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)

Have your doctor follow this study and be ready to create a diet stroke protocol if successful. I'm sure this will fall by the wayside regardless of result because we have NO stroke leadership or strategy.
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 acids

Background

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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