Malnutrition, Sarcopenia
Conditions
Keywords
malnutrition, sarcopenia, immune system, Mitochondria, oxydative stress, inflammaegeing, branch-chained aminoacids, micronutrients, nutrition
Brief summary
Aging is associated with an increased inflammation named inflammageing and with an altered immune response. Different mechanisms have been proposed to explain the phenomenon of inflammageing and increased oxidative stress: deficiencies in essential amino acids, and some micronutrients have an important impact and may induce immune cell dysregulation. Mitochondrial dysfunction may explain the complex relationship between malnutrition sarcopenia, immune dysfunction and aging. Therefore, a personalized nutritional strategy aiming to improve mitochondrial function, decrease oxidative stress, down-regulate inflammation and restore immunity appears to be a logical approach in order to treat malnutrition and its biological and clinical consequences. MIMOSA will investigate the role of nutritional supplements in rescuing altered mitochondrial function and redox state imbalance.
Detailed description
The study participants will all receive optimal standard care ensuring the optimal protein and energy intakes, with at least 1 g protein per kg body weight and day, and 30 kcal per kg body weight and day (or the measured energy expenditure (EE) value). This will be realized by the daily administration of oral nutritional supplements (ONS) providing whole proteins together with dietary advice \[according with the ESPEN nutrition guidelines. All the patients will receive the standard commercially available product used at CHUV (Resource protein ®, Nestlé) and nutritional counselling (SC). All participants included in this study will receive daily, the oral nutritional supplement (ONS), one sachet and two capsule (for blinding purpose). The intervention nutrients will be delivered as follows: * BCAA: 1 sachet containing 4 g of BCAA (details in Table 1) * Micronutrients: 1 sachet containing 4 g of the micronutrient blend and 2 capsules containing 0.6 g of OMEGA 3 PUFA (details in table 1). The placebos will be delivered like this: -1 sachet containing 1 g of maltodextrin and 2 capsules containing 0.6 g of coconut oil. (detailed in Table 1). The duration of the intervention will be 6 weeks, but at least 4 weeks After enrollment patients will be subjected to evaluation of muscle mass by bioimpedance (BIA), muscle strength will be by handgrip strength and muscle performance by the Short Performance Physical Battery (SPPB). Nutritional status will be evaluated by the Mini Nutritional Assessment short form (MNA-SF), Nutrition Risk screening (NRS) score and Body mass index (BMI). Energy expenditure (EE) will be measured by indirect calorimetry using a canopy. Moreover appropriate experiments will be carried out in order to evaluate mitochondrial bioenergetics, replication, and fusion, as well as of redox state. Analyses of inflammageing and immune-senescence will be done by appropriate lab experiments. Micronutrient status will be measured by ELISA or HPLC and ICPMS respectively. Patients will be evaluated at inclusion, at rehabilitation discharge, and one and two months after rehabilitation discharge. The volume of blood required for the above investigations will be 3 x 30 ml over the 2-month period.
