Influence of protein and creatine supplementation on functional capacity, quality of life and muscle function after stroke
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Data
2023-05-05
Autores
Souza, Juli Thomaz de
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Universidade Estadual Paulista (Unesp)
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Introdução: O AVC é uma das principais causas de mortalidade e incapacidade. A fase aguda do AVC é marcada por inflamação, inapetência, disfagia, repouso no leito e alterações da mobilidade que podem comprometer o estado nutricional. Este estudo teve como objetivo avaliar o efeito da suplementação de creatina na massa muscular, força e capacidade funcional de idosos com AVC. Além disso, foram avaliados marcadores bioquímicos de inflamação, degradação muscular e síntese. Metodologia: Ensaio clínico randomizado, duplo-cego, com idosos na fase aguda do AVC. Os participantes foram divididos em dois grupos: Tratamento (recebeu 10g de creatina 2x/dia) e Controle (recebeu 10g de placebo 2x/dia). Ambos os grupos receberam suplementação com proteína isolada do soro do leite em pó para atingir a meta de 1,5g de proteína/kg de peso corporal/dia e atendimento de fisioterapia diário. A intervenção ocorreu em 7 dias de internação. Verificou-se a influência da creatina na massa muscular (bioimpedância e ultrassonografia muscular), força (preensão manual e National Institutes of Health Stroke Scale), capacidade funcional (Escala de Rankin modificada), marcadores bioquímicos (3-Metil-histidina, Interleucina-6, Fator de crescimento semelhante à insulina tipo 1, fator de crescimento/diferenciação-15, procolágeno tipo III, insulina e progranulina). Acompanhamento para verificar capacidade funcional, força muscular, mortalidade e qualidade de vida 90 dias após o AVC. Resultados: Trinta idosos foram incluídos em 2 grupos homogêneos, a maioria do sexo masculino com AVC isquêmico moderado. A suplementação de creatina não influenciou o peso corporal, força muscular, capacidade funcional e massa muscular avaliada por ultrassom e bioimpedância. No entanto, houve um aumento no índice de massa muscular apendicular em homens, mas não em mulheres. Não houve diferença estatisticamente significativa em relação ao uso de creatina e níveis séricos de IL-6 e IGF-1, bem como procolágeno Tipo III, insulina, GDF-15 e 3-Metil-histidina. A creatina influenciou na diminuição da progranulina. A oferta calórica de 21-25 kcal/kg com 1,5g de proteína/kg por dia mostrou-se adequada para a manutenção do peso independentemente da administração de creatina. A creatina não influenciou a mortalidade e a percepção de qualidade de vida 90 dias após o AVC. Discussão: A suplementação foi segura com poucos eventos adversos relacionados e boa tolerância e aceitação. Houve um aumento no índice de massa muscular apendicular em homens, mas não em mulheres. Esse aumento agudo da massa muscular pode ser devido ao edema muscular, uma vez que o transporte de creatina para dentro da célula depende do sódio. De fato, a resposta muscular à creatina é diferente em homens e mulheres. Observa-se que há potencial para a creatina modular alguns aspectos relacionados a biomarcadores inflamatórios no AVC agudo. A literatura mostra a associação entre aumento da progranulina e mortalidade e pior prognóstico funcional após o AVC. Em nossos achados, no grupo tratamento, observou-se redução da progranulina, mas não no grupo controle. Este resultado representa o papel anti-inflamatório da creatina. Assim, a novidade deste estudo é mostrar o potencial da creatina em modular a progranulina na fase aguda do AVC. O trabalho trouxe dados essenciais relacionados à ingestão calórico-proteica durante a internação, mostrando a importância da adequação nutricional para evitar a perda de peso nesse período. Conclusão: A suplementação de creatina provou ser segura. Tem o potencial de modular alguns marcadores inflamatórios após o AVC e influenciou na redução dos valores de progranulina, refletindo seu papel anti-inflamatório. A creatina não afetou a capacidade funcional e a força, mas aumentou a massa muscular apendicular em homens. Estudos com maior número de participantes e maior tempo de intervenção devem ser realizados para melhor compreender a influência da suplementação de creatina na fase aguda do AVC.
