Elsevier

Clinical Nutrition

Volume 30, Issue 5, October 2011, Pages 571-577
Clinical Nutrition

Original article
Effect of essential amino acid supplementation on quality of life, Amino acid profile and strength in institutionalized elderly patients

https://doi.org/10.1016/j.clnu.2011.04.005Get rights and content

Summary

Background & aims

This study assessed the efficacy of supplemented essential amino acids on depressive symptoms, nutrition, muscle function, daily physical activity, and health-related quality of life (HRQoL) of institutionalized elderly patients.

Methods

Forty-one patients (58.5% women; mean age 79.8 yrs) with sequelae of coronary artery disease (73%), femoral fracture (34%), were randomly assigned to receive oral essential amino acids 4 gr 2 times a day for 8 weeks or isocaloric placebo. Before randomization and 8 weeks after the protocol started, the following variables were measured: depressive symptoms (Geriatric Depression Scale, GDS), nutritional panel (Mini Nutritional Assessment, MNA; serum albumin and prealbumin levels), muscle strength (Hand Grip, HG), Activity Daily Life (ADL), Quality of Life (SF-36, HRQoL) and amino acid profile.

Results

Compared with the placebo group, EAA patients improved nutrition (MNA score 22.6 ± 1.5 post vs 21.8 ± 1.6 pre; p < 0. 04, albumin g/dl 4.04 ± 0.35 post vs 3.88 ± 0.3 pre; p < 0.01), GDS(score 10.3 ± 1.75 post vs 13.85 ± 3.37 pre; p < 0.001), HG (Kg 19.75 ± 1.7 post vs 18.68 ± 1.36 pre; p = 0.001), ADL (p < 0.04) and both physical and mental components of SF-36 (p < 0.002).

Conclusions

Oral supplementation with essential amino acids improved several determinants of quality of life in institutionalized elderly patients, including depressive symptoms, nutrition, muscle function and daily life activity.

Introduction

Health-related quality of life (HRQoL) is the perception patients have of the impact of a disease (s) from the physical, psychological, social and somatic domains of functioning and well-being.1

Improving HRQoL is one of the primary objectives of health care in institutionalized elderly patients, as survival becomes less important than HRQoL as experienced by the patient.

Besides socio-economic status, a number of health-related conditions including bad nutrition,2 low physical function,3 depression4 may affect the HRQoL of elderly patients.

In several studies, depression, present principally in elderly patients living in residential care homes (6–11% for major depression, 30% for depressive symptoms)5 has been documented to be linked with HRQoL. In surgery hip-fractured patients, HRQoL was more related to depressed-risk groups than physical recovery.6 In another study, oral supplementation with nutritionally complete formula improved depressive symptoms in acutely hospitalized older patients and during convalescence/rehabilitation periods.7 Provision of a nutrient dense protein-energy liquid supplement to community-living, frail, undernourished elderly people positively affected their emotional role functioning.8

Here, we tested the hypothesis that depression, nutrition, muscle function, daily physical activity and HRQoL could be improved in institutionalized elderly patients by supplementing simple nutritional substances such as essential amino acids (EAAs). Both biochemical and practical considerations were the rationale behind using EAAs.

First, EAA-induced protein synthesis leads to increased muscle mass/function and physical functioning,9 a factor that positively affects HRQoL. Second, several EAAs are precursors of brain neurotransmitter synthesis10 including serotonin, dopamine, norepinephrine, relevant for mood and behavior. Moreover, in clinical practice, increasing protein intake in order to improve body protein synthesis may be challenging for elderly patients since even healthy subjects (from 15% to 41%),11, 12 may eat less protein than their minimal requirement (0.8 g/kg/day) and even if they take adequate protein supplementation, they might be ingesting proteins less efficiently.,11, 12 Finally, recent studies demonstrated that supplementation of the diet with EAAs improves lean body mass, strength and physical function in elderly subjects13 and it is potentially an efficient method of increasing protein intake without affecting satiety.14 So, using EAAs may be an obliged method to boost protein synthesis in elderly patients. In order these latter may improve several determinants of quality of life, including depressive symptoms, nutrition, muscle function and daily life activity.

Section snippets

Subjects

Subjects were recruited from a nursing home in Pavia (RSA “F. Pertusati”), where they had been institutionalized for at least 3 months before enrollment; the eligible participants were male and females aged between 75 and 95 years.

Patients with altered glycometabolic control, diabetes mellitus, dis thyroidism and other endocrinopathies and renal failure were excluded.

Indeed these diseases per se may potentially have a negative impact on protein synthesis.

In addition, the selected patients had

Results

All 300 patients institutionalized in the nursing home were assessed for eligibility: 72 were eligible participants. A total of forty-one subjects were enrolled, out of 72 eligible participants: 10 cases were excluded because they refused to participate and 21 had laboratory abnormalities (severe ischemic heart disease in eight cases, uncontrolled diabetes in seven cases, hypertension not properly controlled by pharmacological treatment at the observation time in four case, and increased

Discussion

The study indicates that supplemented EAAs to elderly patients may improve depressive symptoms and physical performance and potentiates the retrieval of QoL, muscle strength and nutritional status. The GDS score of the subjects studied indicates that they were suffering from moderate depression, which is widespread in the nursing home population26.

Improvement of depression is of great clinical significance as depressive symptoms is associated with a number of adverse conditions4 including

Statement of authorship

None of the authors had a financial or personal interest in any company or organization sponsoring this study.

Conflict of interest

All authors disclose any financial and personal relationships with other people or organisations that could inappropriately influence this work.

Acknowledgments

We would like to thank Prof. Robert Coates (Centro Linguistico, Bocconi University, via Sarfatti, Milano, Italy), medical writer, for his linguistic revision.

MR and RA designed research; MR, NA and AO conducted research; PI provided essential materials; FB performed statistical analysis; MR, EP and RA wrote paper; MR, AO, RA, FB, EP, NA had primary responsibility for final content. FSD helped the authors to discuss the study.

References (37)

  • A.H. Beattie et al.

    A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients

    Gut

    (2000)
  • A.E. Mackenzie et al.

    Predictors of quality of life following stroke

    Disabil Rehabil

    (2002)
  • R.S. Bhat et al.

    Nutrition and geriatric psychiatry: a neglected field

    Curr Opin Psychiatry

    (2005)
  • D. Ames

    Depressive disorders among elderly people in long-term institutional care

    Aust N Z J Psychiatry

    (1993)
  • Y.I.L. Shyu et al.

    Severity of depression risk predicts health outcomes and recovery following surgery for hip-fractured elders

    Osteoporos Int

    (2008)
  • R. Aquilani et al.

    Adequate energy-protein intake is not enough to improve nutritional and metabolic status in muscle-depleted patients with chronic heart failure

    Eur J Heart Fail

    (2008)
  • J.D. Fernstrom et al.

    Neutral amino acids in the brain: changes in response to food ingestion

    J Neurochem

    (1978)
  • S. Walrand et al.

    Optimizing protein intake in aging

    Curr Opin Clin Nutr Metab Care

    (2005)
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