ESPEN 2020 Abstract Submission

Topic: Nutrition and chronic disease

Abstract Submission Identifier: ESPEN20-ABS-1166

GLYCINE, BUT NOT BRANCHED CHAIN AMINO ACIDS, INCREASES FAT-FREE MASS IN CHRONIC HEMODIALYSIS PATIENTS: A RANDOMIZED DOUBLE-BLIND CROSS-OVER TRIAL

L. Genton Graf^*, ¹, M. Pruijm ², D. Teta ³, C. Stoermann ⁴, N. Marangon ⁵, J. Mareschal ¹, A. Wurzner-Ghajarzadeh ², R. Solano ³, V. Lazarevic ⁶, N. Gaia ⁶, P. Cani ⁷, F. Herrmann ⁸, J. Schrenzel ⁹

¹Clinical Nutrition, University Hospitals of Geneva, Geneva, ²Nephrology, University Hospital of Lausanne, Lausanne, ³Nephrology, Cantonal Hospital of Sion, Sion, ⁴Nephrology, University Hospitals of Geneva, ⁵Nephrology, Clinique Champel, ⁶Genomic Research Lab, University Hospitals of Geneva, Geneva, Switzerland, ⁷Louvain Drug Research Institute Welbio, Metabolism and Nutrition Research Group, University of Louvain, Louvain, Belgium, ⁸Rehabilitation and Geriatrics, ⁹Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland

Rationale: Low muscle mass is associated with negative outcome in chronic hemodialysis (HD) patients. Branched-chain amino acids (BCAA) may increase the muscle mass in HD patients. This multi-center placebo-controlled double-blind randomized cross-over study aimed at studying the impact of BCAA on lean body mass.

Methods: We randomized 36 chronic HD patients, with plasma albumin <38g/l or body weight loss >5% of dry body weight, and dietary intakes <30 kcal/kg/d and <1g protein/kg/d. Patients received either oral BCAA (2x7g/d) or an isocaloric placebo consisting of glycine (2x7g/d) for 4 months, followed by a 1-month wash-out period, and the opposite supplement. Primary outcome was lean body mass measured by dual-energy X-ray absorptiometry, secondary outcomes were fat-free mass index measured by bioelectrical impedance (Nutrigard®, Geneva formula)¹ resting energy expenditure, dietary intake, 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 compliant patients (61.2±13.7 yrs, 41% women) completed the study. The type of supplementation did not affect lean body mass index and body weight, but BCAA significantly decreased fat-free mass index, as compared to the placebo containing glycine (coeff -0.27, 95%CI -0.43 to -0.10, p=0.002, respectively). BCAA intake increased plasma transthyretin (coeff 14.10, 95%CI 5.38 to 22.8, p=0.002). BCAA and glycine intake had no effect on the other clinical parameters, blood chemistry tests or plasma amino acids.

Conclusion: BCAA did not improve lean body mass as compared to glycine. Unexpectedly, glycine improved fat-free mass in HD patients, as compared to BCAA. Whether long-term glycine administration might improve the clinical outcomes remains to be demonstrated.

References: 1. Kyle et al, Nutrition17, 248-253, 2001

Disclosure of Interest: None Declared

Keywords: Glycine, Hemodialysis