Evaluation of the recovery after heart surgery following preoperative supplementation with a combination of beta-hydroxy-beta-methylbutyrate, L-arginine, and L-glutamine: a double-blind randomized placebo-controlled clinical trial.

2022-08-13
Trials 23(1)
- Mona Norouzi
- Azadeh Nadjarzadeh
- Majid Maleki
- Sayyed Saeid Khayyatzadeh
- Saeid Hosseini
- Mehdi Yaseri
- Hamed Fattahi

PubMed: 35964137
DOI: 10.1186/s13063-022-06621-1

Study Design

Type: Randomized Controlled Trial (RCT)
Sample size: n = 70
Population: 70 patients undergoing cardiac surgery
Methods: randomized clinical trial, 2 sachets of a combination of 7 g L-arginine, 7 g L-glutamine, and 1.5 g daily HMB or placebo 30 days before operation
Duration: 30 days before operation

Background

The preoperative period is a good time to improve nutrition status, compensate for nutrient deficiencies, and optimize immune function in patients' underlying surgery. In some medical conditions, supplementation with a combination of L-glutamine (Gln), β-hydroxy-β-methylbutyrate (HMB), and L-arginine (Arg) had promising effects on improving recovery. The present study aimed to evaluate the effect of supplementation with Gln/Arg/HMB in patients undergoing heart surgery.

Methods

This randomized clinical trial was conducted on 70 patients undergoing cardiac surgery. Participants were requested to consume 2 sachets of a combination of 7 g L-arginine, 7 g L-glutamine, and 1.5 g daily HMB or placebo 30 days before operation. At the baseline and end of the study, left ventricular ejection fraction and the serum levels of troponin, creatine phosphokinase (CPK), CPK-MB, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin were measured. Also, the Sequential Organ Failure Assessment (SOFA) score, time of stay in hospital and intensive care unit (ICU), and postoperative complications were recorded after surgery.

Results

In total, 60 preoperative patients (30 in each group) with a mean age of 53.13 ± 14.35 years completed the study (attrition rate = 85.7%). Subjects in the Gln/Arg/HMB group had lower serum levels of CPK-MB (median [IQR] = 49 [39.75] vs. 83 [64.55]; P = 0.011), troponin (median [IQR] = 2.13 [1.89] vs. 4.34 [1.99]; P < 0.001), bilirubin (median [IQR] = 0.50 [0.20] vs. 0.40 [0.22]; P < 0.001), and SOFA score (median [IQR] = 2 [2] vs. 5 [2]; P < 0.001) at end of the study compared to the placebo. Also, the time of stay in the hospital (median [IQR] = 5 [1] vs. 6 [3]; P < 0.001) and ICU (median [IQR] = 2.50 [1.00] vs. 3.50 [1.50]; P = 0.002) was lower in the Gln/Arg/HMB group.

Conclusion

The present study showed that perioperative supplementation with a combination of Gln, Arg, and HMB enhances the recovery, reduces myocardial injury, and decreases the time of hospital and ICU stay in cardiac surgery patients. These results need to be confirmed in a larger trial.

Trial registration

IRCT.ir IRCT20120913010826N31. Registered on 13 October 2020.

Research Insights

L-Arginine→Reduced Hospital Stay
time of stay in the hospital (median [IQR] = 5 [1] vs. 6 [3]; P < 0.001) and ICU (median [IQR] = 2.50 [1.00] vs. 3.50 [1.50]; P = 0.002) was lower in the Gln/Arg/HMB group
Effect
Beneficial
Effect size
Moderate
Dose
7 g daily
L-Arginine→Reduced Intensive Care Unit Stay
time of stay in the hospital (median [IQR] = 5 [1] vs. 6 [3]; P < 0.001) and ICU (median [IQR] = 2.50 [1.00] vs. 3.50 [1.50]; P = 0.002) was lower in the Gln/Arg/HMB group
Effect
Beneficial
Effect size
Moderate
Dose
7 g daily
L-Arginine→Reduced Liver Injury Marker
Subjects in the Gln/Arg/HMB group had lower serum levels of ... bilirubin (median [IQR] = 0.50 [0.20] vs. 0.40 [0.22]; P < 0.001)
Effect
Beneficial
Effect size
Moderate
Dose
7 g daily
L-Arginine→Reduced Myocardial Injury
Subjects in the Gln/Arg/HMB group had lower serum levels of CPK-MB (median [IQR] = 49 [39.75] vs. 83 [64.55]; P = 0.011), troponin (median [IQR] = 2.13 [1.89] vs. 4.34 [1.99]; P < 0.001)
Effect
Beneficial
Effect size
Moderate
Dose
7 g daily
L-Arginine→Reduced Organ Failure Severity
Subjects in the Gln/Arg/HMB group had lower ... SOFA score (median [IQR] = 2 [2] vs. 5 [2]; P < 0.001)
Effect
Beneficial
Effect size
Large
Dose
7 g daily
L-Glutamine→Reduced Hospital Stay
time of stay in the hospital (median [IQR] = 5 [1] vs. 6 [3]; P < 0.001) and ICU (median [IQR] = 2.50 [1.00] vs. 3.50 [1.50]; P = 0.002) was lower in the Gln/Arg/HMB group
Effect
Beneficial
Effect size
Moderate
Dose
7 g daily
L-Glutamine→Reduced Intensive Care Unit Stay
time of stay in the hospital (median [IQR] = 5 [1] vs. 6 [3]; P < 0.001) and ICU (median [IQR] = 2.50 [1.00] vs. 3.50 [1.50]; P = 0.002) was lower in the Gln/Arg/HMB group
Effect
Beneficial
Effect size
Moderate
Dose
7 g daily
L-Glutamine→Reduced Liver Injury Marker
Subjects in the Gln/Arg/HMB group had lower serum levels of ... bilirubin (median [IQR] = 0.50 [0.20] vs. 0.40 [0.22]; P < 0.001)
Effect
Beneficial
Effect size
Moderate
Dose
7 g daily
L-Glutamine→Reduced Myocardial Injury
Subjects in the Gln/Arg/HMB group had lower serum levels of CPK-MB (median [IQR] = 49 [39.75] vs. 83 [64.55]; P = 0.011), troponin (median [IQR] = 2.13 [1.89] vs. 4.34 [1.99]; P < 0.001)
Effect
Beneficial
Effect size
Moderate
Dose
7 g daily
L-Glutamine→Reduced Organ Failure Severity
Subjects in the Gln/Arg/HMB group had lower ... SOFA score (median [IQR] = 2 [2] vs. 5 [2]; P < 0.001)
Effect
Beneficial
Effect size
Large
Dose
7 g daily