Glycine increases fat-free mass in malnourished haemodialysis patients: a randomized double-blind crossover trial

Laurence Genton, Daniel Teta, Menno Pruijm, Catherine Stoermann, Nicola Marangon, Julie Mareschal, Isabelle Bassi, Arelene Wurzner-Ghajarzadeh, Vladimir Lazarevic, Luc Cynober, Patrice D Cani, François R Herrmann, Jacques Schrenzel, Laurence Genton, Daniel Teta, Menno Pruijm, Catherine Stoermann, Nicola Marangon, Julie Mareschal, Isabelle Bassi, Arelene Wurzner-Ghajarzadeh, Vladimir Lazarevic, Luc Cynober, Patrice D Cani, François R Herrmann, Jacques Schrenzel

Abstract

Background: Protein energy wasting is associated with negative outcome in patients under chronic haemodialysis (HD). Branched-chain amino acids (BCAAs) may increase the muscle mass. This post hoc analysis of a controlled double-blind randomized crossover study assessed the impact of BCAAs on nutritional status, physical function, and quality of life.

Methods: We included 36 chronic HD patient features of protein energy wasting as plasma albumin <38 g/L, and dietary intakes <30 kcal/kg/day and <1 g protein/kg/day. Patients received either oral BCAA (2 × 7 g/day) or glycine (2 × 7 g/day) for 4 months (Period 1), followed by a washout period of 1 month, and then received the opposite supplement (Period 2). The outcomes were lean body mass measured by dual-energy X-ray absorptiometry, fat-free mass index measured by bioelectrical impedance, resting energy expenditure, dietary intake and appetite rating, physical activity and function, quality of life, and blood parameters. Analyses were performed by multiple mixed linear regressions including type of supplementation, months, period, sex, and age as fixed effects and subjects as random intercepts.

Results: Twenty-seven patients (61.2 ± 13.7 years, 41% women) were compliant to the supplementations (consumption >80% of packs) and completed the study. BCAA did not affect lean body mass index and body weight, but significantly decreased fat-free mass index, as compared with glycine (coeff -0.27, 95% confidence interval -0.43 to -0.10, P = 0.002, respectively). BCAA and glycine intake had no effect on the other clinical parameters, blood chemistry tests, or plasma amino acids.

Conclusions: Branched-chain amino acid did not improve lean body mass as compared with glycine. Unexpectedly, glycine improved fat-free mass index in HD patients, as compared with BCAA. Whether long-term supplementation with glycine improves the clinical outcome remains to be demonstrated.

Trial registration: ClinicalTrials.gov NCT02962089.

Keywords: Amino acids; Body composition; Lean body mass; Malnutrition.

Conflict of interest statement

L.G. has received grants from the Swiss National Science Foundation, Alfred and Alice Lachmann Foundation, and Fresenius Kabi; speaker honoraria from Fresenius Kabi; advisory honoraria from Baxter and Abbott; and travel grants from Nestlé Health Science and Abbott. P.D.C. is a co‐founder of A‐Mansia Biotech S.A. (Belgium) and owner of several patents concerning the use of specific bacteria or components on the treatment of obesity, diabetes, and cardiometabolic disorders. D.T. has received grants from Fresenius Medical Care, Amgen, and Baxter; speaker honoraria from Fresenius Medical Care, B. Braun, Abbott International, Baxter, Genzyme, and Sanofi Aventis; travel grants for Fresenius Medical Care, Amgen, and Vifor; and a grant for teaching material from Abbott International. M.P., C.S., N.M., J.M., I.B., A.W.‐G., V.L., L.C., F.H., and J.S. have no conflicts of interest.

© 2021 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.

Figures

Figure 1
Figure 1
Line plot showing the evolution of (A) weight (kg), (B) lean body mass index (kg/m2), (C) fat mass index (DXA), (D) fat‐free mass index (kg/m2/day), and (E) fat mass index (BIA) (kg) in the BCAA–glycine group (black squares and line) and in the glycine–BCAA group (grey dots and line). The grey zone indicates the washout period, which occurred for each patient between Months 4 and 5.

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