Sukkar S G, Gallo F, Borrini C, Vaccaro A, Marchello C, Boicelli R, Borgarelli C, Solari P, Ratto C E, Ravera G
U.O. di Dietetica e Nutrizione Clinica, IRCSS Az, Ospedaliera Universitaria San Martino IST di Genova, Genoa, Italy.
Med J Nutrition Metab. 2012 Dec;5(3):259-266. doi: 10.1007/s12349-012-0098-7. Epub 2012 Jun 22.
The aim of this study was to verify the clinical efficacy of a diet associated with already commercially available oral amino acid functional cluster (AFC) compared to the administration of a diet associated with a nitrogen protein-based supplement (casein) in antagonizing malnutrition in patients with Chronic renal failure (CRF) undergoing haemodialysis. The secondary aim was to assess the changes in protein levels during the acute phase such as the expression of inflammatory cytokines. Twenty patients in haemodialysis aged between 18 and 85 of both genders (13 m, 7f) were recruited, randomized and divided into two groups and treated for 4 months respectively with: (1) oral AFC supplement (*)8 g/die: group A, and (2) oral supplementation of a protein nitrogenous mixture compared to AFC with a casein protein source) of 6.6 g: group P. During the initial assessment and thereafter on a monthly basis all patients underwent the following: Dietary recall 24 h; Anthropometric: Weight, height, BMI, expected dry weight, actual weight; Biochemical: Albumin, transferrin, Na, K, Cl, Ca, P, Mg, long-interval creatinine (Aminotrofic(®): Errekappa Euroterapici, Milano) pre-albumin, α1 acid glycoprotein, C reactive protein (CRP), protein nitrogen appearance (PNA); Instrumental: Handgrip strength evaluation, Calorimetry by means of Armband, Bio-impedance analysis (BIA), Spitzer Index (quality of life), Subjective Global Assessment Generated by the patient (PG SGA). Considering the nutritional parameters, no significant differences concerning dry weight emerged between the beginning (T0) and the end (T4) (weight A to T0: kg 64.41 ± 6.34; weight A to T4: kg 64.51 ± 7.05: P = NS; weight P to T0: kg 60.17 ± 11.94; weight P to T4: kg 59.86 ± 11.43: P = NS); biochemical parameters, significant differences were observed only for two parameters: pre-albumin (Pre-albumin A to T0 30.12 ± 7.23; Pre-albumin A to T4: 28.91 ± 5.8; Pre-albumin P to T0 22.51 ± 6.04; Pre-albumin P to T4: 26.10 ± 9.82), and Transferrin (Transferrin A to T0 171.77 ± 28.87 mg/dL, Transferrin A to T4: 181.44 ± 38.83 mg/dL: P < 0.005; Transferrin P to T0 160.29 ± 27.46 mg/dL, Transferrin P to T4: 146.57 ± 24.96 mg/dL: P < 0.005), but not in other parameters. From a nutritional perspective, after 4 months of treatment an increase in protein synthesis was noted in group A compared to group P which was proved by the significant increase of transferrin. This pilot study suggests the AFC oral supplementation may represent a valid alternative to intradialytic parenteral treatment and may also allow for an improvement in blood chemical values and nutritional status.
本研究的目的是验证与市售口服氨基酸功能簇（AFC）相关的饮食，与基于氮蛋白补充剂（酪蛋白）的饮食相比，在对抗接受血液透析的慢性肾衰竭（CRF）患者营养不良方面的临床疗效。次要目的是评估急性期蛋白质水平的变化，如炎症细胞因子的表达。招募了20名年龄在18至85岁之间的血液透析患者（13名男性，7名女性），随机分为两组，分别接受4个月的治疗：（1）口服AFC补充剂（*）8克/天：A组，和（2）口服补充与AFC相比含酪蛋白蛋白质来源的蛋白质含氮混合物6.6克：P组。在初始评估及之后每月，所有患者接受以下检查：24小时饮食回顾；人体测量：体重、身高、体重指数、预期干体重、实际体重；生化检查：白蛋白、转铁蛋白、钠、钾、氯、钙、磷、镁、长期间隔肌酐（Aminotrofic（®）：Errekappa Euroterapici，米兰）、前白蛋白、α1酸性糖蛋白、C反应蛋白（CRP）、蛋白质氮呈现（PNA）；仪器检查：握力评估、通过臂带进行的量热法、生物电阻抗分析（BIA）、斯皮策指数（生活质量）、患者生成的主观整体评估（PG SGA）。考虑到营养参数，开始时（T0）和结束时（T4）之间干体重无显著差异（A组T0时体重：64.41±6.34千克；A组T4时体重：64.51±7.05千克：P=无显著性差异；P组T0时体重：60.17±11.94千克；P组T4时体重：59.86±11.43千克：P=无显著性差异）；生化参数方面，仅观察到两个参数有显著差异：前白蛋白（A组T0时前白蛋白30.12±7.23；A组T4时：28.91±5.8；P组T0时前白蛋白22.51±6.04；P组T4时：26.10±9.82）和转铁蛋白（A组T0时转铁蛋白171.77±28.87毫克/分升，A组T4时：181.44±38.83毫克/分升：P<0.005；P组T0时转铁蛋白160.29±27.46毫克/分升，P组T4时：146.57±24.96毫克/分升：P<0.005），其他参数无差异。从营养角度来看，治疗4个月后，与P组相比，A组蛋白质合成增加，这通过转铁蛋白的显著增加得到证实。这项初步研究表明，口服AFC补充剂可能是透析期间胃肠外治疗的有效替代方法，还可能改善血液化学值和营养状况。
