Beta-hydroxy-beta-methylbutyrate supplementation in critically ill trauma patients

Area of Science:

• Critical Care Medicine
• Nutritional Support
• Trauma Surgery

Background:

• Critically injured patients often experience negative nitrogen balance and muscle loss, increasing morbidity and mortality.
• Enteral supplements like Juven (HMB, ARG, GLN) have shown efficacy in cachectic patients.
• HMB has demonstrated potential in reducing muscle proteolysis in cancer patients.

Purpose of the Study:

• To investigate the effects of HMB alone or HMB/ARG/GLN on nitrogen balance and muscle proteolysis in critically injured trauma patients.
• To test the hypothesis that supplementation would improve nitrogen balance and decrease muscle proteolysis.

Main Methods:

• A prospective, randomized, blinded study involving 100 adult trauma patients (Injury Severity Score >18).
• Patients received standard tube feeds plus one of three iso-nitrogenous supplements: HMB, HMB/ARG/GLN, or placebo for 28 days.
• Urinary 3-methylhistidine (3-MH) was measured as a marker for muscle proteolysis.

Main Results:

• A significant treatment effect (p=0.05) was observed on nitrogen balance (g/d) over 14 days.
• Improvement in nitrogen balance was noted in the HMB (-4.3 g/d) and HMB/ARG/GLN (-5.6 g/d) groups compared to placebo (-8.9 g/d).
• No significant difference in 3-MH to creatinine ratios was found between groups, indicating muscle protein turnover was not reduced.

Conclusions:

• Supplementation with HMB alone may enhance nitrogen balance in critically injured adult patients.
• The observed improvement in nitrogen balance is not attributable to a decrease in muscle protein turnover.
• Further research may explore the specific mechanisms by which HMB impacts nitrogen balance in trauma.