ABSTRACT
Exercise is known to improve physical functioning and health status in Chronic Obstructive Pulmonary Disease (COPD). Recently, disturbances in protein turnover and amino acid kinetics have been observed after exercise in COPD. The objective was to investigate which dairy protein is able to positively influence the protein metabolic response to exercise in COPD. 8 COPD patients and 8 healthy subjects performed a cycle test on two days while ingesting casein or whey protein. Whole body protein breakdown (WbPB), synthesis (WbPS), splanchnic amino acid extraction (SPE), and NetWbPS (=WbPS-WbPB) were measured using stable isotope methodology during 20 min of exercise (at 50% peak work load of COPD group). The controls performed a second exercise test at the same relative workload. Exercise was followed by 1 h of recovery. In the healthy group, WbPS, SPE, and NetPS were higher during casein than during whey feeding (P<.01). WbPS and NetPS were higher during exercise, independent of exercise intensity (P<.01). NetPS was higher during casein feeding in COPD due to lower WbPB (P<.05). Higher SPE was found during exercise during casein and whey feeding in COPD (P<.05). Lactate levels during exercise were higher in COPD (P<.05) independent of the protein. Post-exercise, lower NetPS values were found independent of protein type in both groups. Casein resulted in more protein anabolism than whey protein which was maintained during and following exercise in COPD. Optimizing protein intake might be of importance for muscle maintenance during daily physical activities in COPD.
Subject(s)
Caseins/administration & dosage , Caseins/metabolism , Exercise , Milk Proteins/administration & dosage , Milk Proteins/metabolism , Proteolysis , Pulmonary Disease, Chronic Obstructive/metabolism , Administration, Oral , Adult , Aged , Amino Acids/metabolism , Bicycling , Case-Control Studies , Caseins/chemistry , Eating , Exercise/physiology , Exercise Test , Humans , Male , Middle Aged , Milk Proteins/chemistry , Protein Biosynthesis , Pulmonary Disease, Chronic Obstructive/drug therapy , Time Factors , Whey ProteinsABSTRACT
BACKGROUND: Neuromuscular abnormalities and low exercise tolerance are frequently observed in overt hypothyroidism, but it remains controversial if they can also occur in subclinical hypothyroidism (sHT). The aim of this study is to evaluate neuromuscular symptoms, muscle strength, and exercise capacity in sHT, compared with healthy euthyroid individuals. METHODS: A cross-sectional study was performed with 44 sHT and 24 euthyroid outpatients from a university hospital. Neuromuscular symptoms were questioned. Muscle strength was tested for neck, shoulder, arm, and hip muscle groups, using manual muscle testing (MMT). Quadriceps muscle strength was tested with a chair dynamometer and inspiratory muscle strength (IS) by a manuvacuometer. Functional capacity was estimated based on the peak of oxygen uptake (mL/kg/min), using the Bruce treadmill protocol. RESULTS: Cramps (54.8% versus 25.0%; P < 0.05), weakness (45.2% versus 12.6; P < 0.05), myalgia (47.6% versus 25.0%; P = 0.07), and altered MMT (30.8% versus 8.3%; P = 0.040) were more frequent in sHT. Quadriceps strength and IS were not impaired in sHT and the same was observed for functional capacity. IS was significantly lower in patients complaining of fatigue and weakness (P < 0.05) and tended to be lower in those with altered MMT (P = 0.090). CONCLUSION: Neuromuscular complaints and altered MMT were significantly more frequent in sHT than in controls, and IS was lower in patients with these abnormalities. Results suggest that altered muscle strength by MMT and the coexistence of neuromuscular complaints in patients with sHT may indicate neuromuscular dysfunction.
Subject(s)
Hypothyroidism/physiopathology , Adult , Case-Control Studies , Cross-Sectional Studies , Exercise Test , Female , Humans , Male , Middle Aged , Muscle Fatigue , Muscle Weakness , Muscle, Skeletal/physiopathology , Thyrotropin/bloodABSTRACT
BACKGROUND: It is often suggested that chronic wasting diseases [eg, chronic obstructive pulmonary disease (COPD)] may benefit from branched-chain amino acid (BCAA) administration via improved protein metabolism. OBJECTIVE: The aim was to examine whether adding BCAAs to a soy protein meal would enhance protein anabolism in COPD patients and in healthy elderly persons. DESIGN: Eight normal-weight COPD patients and 8 healthy control subjects were examined on 2 test days. Simultaneous continuous intravenous infusion of l-[ring-(2)H(5)]phenylalanine (Phe) and l-[ring-(2)H(2)]tyrosine tracers was done postabsorptively and at 2 h of ingestion of a maltodextrin soy or maltodextrin soy + BCAA protein meal (rate of ingestion: 0.02 g protein.kg body weight(-1).20 min(-1)) in a crossover design. Together with the meal, oral ingestion of 1-[(13)C]Phe was performed to measure first-pass Phe splanchnic extraction (SPE(Phe)). The endogenous rate of Phe appearance [reflecting whole-body protein breakdown (WbPB)], whole-body protein synthesis (WbPS), and net WbPS (WbPS - WbPB) were calculated. Arterialized venous blood was sampled for amino acid enrichment and concentration analyses. RESULTS: Soy feeding induced a reduction in WbPB and an increase in WbPS. BCAA supplementation of soy protein resulted in a significantly higher (P < 0.05) increase in WbPS than did soy protein alone in COPD patients but not in the healthy elderly. BCAA supplementation did not significantly alter the change in WbPB or net WbPS. Furthermore, BCAA supplementation decreased (absolute) SPE(Phe) (P < 0.05) but did not change the percentage Phe hydroxylation in the splanchnic area, which indicates a BCAA-related reduction in splanchnic protein synthesis. CONCLUSION: BCAA supplementation to soy protein enhances WbPS in patients with COPD and alters interorgan protein metabolism in favor of the peripheral (muscle) compartment in healthy elderly and even more in COPD patients.
