Is your doctor even measuring your muscle wasting?
New technique helps determine degree of muscle wasting in critically ill patients
Influence of essential amino acids on muscle mass and muscle strength in patients with cerebral stroke during early rehabilitation: protocol and rationale of a randomized clinical trial (AMINO-Stroke Study)
- Nadja ScherbakovView ORCID ID profile,
- Nicole Ebner,
- Anja Sandek,
- Andreas Meisel,
- Karl Georg Haeusler,
- Stephan von Haehling,
- Stefan D. Anker,
- Ulrich Dirnagl,
- Michael Joebges and
- Wolfram DoehnerEmail author
BMC NeurologyBMC series – open, inclusive and trusted201616:10
DOI: 10.1186/s12883-016-0531-5
© Scherbakov et al. 2016
Received: 24 October 2015
Accepted: 14 January 2016
Published: 22 January 2016
Abstract
Background
Patients with stroke are at a
high risk for long-term handicap and disability. In the first weeks
after stroke muscle wasting is observed frequently. Early post-stroke
rehabilitation programs are directed to improve functional independence
and physical performance. Supplementation with essential amino acids
(EAAs) might prevent muscle wasting and improve rehabilitation outcome
by augmenting muscle mass and muscle strength. We aim to examine this in
a double blinded, randomized placebo-controlled clinical trial.
Methods
Patients with ischemic or
haemorrhagic stroke will be enrolled at begin of the early post-stroke
rehabilitation in a parallel group interventional trial. Oral
supplementation of EAAs or placebo will be given for 12 weeks in a
double blinded manner. Physical and functional performance will be
assessed by exercise testing before supplementation of EAAs as well as
at discharge from the in-patient rehabilitation, at 12 weeks and 1 year
afterwards.
Discussion
This is the first randomized
double-blinded placebo-controlled clinical study aiming to assess the
effect of the EAAs supplementation on muscle strength, muscle function
and physical performance in stroke patients during early post-stroke
rehabilitation. Supplementation of EAAs could prevent muscle mass
wasting and improve functional independence after stroke.
Trial registration
The study is registered at the German registry for clinical trials as well as at World Health Organization (WHO; number DRKS00005577).
Keywords
Double blinded randomized study Post-stroke rehabilitation Skeletal muscle wasting Physical performance Essential amino acidsBackground
Long-term
disability and functional dependency are the main complications after
stroke. Impaired skeletal muscle innervation due to damage results in
the degeneration of motor units, paresis, and immobility accompanied by
skeletal muscle atrophy [1–4].
Notably, loss of muscle mass and muscle function, defined as
sarcopenia, have been originally described as a phenomenon of aging [5].
However, muscle wasting observed in stroke patients is a
disease-related phenomenon and the term ‘stroke-related sarcopenia’ has
been suggested [1]. The aetiology of sarcopenia is multifactorial [6].
This is also true for stroke-depended sarcopenia. Several
pathophysiological mechanisms including metabolic imbalance, inactivity,
malnutrition, and inflammation may contribute to the reduction of
muscle mass after stroke [7, 8].
Stroke-related muscle wasting is accompanied by body weight loss,
neuro-hormonal activation, and a systemic shift towards catabolic
over-activation [8].
In addition, activation of catabolic pathways in the skeletal muscle of
the paretic and non-paretic limbs has been observed in experimental
stroke [9].
Early
rehabilitation has a great impact on the functional recovery after
stroke. A previous study showed that 80 % of the patients achieve best
functional recovery within 6 weeks after stroke, and after 12.5 weeks
95 % of all stroke patients completed their functional recovery [10]. However, one year after stroke more than 30 % of the patients remained functionally dependent [11].
Skeletal
muscles play a central role in post-stroke rehabilitation. The goal of
rehabilitation is to restore functional muscle capacity and to prevent
long-term disability. Therefore, prevention of muscle wasting,
increasing muscle strength, reactive development of novel neuromuscular
junctions, and stabilisation of the catabolic-anabolic imbalance are
primary aims of post-stroke rehabilitation.
Nutritional
intervention may contribute to the improvement of muscle bulk and
functional capacity in the early post-stroke rehabilitation. Thus, a
beneficial effect of dietary supplementation of essential amino acids
(EAAs) has been shown for an improvement of skeletal muscle mass and
function in the elderly [12, 13]. Availability of EAAs is regarded as a limiting step in the synthesis of new muscle proteins [14].
Previously it has been shown that supplementation of EAAs in the
elderly was responsible for amino acid-induced stimulation of muscle
protein anabolism [15].
Therefore, an individually adjusted rehabilitation program that
includes physical, functional and neuropsychological training as well as
dietary supplementation of the EAA might provide the best
rehabilitation outcome. Thus, in the present clinical trial the
following hypotheses will be tested:
-
Oral uptake of EAAs restores skeletal muscle function and physical performance;
-
Oral uptake of EAAs contributes to physical independence and enhances the effectiveness of post-stroke rehabilitation;
-
Availability of EAAs reduces muscle wasting after stroke.
We
aim to demonstrate that nutritional supplementation with biologically
limited available EAAs (l-leucine, l-lysine, l-isoleucine, l-valine,
l-threonine, l-cystine, l-histidin, l-phenylalanine, l-methionine,
l-tyrosin, and l-tryptophane), in synergy with individually adjusted
physical training prevent muscle wasting after stroke and improve the
effect of post-stroke early rehabilitation.
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