri", IRCCS, Via G. Mazzini, 129, 25065, Lumezzane, BS, Italy
| | - Eleonora Baldissarro
- Dipartimento di Medicina Fisica e Riabilitativa, Centro Medico di Nervi, Istituti Clinici Scientifici "Maugeri", IRCCS, Via Missolungi 14, 16167, Nervi, GE, Italy
| | - Manuela Verri
- Dipartimento di Biologia e Biotecnologie Università degli Studi di Pavia, Via Ferrata, 1, 27100, Pavia, Italy
| | - Federica Boschi
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Viale Taramelli, 14, 27100, Pavia, Italy.
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11
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Aquilani R, Zuccarelli GC, Condino AM, Catani M, Rutili C, Del Vecchio C, Pisano P, Verri M, Iadarola P, Viglio S, Boschi F. Despite Inflammation, Supplemented Essential Amino Acids May Improve Circulating Levels of Albumin and Haemoglobin in Patients after Hip Fractures. Nutrients 2017. [PMID: 28635634 PMCID: PMC5490616 DOI: 10.3390/nu9060637] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Essential amino acids (EAAs) are nutritional substrates that promote body protein synthesis; thus we hypothesised that their supplementation may improve circulating albumin (Alb) and haemoglobin (Hb) in rehabilitative elderly patients following hip fractures (HF). Out of the 145 HF patients originally enrolled in our study, 112 completed the protocol. These subjects were divided into two randomised groups, each containing 56 patients. For a period of two months, one group (age 81.4 ± 8.1 years; male/female 27/29) received a placebo, and the other (age 83.1 ± 7.5 years; male/female 25/31) received 4 + 4 g/day oral EAAs. At admission, the prevalence of both hypoAlb (<3.5 g/dL) and hypoHb (<13 g/dL male, <12 g/dL female) was similar in the placebo group (64.3% hypoAlb, 66% hypoHb) and the treated group of patients (73.2% hypoAlb, 67.8% hypoHb). At discharge, however, the prevalence of hypoAlb had reduced more in EAAs than in placebo subjects (31.7% in EAAs vs. 77.8% in placebo; p < 0.001). There was a 34.2% reduction of anaemia in hypoHb in EAA subjects and 18.9% in placebo subjects, but the difference was not statistically significant. Oral supplementation of EAAs improves hypoAlb and, to a lesser extent, Hb in elderly rehabilitative subjects with hip fractures. Anaemia was reduced in more than one third of patients, which, despite not being statistically significant, may be clinically relevant.
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Affiliation(s)
- Roberto Aquilani
- Dipartimento di Biologia e Biotecnologie Università degli Studi di Pavia, Via Ferrata, 1. I-27100 Pavia, Italy.
| | - Ginetto Carlo Zuccarelli
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Anna Maria Condino
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Viale Taramelli, 14. I-27100 Pavia, Italy.
| | - Michele Catani
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Carla Rutili
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Consiglia Del Vecchio
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Pietro Pisano
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Manuela Verri
- Dipartimento di Biologia e Biotecnologie Università degli Studi di Pavia, Via Ferrata, 1. I-27100 Pavia, Italy.
| | - Paolo Iadarola
- Dipartimento di Biologia e Biotecnologie Università degli Studi di Pavia, Via Ferrata, 1. I-27100 Pavia, Italy.
| | - Simona Viglio
- Dipartimento di Medicina Molecolare, Università degli Studi di Pavia, Viale Taramelli, 3/B. I-27100 Pavia, Italy.
| | - Federica Boschi
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Viale Taramelli, 14. I-27100 Pavia, Italy.
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