Interventions
DIETARY_SUPPLEMENTBCAA
daily administration of oral nutritional supplements (ONS) 1) providing whole proteins together with dietary advice according with the ESPEN nutrition guidelines. All the patients will receive the standard commercially available product used at CHUV (Resource protein ®, nestle) and nutritional counselling (SC) and 4 gram per day of BCAAs mixture. Ratio between the BCAAs will be Leucine/Isoleucine/Valine=2:1:1
DIETARY_SUPPLEMENTMicronutriments
daily administration of oral nutritional supplements (ONS) 1) providing whole proteins together with dietary advice according with the ESPEN nutrition guidelines. All the patients will receive the standard commercially available product used at CHUV (Resource protein ®, nestle ) and nutritional counselling (SC) and Vitamin A 1200 mg RE, Vitamin D3 2000 IU, Thiamine B1 100 mg, Cobalamin B12 10 mcg, Ascorbic acid C 200 mg, Iron 30 mg, Selenium 100 mcg, Zinc 20 mg, Omega-3 PUFA 1 g
DIETARY_SUPPLEMENTstandard treatment + placebo
daily administration of oral nutritional supplements (ONS) 1) providing whole proteins together with dietary advice according with the ESPEN nutrition guidelines. All the patients will receive the standard commercially available product used at CHUV (Resource protein ®, nestle ) and nutritional counselling (SC) and maltodextrin 4 g as placebo
Sponsors
Patrizia D'Amelio
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
The intervention nutrients will be delivered as powder in sachets identified as B (BCAA, 4 gr) or C (mixture of micronutrients, 4 gr), placebo sachets identified as A will contain maltodextrin, (4 gr); the sachets will be mixed by the patients in a juice. Blinding will be maintained until interim evaluation and after for the full trial. In order to assure the blinding the sachets will be opaque identified by a single letter ready to be mixture with a juice with similar taste and texture between the different formulations
Intervention model description
three arms study double blind placebo controlled
Eligibility
Sex/Gender
ALL
Age
75 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥75 years * Patients entering a rehabilitation program * Diagnosis of malnutrition defined by a MNA-SF (mini-nutritional assessment short form) score below 11 points. * Commitment to accept the nutritional supplement proposed, willing and able to give written informed consent * Ability to understand and comply with the requirements of the study
Exclusion criteria
* Presence of malignancy, * Life expectancy of less than two months calculated by Multidimensional Prognostic Index (MPI ), * Congestive heart failure (NYHA IV), * Chronic renal disease (creatinine clearance \<40 ml/min calculated by cockroft), * Liver cirrhosis (Child B-C), * Tube/percutaneous endoscopic gastrostomy feeding or parenteral nutrition, * Severe dysphagia, * Mini-Mental State Examination (MMSE)≤18 and MNA\>11 points. MMSE ≥ 18 identifies patients with mild form of cognitive impairment; those patients generally do not have problems in swallowing and are able to take drugs. * Severe anaemia (Hb\<10 g/l) or leukopenia (\<2G/l).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in mitochondrial ATP production (nmol/ml) | change vesus baseline at 30, 60 days after discharge | Production of ATP will be measured using the ATP Bioluminescent Assay Kit |
| Change in redox state (plasmatic concentration of metabolites) | change vesus baseline at 30, 60 days after discharge | analyses of thiometabolome contains: methionine, methionine sulfone, methionine sulfoxide, cysteine, homocysteine, homocystine, cystathionine, formylmethionine, cystine, glutathione, glutathione disulfide, taurine, S-adenosylmethionine, S-adenosylhomocysteine, N-acetylcysteine, cysteic acid, serine, glycine, glutamic acid, lypoic acid, selenocysteine, thioctic acid, pyruvic acid. |
| Change in mitochondrial electron flux (nmol cit/min/mg prot) | change vesus baseline at 30, 60 days after discharge | The activity of Complex I and III will be measured on non-sonicated mitochondrial samples |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| muscle function (score) | change versus baseline at rehab discarge (21 days), 30, 60 days after discharge | Short performance physical battery will be used to measure muscle performance |
| muscle mass (Kg/body weight) | change versus baseline at rehab discarge (21 days), 30, 60 days after discharge | Bioelectrical impedance analysis (BIA) will be used to measure muscle mass |
| change micronutrients status (concentration of micronutrients) | change versus baseline at 60 days after discharge | Blood levels of Vitamins A, B12, D and E, as well as of trace elements Cu, Fe, Se, and Zn will be determined by ELISA or HPLC and ICPMS |
| change in perceived health status (score) | change versus baseline at rehab discarge (21 days), 30, 60 days after discharge | questionnaire |
| muscle strength (Kg) | change versus baseline at rehab discarge (21 days), 30, 60 days after discharge | Hand grip will be used to measure muscle strenght |
| change in inflammation | change versus baseline at 30, 60 days after discharge | Production of pro-inflammatory cytokines involved in inflammageing and in muscle waste will be measured by ELISA technique; we will measure IL-6 and TNF-alpha (pg/ml). |
| change phase angle (score) | change versus baseline at rehab discarge (21 days), 30, 60 days after discharge | Bioelectrical impedance analysis (BIA) will be carried out |
Countries
Switzerland
Contacts
Primary ContactPatrizia D'amelio
Outcome results
None listed