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Nutritional effect of oral supplement enriched in beta-hydroxy-beta-methylbutyrate, glutamine and arginine on resting metabolic rate after laparoscopic gastric bypass

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Abstract

Background

Weight regain that begins 12–18 months after laparoscopic gastric bypass has been attributed to changes in resting metabolic rate (RMR), which is largely determined by lean body mass (LBM). An oral supplement containing beta-hydroxy-beta-methylbutyrate, glutamine, and arginine (HMB/Glu/Arg) has helped to restore LBM in cachexia due to cancer and in critically ill trauma patients. The objective of this study was to evaluate the effect of oral HMB/Glu/Arg on LBM and RMR following laparoscopic gastric bypass (LGB).

Methods

Patients who underwent LGB were randomized to receive 24 g of HMB/Glu/Arg dissolved in water twice daily for 8 weeks or to receive no supplement. Weight loss, LBM, and RMR were assessed preoperatively, 2 and 8 weeks postoperatively. LBM was determined by dual emission x-ray absorptiometry (DXA) and RMR was measured by indirect calorimetry.

Results

Thirty patients were enrolled: 80% white; 20% African American; 96.7% women; mean age 46.9 ± 8.4 years; mean weight 113.4 ± 11.6 kg; and mean body mass index (BMI) 43.3 ± 4.1 kg/m2. The experimental and control groups included 14 and 16 patients, respectively, and there was no difference in baseline demographics and characteristics between the two groups. At 8 weeks, weight, BMI, LBM, and RMR significantly decreased by 15.7 ± 2.5 kg, 6.0 ± 1.0 kg/m2, 7.8 ± 4.0 kg, and 290.6 ± 234.9 kcal/day, respectively (P < 0.0001 for each variable). However, when comparing these changes between the two groups, no statistical significance was observed.

Conclusions

There is a significant decrease in weight, BMI, LBM, and RMR in all subjects after LGB, and these changes were not affected by the use of HMB/Glu/Arg. Potential preservation of LBM as a result of HMB/Glu/Arg requires further investigation. However, its consumption (78 calories per serving) did not adversely affect weight loss in the experimental group.

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Acknowledgments

The nutritional supplement containing HMB/Glu/Arg was provided by Abbott Laboratories, Illinois, U.S.A. The authors acknowledge the support of Dr. Barbara Gower, Director, Human Physiology Core, Diabetes Research and Training Center, UAB for her assistance with dual-emission X-ray absorptiometry. The Human Physiology Core, Diabetes Research and Training Center, UAB is supported by grants provided by National Institute of Diabetes and Digestive and Kidney Disease (P30 DK56336 and 1P60DK079626) and National Center for Research Resources (UL 1RR025777).

Disclosures

This study was supported by a research grant (F061211001) provided by Abbott Laboratories, Illinois, U.S.A. The authors, Dr. Ronald H. Clements, Neha Saraf, Manasi Kakade, Kishore Yellumahanthi, Merritt White, and Jo Ann Hackett have no commercial associations that might be a conflict of interest to this study.

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Authors and Affiliations

  1. Section of Surgical Sciences, Division of General Surgery, Vanderbilt University, 1161 Medical Center Drive, D5203, Nashville, TN, 37232-7610, USA

    Ronald H. Clements

  2. Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama, Birmingham, Alabama

    Neha Saraf, Manasi Kakade, Kishore Yellumahanthi, Merritt White & Jo Ann Hackett

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  1. Ronald H. Clements
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  2. Neha Saraf
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  5. Merritt White
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Correspondence to Ronald H. Clements.

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Clements, R.H., Saraf, N., Kakade, M. et al. Nutritional effect of oral supplement enriched in beta-hydroxy-beta-methylbutyrate, glutamine and arginine on resting metabolic rate after laparoscopic gastric bypass. Surg Endosc 25, 1376–1382 (2011). https://doi.org/10.1007/s00464-010-1371-9

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