Subject(s)
Amino Acids, Branched-Chain/pharmacology , Dietary Proteins/metabolism , Dietary Proteins/pharmacology , Pulmonary Disease, Chronic Obstructive/metabolism , Soybean Proteins/chemistry , Soybean Proteins/pharmacology , Aged , Case-Control Studies , Humans , Male , Middle AgedABSTRACT
Decreased plasma and muscle glutamate concentrations have been observed in patients with chronic obstructive pulmonary disease (COPD), suggesting disturbances in glutamate metabolism. The present study was conducted to further examine glutamate metabolism in 8 male COPD patients (68 +/- 4 y) by measurement of whole-body (WB) glutamate production and splanchnic glutamate extraction in the postabsorptive state as well as in response to feeding. Because COPD is particularly prevalent in the elderly and aging per se may also affect glutamate metabolism, 2 male control groups were included: 8 healthy elderly (63 +/- 3 y) and 8 young (22 +/- 1 y) subjects. On 2 test days, the stable isotope L-15N-glutamate was infused i.v. or enterally according to a primed constant and continuous infusion protocol. After 90 min of infusion, subjects ingested a carbohydrate-protein drink (28% milk protein, 72% maltodextrin) every 20 min for 2 h. Arterialized-venous blood samples were taken at the end of the postabsorptive and feeding periods. Postabsorptive WB glutamate production and splanchnic glutamate extraction were significantly lower in the elderly and COPD patients than in the young (P < 0.01). Feeding further decreased WB endogenous glutamate production in the elderly and COPD patients, with COPD patients tending (P = 0.07) to have a greater decrease. Splanchnic glutamate extraction increased during feeding in the elderly (P < 0.05) but did not change in COPD patients. In conclusion, aging reduces postabsorptive WB endogenous glutamate production and splanchnic glutamate extraction. COPD does not affect postabsorptive WB glutamate metabolism but may influence splanchnic glutamate metabolism during feeding.
Subject(s)
Aging/metabolism , Eating , Glutamic Acid/metabolism , Postprandial Period , Pulmonary Disease, Chronic Obstructive/metabolism , Viscera/metabolism , Adult , Aged , Case-Control Studies , Glutamic Acid/biosynthesis , Humans , Male , Middle AgedABSTRACT
BACKGROUND: Previously, we reported increased values for whole-body protein turnover in patients with chronic obstructive pulmonary disease (COPD) in the postabsorptive state. OBJECTIVE: The objective was to investigate whether intake of a carbohydrate-protein meal influences whole-body protein turnover differently in COPD patients and control subjects. DESIGN: Eight normal-weight patients with moderate COPD and 8 healthy control subjects were examined in the postabsorptive state and after 2 h of repeatedly ingesting a maltodextrin casein-based protein meal (0.02 g x kg body wt(-1) x 20 min(-1)). Combined simultaneous, continuous, intravenous infusion of L-[ring-2H5]-phenylalanine and L-[ring-2H2]-tyrosine tracer and oral repeated ingestion of 1-13C-phenylalanine were performed to measure whole-body protein synthesis (WbPS) and first-pass splanchnic extraction of phenylalanine. Endogenous rate of appearance of phenylalanine as the measure of whole-body protein breakdown (WbPB) and netWbPS was calculated as WbPS--WbPB. Arterialized venous blood was sampled for amino acid enrichment and concentration analyses. RESULTS: Feeding induced an increase in WbPS and a reduction in WbPB. The reduction in WbPB was larger in the COPD group than in the control group (P < 0.05) and was related to the lower splanchnic extraction of phenylalanine in the patients. Consequently, netWbPS increased more after feeding in the COPD group than in the control group (P < 0.05). CONCLUSION: Feeding induces more protein anabolism in normal-weight patients with moderate COPD than in healthy control subjects. This is probably because these COPD patients are characterized by an adaptive interorgan response to feeding to prevent or delay weight loss at this disease stage.
