Dietary treatment of rheumatoid cachexia with beta-hydroxy-beta-methylbutyrate, glutamine and arginine: a randomised controlled trial

Clin Nutr. 2005 Jun;24(3):442-54. doi: 10.1016/j.clnu.2005.01.006. Epub 2005 Apr 21.

Abstract

Background & aims: Rheumatoid arthritis (RA) is complicated by cytokine-driven alterations in protein and energy metabolism and consequent muscle wasting (cachexia). The aim of this randomised controlled trial was to investigate the efficacy of a mixture of beta-hydroxy-beta-methylbutyrate, glutamine and arginine (HMB/GLN/ARG) as nutritional treatment for rheumatoid cachexia.

Methods: Forty RA patients supplemented their diet with either HMB/GLN/ARG or a nitrogen (7.19 g/day) and calorie (180 kcal/day) balanced mixture of alanine, glutamic acid, glycine, and serine (placebo) for 12 weeks. Body composition and other outcomes were assessed at baseline and follow-up, and analysed by mixed ANOVA.

Results: Dietary supplementation with HMB/GLN/ARG was not superior to placebo in the treatment of rheumatoid cachexia (groupxtime interactions P>0.05 for all outcomes). Both amino acid mixtures significantly increased (main effect of time) fat-free mass (727+/-1186 g, P<0.01), total body protein (719+/-1703 g, P=0.02), arms (112+/-183 g, P<0.01) and legs (283+/-534 g, P<0.01) lean mass, and some measures of physical function. No significant adverse event occurred during the study, but patients in the HMB/GLN/ARG group reported fewer gastrointestinal complaints compared to placebo.

Conclusions: Dietary supplementation with HMB/GLN/ARG is better tolerated but not more effective in reversing cachexia in RA patients compared to the mixture of other non-essential amino acids used as placebo. Further controlled studies are necessary to confirm the beneficial anabolic and functional effects of increased nitrogen intake in this population.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Arginine / administration & dosage*
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / metabolism*
  • Arthritis, Rheumatoid / psychology
  • Body Composition / physiology
  • Body Mass Index
  • Cachexia / diet therapy*
  • Cachexia / etiology
  • Cachexia / psychology
  • Dietary Supplements
  • Double-Blind Method
  • Female
  • Glutamine / administration & dosage*
  • Hand Strength / physiology
  • Humans
  • Male
  • Middle Aged
  • Surveys and Questionnaires
  • Valerates / administration & dosage*

Substances

  • Valerates
  • Glutamine
  • beta-hydroxyisovaleric acid
  • Arginine