Background: Stroke is a leading cause of mortality and disability. The acute phase of stroke is marked by inflammation, loss of appetite, dysphagia, bed rest, and mobility changes that can compromise the nutritional status. This study aimed to evaluate the effect of creatine supplementation on muscle mass, strength, and functional capacity of older people with stroke. In addition, biochemical markers of inflammation, muscle degradation, and synthesis were assessed. Methodology: Randomized, double-blind, clinical trial with older people in the acute phase of stroke. The participants were divided into two groups: Treatment (received 10g of creatine 2x/day) and Control (received 10g of placebo 2x/day). Both groups received supplementation with powdered milk protein serum isolate to achieve the goal of 1.5g of protein/kg of body weight/day and daily early mobility training. The intervention occurred in 7-days hospitalization. Were verified the influence of creatine on muscle mass (bioimpedance and muscle ultrasound), strength (handgrip and National Institutes of Health Stroke Scale), functional capacity (Modified Rankin Scale), biochemical markers (3-Methylhistidine, Interleukin-6, Insulin-like growth factor 1, Growth/Differentiation Factor-15, type III procollagen, insulin, and progranulin). Follow-up to verify functional capacity, muscle strength, mortality, and quality of life 90 days after stroke. Results: Thirty older people were included in 2 homogeneous groups, mostly male with moderate ischemic stroke. Creatine supplementation did not influence body weight, muscle strength, functional capacity, and muscle mass evaluated by ultrasound and bioimpedance. However, there was an increase in appendicular muscle mass index in men but not in women. There was no statistically significant difference regarding the use of creatine and serum levels of IL-6 and IGF-1, as also Type III procollagen, insulin, GDF-15, and 3-Methylhistidine. Creatine influenced the decrease of progranulin. The caloric supply of 21-25 kcal/kg with 1.5g of protein/kg per day proved adequate for weight maintenance regardless of creatine administration. Creatine did not influence mortality and perception of quality of life 90 days after stroke. Discussion: Supplementation was safe with few related adverse events and good tolerance and acceptance. There was an increase in appendicular muscle mass index in men but not in women. This acute increase in muscle mass may be due to muscle edema since creatine transport into the cell depends on sodium. Indeed, the muscular response to creatine is different in men and women. It is observed that there is potential for creatine to modulate some aspects related to inflammatory biomarkers in acute stroke. Literature shows the association between increased progranulin and mortality and worse functional prognosis after stroke. In our findings, in the treatment group, the reduction in progranulin was observed, but not in the control group. This result represents the anti-inflammatory role of creatine. Thus, the novelty of this study is to show the potential of creatine to modulate progranulin in the acute phase of the stroke. The work brought essential data related to caloric-protein intake during hospitalization, showing the importance of nutritional adjustment to avoid weight loss during this period. Conclusion: Creatine supplementation proved to be safe. It has the potential to modulate some inflammatory markers after stroke and influenced the reduction of progranulin values, reflecting its anti-inflammatory role. Creatine did not impact functional capacity, and strength but increased appendicular muscle mass in men. Studies with a larger number of participants and longer intervention time should be carried out to better understand the influence of creatine supplementation in the acute phase of stroke.
Background: Stroke is a leading cause of mortality and disability. The acute phase of stroke is marked by inflammation, loss of appetite, dysphagia, bed rest, and mobility changes that can compromise the nutritional status. This study aimed to evaluate the effect of creatine supplementation on muscle mass, strength, and functional capacity of older people with stroke. In addition, biochemical markers of inflammation, muscle degradation, and synthesis were assessed. Methodology: Randomized, double-blind, clinical trial with older people in the acute phase of stroke. The participants were divided into two groups: Treatment (received 10g of creatine 2x/day) and Control (received 10g of placebo 2x/day). Both groups received supplementation with powdered milk protein serum isolate to achieve the goal of 1.5g of protein/kg of body weight/day and daily early mobility training. The intervention occurred in 7-days hospitalization. Were verified the influence of creatine on muscle mass (bioimpedance and muscle ultrasound), strength (handgrip and National Institutes of Health Stroke Scale), functional capacity (Modified Rankin Scale), biochemical markers (3-Methylhistidine, Interleukin-6, Insulin-like growth factor 1, Growth/Differentiation Factor-15, type III procollagen, insulin, and progranulin). Follow-up to verify functional capacity, muscle strength, mortality, and quality of life 90 days after stroke. Results: Thirty older people were included in 2 homogeneous groups, mostly male with moderate ischemic stroke. Creatine supplementation did not influence body weight, muscle strength, functional capacity, and muscle mass evaluated by ultrasound and bioimpedance. However, there was an increase in appendicular muscle mass index in men but not in women. There was no statistically significant difference regarding the use of creatine and serum levels of IL-6 and IGF-1, as also Type III procollagen, insulin, GDF-15, and 3-Methylhistidine. Creatine influenced the decrease of progranulin. The caloric supply of 21-25 kcal/kg with 1.5g of protein/kg per day proved adequate for weight maintenance regardless of creatine administration. Creatine did not influence mortality and perception of quality of life 90 days after stroke. Discussion: Supplementation was safe with few related adverse events and good tolerance and acceptance. There was an increase in appendicular muscle mass index in men but not in women. This acute increase in muscle mass may be due to muscle edema since creatine transport into the cell depends on sodium. Indeed, the muscular response to creatine is different in men and women. It is observed that there is potential for creatine to modulate some aspects related to inflammatory biomarkers in acute stroke. Literature shows the association between increased progranulin and mortality and worse functional prognosis after stroke. In our findings, in the treatment group, the reduction in progranulin was observed, but not in the control group. This result represents the anti-inflammatory role of creatine. Thus, the novelty of this study is to show the potential of creatine to modulate progranulin in the acute phase of the stroke. The work brought essential data related to caloric-protein intake during hospitalization, showing the importance of nutritional adjustment to avoid weight loss during this period. Conclusion: Creatine supplementation proved to be safe. It has the potential to modulate some inflammatory markers after stroke and influenced the reduction of progranulin values, reflecting its anti-inflammatory role. Creatine did not impact functional capacity, and strength but increased appendicular muscle mass in men. Studies with a larger number of participants and longer intervention time should be carried out to better understand the influence of creatine supplementation in the acute phase of stroke.
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Palavras-chave
Acidente vascular cerebral, Creatina, Músculo esquelético, AVC, Idosos - Doenças