Subject(s)
Proteins/metabolism , Pulmonary Disease, Chronic Obstructive/metabolism , Blood Glucose/analysis , Humans , Insulin/blood , Male , Phenylalanine/metabolism , Splanchnic CirculationABSTRACT
OBJECTIVE: To evaluate the physical capacity and nutritional status of patients before orthotopic liver transplantation (OLT) and to correlate these parameters to the severity of liver function. METHODS: Thirty-two patients before OTL were classified as Child-Pugh A (25%), B (22%) and C (53%). Physical capacity was analyzed by the quadriceps and ankle strength, balance, coordination, gait velocity, 6 minute walk test, get up and go test, Barthel and Karnofsky indexes. Nutritional status was evaluated by using Mendenhall score and Blackburn classification. RESULTS: Quadriceps weakness was found in 32% of the patients. Impaired balance and coordination were detected in 34.8% and 15.6% of the patients. Low physical performance was found in 72.5% of the patients (6 min walk test: 31.6% severely; 40.9% moderately impaired) and 43.8% required considerable assistance when the Karnofsky index was applied. Malnutrition was found in 62.5% of the patients (34.37% moderately and severely malnourished and 28.13% mildly malnourished). Chi-square analysis showed no association between Child-Pugh classification and nutritional status, the 6 min walk test and Karnofsky index. The association between the two functional tests was statistically significant (p<0.001). CONCLUSION: The results show that physical impairment and nutritional deficit were highly prevalent in the patients studied, independent of the degree of hepatic dysfunction evaluated by the traditional Child-Pugh classification.
Subject(s)
Liver Diseases/physiopathology , Liver Transplantation , Nutrition Assessment , Nutritional Status , Physical Fitness/physiology , Anthropometry , Female , Humans , Liver Diseases/surgery , Liver Function Tests , Male , Middle Aged , Motor Activity/physiology , Nutrition Disorders/diagnosis , Severity of Illness Index , Waiting ListsABSTRACT
OBJETIVO: Avaliar o estado nutricional, os indicadores de capacidade física e suas relações com a função hepática, em pacientes candidatos ao transplante de fígado. MÉTODOS: Foram estudados 32 pacientes pré-transplante, classificados como Child-Pugh A (25 por cento), B (22 por cento) e C (53 por cento). A capacidade física foi avaliada pelos parâmetros: força muscular do quadríceps, dos flexores plantares e dorsais do pé; equilíbrio estático; coordenação; velocidade da marcha; teste de 6 minutos de caminhada e teste "timed get up and go"; índices de Barthel e de Karnofsky. O estado nutricional foi avaliado pelo escore de Mendenhall e classificado segundo Blackburn. RESULTADOS: Foi detectado déficit de força de quadríceps (32 por cento dos pacientes), do equilíbrio (34,8 por cento), da velocidade da marcha (66,7 por cento) e da coordenação (15,6 por cento). O teste de caminhada indicou baixo desempenho físico em 72,5 por cento dos pacientes (moderado em 40,9 por cento e grave em 31,6 por cento). O índice de Karnofsky revelou que 43,8 por cento dos pacientes necessitava assistência considerável. Foi identificada desnutrição em 62,5 por cento dos pacientes (leve em 28,13 por cento; moderada e grave em 34,37 por cento). O teste do qui quadrado não mostrou associação entre a classificação de Child-Pugh e o estado nutricional, o teste de caminhada e o índice de Karnofsky. A associação entre o teste de caminhada e o índice de Karnofsky foi altamente significante (p<0,001). CONCLUSÃO: Os resultados monstraram que a incapacidade física e a desnutrição foram altamente prevalentes nos pacientes estudados, independente do grau da disfunção hepática avaliada segundo a classificação tradicional de Child-Pugh
Subject(s)
Humans , Male , Female , Middle Aged , Anthropometry , Liver Diseases/physiopathology , Liver Transplantation , Nutrition Assessment , Nutritional Status , Physical Fitness/physiology , Liver Diseases/surgery , Liver Function Tests , Motor Activity/physiology , Nutrition Disorders/diagnosis , Severity of Illness Index , Waiting ListsABSTRACT
O objetivo deste trabalho foi estudar, aplicando o sistema Peak Performance de análise cinemática tridimensional, a variaçäo angular da articulaçäo subtalar durante a marcha. Foram estudadas 29 mulheres assintomáticas, entre 40 e 75 anos, devido à grande demanda no ambulatório de MFR-HUCFF de mulheres com idade acima de 40 anos, que apresentam doenças que comprometem funçäo da articulaçäo subtalar. Utilizou-se o "Sistema Peak Performance para Análise Tridimensional do Movimento" com o programa computacional "Peakl versäo 5.2" que aplica o método "Direct Linear Transformation - DLT". Aplicou-se uma variaçäo da metodologia proposta por Nawoczenski e cols., 1995. Tendo em vista que o programa computacional utilizado, "Peak versäo 5.2", näo é específico para a análise de marcha, foi desenvolvida uma rotina matemática para a conversäo dos valores calculados nos ângulos da subtalar. Observou-se que näo existem diferenças significativas entre o comportamento da articulaçäo subtalar direita e esquerda durante o ciclo da marcha.
