Abstract 15928: Supplementation of L-Alanyl Glutamine and Fish Oil Improves Body Composition and Quality of Life in Patients With Advanced Heart Failure
Introduction: Reduced skeletal muscle mass, strength and exercise capacity have been described in subjects with heart failure (HF). Prior studies suggest beneficial effects of ω-3 polyunsaturated fatty acids (PUFAs) on exercise performance in patients with HF.
Hypothesis: Supplementation of L-alanyl glutamine and PUFA (GLUTFISH) increases oxidative function, muscle strength and exercise performance in patients with HF.
Methods: In a randomized double-blind, placebo-controlled trial, 31 patients with advanced HF (age 59±10 yrs, BMI 28.7±3.8kg/m2, LVEF 27.9±7.8%, peak VO2 15.3±3.8mL/kg/min) were randomized to L-alanyl glutamine (8g/d) and PUFA (6.5g/d) or placebo (safflower oil and milk powder; PLACEBO) for 3 months. 6 minute walk test (6MWT), hand grip strength (HGS), Biodex muscle testing, echocardiography and quality of life questionnaires were performed at baseline, 1 and 3 months. Cardiopulmonary stress test (CPET), dual-energy X-ray absorptiometry (DEXA) and lateral quadriceps muscle biopsy were performed at baseline and at 3 months. Immunohistology, fatty acid oxidation and gene expression were performed on the skeletal muscle biopsies.
Results: There were no differences in muscle function, echocardiography, 6MWT or HGS. There was a non-significant increase in peak VO2 on GLUTFISH (8±18 vs 3±17%; p=0.39). Lean muscle mass increased on GLUTFISH (54.4±9.9 to 56.1±9.4 kg at 3 months; p=0.04).Quality of life assessed by the Minnesota Living with HF Questionnaire improved on GLUTFISH (36±22 to 24±16; p=0.02). Using the Kansas City Cardiomyopathy Questionnaire, patients on GLUTFISH improved quality of life (62±27 to 75±16; p=0.04), social limitations (72±24 to 86±15; p=0.006) and overall score (73±19 to 83±12; p=0.04). Molecular analysis revealed no differences in muscle fiber composition, fiber cross sectional area, gene expression of metabolic marker genes (PGC1a, CPT1, PDK4, GLUT4) and fatty acid oxidation rates.
Conclusion: GLUTFISH did not improve exercise performance or muscle function but increased lean muscle mass and quality of life in patients with advanced HF. These findings suggest that combined supplementation of L-alanyl glutamine and PUFA may improve quality of life and body composition in patients with advanced HF.
- © 2013 by American Heart Association, Inc.