Perioperative Nutritional Support With Beta-hydroxy-beta-methylbutyrate, Arginine, and Glutamine in Surgery for Abdominal Malignancies

Noriko Wada, MD, PhD; Yukinori Kurokawa, MD, PhD; Koji Tanaka, MD, PhD; Yasuhiro Miyazaki, MD, PhD; Tomoki Makino, MD, PhD; Tsuyoshi Takahashi, MD, PhD; Hiroshi Wada, MD, PhD; Makoto Yamasaki, MD, PhD; Kiyokazu Nakajima, MD, PhD; Hidetoshi Eguchi, MD, PhD; Shuji Takiguchi, MD, PhD; Masaki Mori, MD, PhD; Yuichiro Doki, MD, PhD

Disclosures

Wounds. 2018;30(9):251-256. 

In This Article

Abstract and Introduction

Abstract

Although beta-hydroxy-beta-methylbutyrate (HMB), arginine (Arg), and glutamine (Gln) may contribute to wound healing, no prospective studies have investigated the efficacy of a compound consisting of HMB, Arg, and Gln (HMB/Arg/Gln) for reducing wound complications following open abdominal surgery.

Objective: This study evaluates the usefulness of perioperative nutrition using HMB/Arg/Gln in patients who were scheduled to undergo open surgery for abdominal malignancies in a randomized controlled trial.

Materials and Methods: Patients scheduled for open surgery for abdominal malignancies were randomized to receive HMB/Arg/Gln (1.2 g HMB, 7 g L-Arg, and 7 g L-Gln) or placebo (isocaloric juice). The supplements were provided once daily for 3 days preoperatively and once daily for 7 days postoperatively. The primary endpoint was the incidence of wound complications. Secondary endpoints included the incidence of other complications, postoperative duration of hospital stay, total-body skeletal muscle mass, handgrip strength, and skin water content.

Results: Sixty-one patients were randomly assigned to either the HMB/Arg/Gln (n = 31) or the placebo (n = 30) group. One patient in the HMB/Arg/Gln group was ineligible because laparoscopic surgery was performed; thus, 60 patients were analyzed. The incidence of wound complications (20%) was the same in both groups (P = 1.000). There were no significant differences in the incidence of other complications, body composition, handgrip strength, or skin water content between the 2 groups. Serum growth hormone (GH) levels were significantly higher for patients whose total intake was > 80% of planned volume in the HMB/Arg/Gln group.

Conclusions: The incidence of wound complications would not be reduced by perioperative HMB/Arg/Gln administration in patients who underwent open surgery. The efficacy of HMB/Arg/Gln for increasing serum GH levels needs to be validated in another large-scale randomized controlled trial.

Introduction

Wound complications are common following open surgery,[1] with reported incidences of wound infection of 6.3% to 18.2% after open gastrectomy,[2–4] 5.8% to 18.8% after open distal pancreatectomy,[5–7] and 13.3% to 18.0% after open hepatectomy.[8,9] One of the main causes of wound complications is delayed wound healing. The healing process relies on collagen synthesis, and nutrients such as arginine (Arg) and glutamine (Gln), which promote collagen synthesis, play an important role and decrease the rate of wound complications.[10,11] The maintenance of lean body mass (LBM) is another essential factor that influences wound healing. When there is insufficient protein levels to heal a wound, LBM supplies the amino acids for protein synthesis. Therefore, the loss of LBM is directly related to delayed wound healing. Beta-hydroxy-beta-methylbutyrate (HMB), a leucine (Leu) metabolite, has been shown to increase LBM by stimulating muscle protein synthesis.[12–15]

A compound consisting of HMB, Arg, and Gln (HMB/Arg/Gln) was shown to promote collagen synthesis, contribute to wound healing, and maintain LBM.[14,15] When sterile polytetrafluoroethylene tubes were implanted for 14 days in the subcutaneous tissue of healthy elderly adults with or without HMB/Arg/Gln supplementation, the amount of collagen synthesized in the tubes was significantly higher in the HMB/Arg/Gln group.[16] Tatti and Barber[17] reported that diabetic foot ulcers healed significantly more quickly when HMB/Arg/Gln was administered. A meta-analysis[12] found LBM was significantly increased in healthy adults following the administration of HMB. However, no prospective studies have investigated the efficacy of HMB/Arg/Gln in reducing wound complications or maintaining LBM following open abdominal surgery. Thus, this study evaluates the usefulness of perioperative nutrition using HMB/Arg/Gln in patients who were scheduled to undergo open surgery for abdominal malignancies in a randomized controlled trial (RCT).

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....