Conditionally essential amino acids reduce atrophy, complications after fracture fixation
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According to published results, conditionally essential amino acid supplementation may protect against complications and skeletal muscle wasting after operative fixation of extremity and pelvic fractures.
In a prospective randomized controlled trial (RCT), Nathan R. Hendrickson, MD, and colleagues analyzed 400 adults with pelvic and extremity fractures who were indicated for operative fixation at a level-1 trauma center.
According to the study, 200 patients were randomized to receive oral conditionally essential amino acid (CEAA) supplementation twice daily for 2 weeks. These patients were provided with a commercially available powdered CEAA supplement, which contained 7 g of arginine, 7 g of glutamine and 1.5 g of the leucine metabolite beta-hydroxymethylbutyrate. Additionally, a control group of 194 patients were randomized to standard nutrition.
Fat-free mass (FFM) was measured preoperatively and at 6 weeks and 12 weeks postoperatively. Other outcome measures included overall complication rate, unplanned reoperation, fracture nonunion, surgical site infection (SSI) and mortality.
Hendrickson and colleagues found the CEAA group had a “significantly lower” overall complication rate compared with the control group (30.5% vs. 43.8%, respectively). The CEAA group also saw an initial reduction in muscle wasting compared with the control group. At 6 weeks, FFM decreased by 0.9 kg in the control group and by 0.33 kg in the CEAA group; however, no other differences in FFM were recorded at subsequent time intervals, the researchers noted. While no significant differences were seen in unplanned reoperation or SSI rates, the CEAA group had “significantly lower” rates of nonunion and mortality compared with the control group.
“Our results suggest that this inexpensive, low-risk intervention has considerable potential to improve outcomes after fracture fixation,” the researchers wrote in the study. “This study will serve as the foundation for multicenter RCTs that are designed to assess the impact of CEAA nutrition supplementation in reducing complications and loss of functional muscle mass in high-risk populations,” they concluded.
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