Effect of beta-hydroxy-beta-methylbutyrate (HMB) supplementation with nutritional counselling in patients on the waiting list for liver transplantation.

• Autor(a) principal: Samanta Catherine Ferreira
• Data de Publicação: 2023
• Tipo de documento: Tese
• Idioma: eng
• Título da fonte: Repositório Institucional da UFMG
• Texto Completo: http://hdl.handle.net/1843/62152; https://orcid.org/0000-0002-6240-8488
• topic: Liver transplantation; Skeletal muscle; Muscle strength; Quality of life; Beta-hydroxy-beta-methylbutyrate (HMB); Supplementation; Malnutrition; Dietary intake; Nutritional intervention

Objective: The primary aim of this study was to evaluate the effects of HMB supplementation with nutritional counseling on anthropometric measures of muscle mass, strength, functionality, and quality of life in patients waiting for liver transplantation (LTx). The secondary aim was to evaluate food intake during 12 weeks of nutritional follow-up and assess factors independently associated with the difference between caloric and protein (end-beginning) intake in patients on the waiting list for liver transplantation LTx. Methods: Double-blind, randomized study with supplementation of 3.0g of HMB or active control with nutritional counseling for 12 weeks in patients >18y, evaluated at five moments. Body composition and anthropometric data (resistance, reactance, phase angle, weight, body mass index (BMI), arm circumference (AC), arm muscle area, and adductor pollicis muscle thickness) were collected. Muscle strength was assessed using dynamometry, physical function was evaluated using the frailty index (FI), and quality of life was also evaluated. Dietary guidelines for patients with cirrhosis were used to prescribe the nutritional plan (35kcal/kg; 1.5g/kg dry weight for protein; other nutrients according to Dietary Recommended Allowances - DRIs; late evening snack) and to evaluate the nutritional goals (30kcal/kg; 1.2g/kg dry weight for protein). Food intake was assessed and quantified using 24-hour recall and food records in six moments: Baseline, week 0 (W0), week 2 (W2), week 4 (W4), week 8 (W8), and week 12 (W12). Data were evaluated using SPSS 22.0. The modified intention-to-treat principle was adopted. Differences between weeks and supplements were performed using the Generalized Estimating Equation (GEE) test. Dietetic consumption was evaluated through the weeks using the paired t-test or Wilcoxon test. Linear regression models were performed to identify factors independently associated with the difference between caloric (kcal/kg) and protein intake (g/kg) in W12- Baseline. The level of significance was 5%. Results: Forty-seven patients were enrolled [HMB: 23; active control: 24]. There was a significant difference in both groups for AC (p=0.03), dynamometry (p=0.02), and FI (p=0.01). There was an increase in dynamometry between T0 and T12 in both groups [HMB (Δdynamometry: 10.1±16.4%; p<0.05); active control (Δdynamometry: 23.0±70.3%; p<0.05)]. The AC increased in both groups between T0 and T4 [HMB (ΔAC: 0.9±2.8%; p<0.05); active control (ΔAC: 1.6±3.6%; p<0.05)] and between T0 and T12 [HMB (ΔAC: 3.2±6.7%; p<0.05); active control (ΔAC: 2.1±6.6%; p<0.05)]. The FI decreased in both groups, between T0 and T4 [HMB (ΔFI: -4.2±6.9%; p<0.05); active control (ΔFI: -3.2±9.6%; p<0.05)] and between T0 and T12 [HMB (ΔFI: -4.4±11.2%; p<0.05); active control (ΔFI: -5.5±11.3%; p<0.05)]. The other variables did not change (p>0.05). About food intake, only 25.5%(n=12) of patients consumed more than 30kcal/kg, and 36.2% (n=17) more than 1.2g/kg of protein in 12 weeks of follow-up. The mean energy intake at baseline was 1782±784kcal (27.6±13.2kcal/kg), and in W12, 1695±413kcal (26.9±7.7kcal/kg; p>0.05), without difference between times. The mean of protein intake in baseline was 70.4±38.4g [1.0 (0.2 – 3.1g/kg)] and 67.5±22.7g [1.0 (0.3 – 2.5 g/kg)] in W12. The total protein intake g/kg increased between week W0 [63.4±29.8g; 0.8 (0.2 – 2.2g/kg)] and W8 [72.0±28.0g; 1.0 (0.4 – 2.6g/kg; p=0.026; p=0.032, respectively]. The consumption of cholesterol, calcium, phosphorus, magnesium, iron, and niacin increased (p<0.05) during follow-up, as well as the consumption of the leguminous; roots and tubers; dairy; and meat, poultry, and fish groups through the time (p<0.05). The presence of ascites, subjective global assessment classification, frailty index classification, short physical performance battery score, systemic symptoms, and emotional function were independently associated with the caloric intake difference between W12- Baseline (p<0.05). Diabetes mellitus, subjective global assessment, poor performance, fatigue, systemic symptoms, and emotional function were independently associated with the difference in protein intake between W12-Baseline (p<0.05). Conclusion: The nutritional intervention with supplementation with HMB or active control in patients on the liver transplant waiting list improved arm circumference and dynamometry and reduced the frailty index in both groups. Concerning food intake, patients on the waiting list for LTx modestly improved food intake during nutritional follow-up, but only a few patients could reach the nutritional recommendations of current guidelines. Some clinical and nutritional variables independently influenced caloric and proteic intake between W12-Baseline weeks.