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Clin Nutr. 2018 Feb 21. pii: S0261-5614(18)30080-3. doi: 10.1016/j.clnu.2018.02.017. [Epub ahead of print]

Impact of 3-week citrulline supplementation on postprandial protein metabolism in malnourished older patients: The Ciproage randomized controlled trial.

Author information

1
Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier (GH) Henri-Mondor, Hôpital Emile-Roux, Département de Gérontologie, 94456, Limeil-Brévannes, France; Université Paris-Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, EA 4466, Laboratoire de Biologie de la Nutrition, 75006, Paris, France. Electronic address: olivier.bouillanne@aphp.fr.
2
Université Paris-Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, EA 4466, Laboratoire de Biologie de la Nutrition, 75006, Paris, France; AP-HP, Hôpitaux Universitaires (HU) Paris-Ile-de-France-Ouest, Hôpital Raymond-Poincaré, Unité de Nutrition clinique-TCA, 92380, Garches, France.
3
Université Paris-Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, EA 4466, Laboratoire de Biologie de la Nutrition, 75006, Paris, France.
4
AP-HP, Hôpital Henri-Mondor, Département de Pharmacie, 94000, Créteil, France.
5
Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA 7376, CEpiA (Clinical Epidemiology and Aging), 94000, Créteil, France; AP-HP, Hôpital Henri-Mondor, Service de Santé Publique, 94000, Créteil, France.
6
INRA, CRNH Auvergne, UMR 1019, Unité de Nutrition Humaine, 63009, Clermont-Ferrand, France; Université d'Auvergne, Clermont Université, Unité de Nutrition Humaine, 63009, Clermont-Ferrand, France; Centre Hospitalier Universitaire Clermont-Ferrand, Département de Nutrition Clinique, 63003, Clermont-Ferrand, France.
7
AP-HP, Hôpital Robert Debré, Département de Biochimie et d'Hormonologie, 75019, Paris, France.
8
AP-HP, HU Est-Parisien, Hôpital Rothschild, Service de Gériatrie, 75012, Paris, France.
9
Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA 7376, CEpiA (Clinical Epidemiology and Aging), 94000, Créteil, France; AP-HP, Hôpital Henri-Mondor, Service de Santé Publique, 94000, Créteil, France; AP-HP, Hôpital Henri-Mondor, Unité de Recherche Clinique (URC-Mondor), 94000, Créteil, France.
10
AP-HP, GH Henri-Mondor, Hôpital Albert-Chenevier, Département de Gérontologie, 94000, Créteil, France.
11
INSERM, Centre d'Investigation Clinique 1430, Plateforme de Ressources Biologiques, 94000, Créteil, France.
12
Université Paris-Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, EA 4466, Laboratoire de Biologie de la Nutrition, 75006, Paris, France; AP-HP, HU Paris-Centre, Hôpital Cochin, Service de Biochimie, 75014, Paris, France.
13
Université Paris-Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, EA 4466, Laboratoire de Biologie de la Nutrition, 75006, Paris, France; AP-HP, Hôpital Necker-Enfants malades, Département de Biochimie A, 75015, Paris, France.
14
Université Paris-Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, EA 4466, Laboratoire de Biologie de la Nutrition, 75006, Paris, France; AP-HP, HU Paris-Nord-Val-de-Seine, Hôpital Bichat, Département de Gérontologie, 75018, Paris, France.
15
INRA, CRNH Auvergne, UMR 1019, Unité de Nutrition Humaine, 63009, Clermont-Ferrand, France; Université d'Auvergne, Clermont Université, Unité de Nutrition Humaine, 63009, Clermont-Ferrand, France.
16
Université Paris-Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, EA 4466, Laboratoire de Biologie de la Nutrition, 75006, Paris, France; AP-HP, Hôpital Henri-Mondor, Département de Pharmacie, Unité de Nutrition, 94000, Créteil, France.

Abstract

BACKGROUND:

Citrulline (CIT), is not extracted by the splanchnic area, can stimulate muscle protein synthesis and could potentially find clinical applications in conditions involving low amino acid (AA) intake, such as in malnourished older subjects.

OBJECTIVE:

Our purpose was to research the effects of CIT supplementation on protein metabolism in particular on non-oxidative leucine disposal (NOLD, primary endpoint), and splanchnic extraction of amino acids in malnourished older patients.

DESIGN:

This prospective randomized multicenter study determined whole-body and liver protein synthesis, splanchnic protein metabolism and appendicular skeletal muscle mass (ASMM) in 24 malnourished older patients [80-92 years; 18 women and 6 men] in inpatient rehabilitation units. All received an oral dose of 10 g of CIT or an equimolar mixture of six non-essential amino acids (NEAAs), as isonitrogenous placebo, for 3 weeks.

RESULTS:

NOLD and albumin fractional synthesis rates were not different between the NEAA and CIT groups. Splanchnic extraction of dietary amino acid tended to decrease (p = 0.09) in the CIT group (45.2%) compared with the NEAA group (60.3%). Total differences in AA and NEAA area under the curves between fed-state and postabsorptive-state were significantly higher in the CIT than in the NEAA group. There were no significant differences for body mass index, fat mass (FM), lean mass (LM) or ASMM in the whole population except for a tendential decrease in FM for the citrulline group (p = 0.089). Compared with Day 1, lean mass and ASMM significantly increased (respectively p = 0.016 and p = 0.018) at Day 20 in CIT-treated women (mean respective increase of 1.7 kg and 1.1 kg), and fat mass significantly decreased (p = 0.001) at Day 20 in CIT-group women (mean decrease of 1.3 kg).

CONCLUSIONS:

Our results demonstrate that CIT supplementation has no effect on whole-body protein synthesis or liver protein synthesis in malnourished older subjects. However, CIT supplementation was associated with a higher systemic AA availability. In the subgroup of women, CIT supplementation increased LM and ASMM, and decreased FM.

KEYWORDS:

Amino acids; Citrulline; Lean mass; Malnutrition; Older adults; Protein metabolism

PMID:
29503060
DOI:
10.1016/j.clnu.2018.02.017

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