Impact of protein pulse feeding on lean mass in malnourished and at-risk hospitalized elderly patients: A randomized controlled trial

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2013-04, Vol.32 (2), p.186-192
• Main Authors: Bouillanne, Olivier, Curis, Emmanuel, Hamon-Vilcot, Brigitte, Nicolis, Ioannis, Chrétien, Pascale, Schauer, Nathalie, Vincent, Jean-Pierre, Cynober, Luc, Aussel, Christian
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon; Activities of Daily Living; Aged, 80 and over; Aging; amino acids; Appendicular muscle mass; bioelectrical impedance; Biological and medical sciences; Body cell mass; body composition; Body Composition - drug effects; Body Mass Index; Body Weight; confidence interval; Diet; dietary protein; Dietary Proteins - administration & dosage; Elderly; Energy Intake; Feeding. Feeding behavior; Female; Follow-Up Studies; food intake; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; Hand Strength - physiology; Hospitalization; Humans; Lean mass; Male; Malnutrition; Malnutrition - diet therapy; Meals; Medical sciences; Metabolic diseases; Muscle, Skeletal - drug effects; Nutrition Assessment; Nutritional Status; Orosomucoid - analysis; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); patients; physical activity; Prealbumin - analysis; Prospective Studies; protein intake; Protein pulse feeding; protein synthesis; randomized clinical trials; Serum Albumin - administration & dosage; skeletal muscle; Treatment Outcome; Vertebrates: anatomy and physiology, studies on body, several organs or systems; X-radiation
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2012.08.015

Summary Background & aims Aging is associated with a blunted anabolic response to dietary intake, possibly related to a decrease in systemically available amino acids (AAs), which in turn may stem from increased splanchnic AA metabolism. This splanchnic sequestration can be saturated by pulse feeding (80% of daily protein intake in a single meal), enabling increased protein synthesis. This study aimed to evaluate the efficacy of a new nutritional strategy, termed protein pulse feeding. Methods This prospective randomized study ( ClinicalTrials.gov registration number NCT00135590) enrolled 66 elderly malnourished or at-risk patients in an inpatient rehabilitation unit. All were given a controlled diet for 6 weeks. In a spread diet (SD) group ( n  = 36), dietary protein was spread over the four daily meals. In a pulse diet (PD) group ( n  = 30), 72% of dietary protein (1.31 g/kg weight/d on average) was consumed in one meal at noon. The patients were evaluated at admission and at 6 weeks for body composition [lean mass (LM), appendicular skeletal muscle mass (ASMM), and body cell mass (BCM) indices, measured by X-ray absorptiometry combined with bioelectrical impedance analysis] (primary outcome), hand grip strength, and activities of daily living (ADL) score. Results Protein pulse feeding was significantly more efficacious than protein spread feeding in improving LM index (mean changes from baseline for PD group: +0.38 kg/m2 ; 95% confidence interval (CI), [0; 0.60]; for SD group: −0.21 kg/m2 ; 95% CI, [−0.61; 0.20]; p  = 0.005 between the two groups), ASMM index (+0.21 kg/m2 ; 95% CI, [0; 0.34] and −0.11 kg/m2 ; 95% CI, [−0.20; 0.09]; p  = 0.022), BCM index (+0.44 kg/m2 ; 95% CI, [0.08; 0.52] and −0.04 kg/m2 ; 95% CI, [−0.09; 0.10]; p  = 0.004). There was no significant effect for hand-grip strength or ADL score. Conclusions This study demonstrates for the first time that protein pulse feeding has a positive, clinically relevant effect on lean mass in malnourished and at-risk hospitalized elderly patients.