Nutritional Effect of Oral Supplement Enriched in Beta-hydroxy-beta -methylbutyrate, Glutamine and Arginine on Resting Metabolic Rate After Laparoscopic Gastric Bypass.

Objective– To evaluate the nutritional effect of an oral supplement enriched in beta-hydroxy-beta-methylbutyrate, glutamine and arginine (HMB/Glu/Arg) on resting metabolic rate (RMR) following laparoscopic gastric bypass (LGB). Although, LGB is a highly effective approach to induce weight loss in morbid obesity, most patients regain 10-15% of this weight over time. Studies indicate, this is due to a decrease in RMR which is largely determined by loss in lean body mass (LBM) after LGB. There is evidence that HMB/Glu/Arg helps restore LBM in cachexia due to cancer and critically ill trauma patients. If this effect can help modulate RMR in bariatric patients, more stable weight maintenance may be achieved.

Method– Patients scheduled to undergo LGB were randomized to an experimental arm receiving (HMB/Glu/Arg) and to a control arm not receiving it. The experimental group was required to consume 24g of supplement dissolved in water, twice daily and record their consumption. Primary outcomes of interest included weight loss, LBM determined by double emission x-ray aborptiometry (DXA) and RMR measured by indirect calorimetry. These were assessed at baseline, 2 and 8 week intervals.

Results– 27 morbidly obese patients with mean age 46 + 8.5 years (78% Whites, 22% African Americans, 96% females) and mean BMI 43.2 +4.1 kg/m2 were enrolled. Paired t test was used to compare means in all subjects (N=27) and the results are depicted in the table below.

VariableBaseline8 weekChange p value
Weight(kg)112.7 +11.896.8 +12.0– 15.7 +2.6<0.0001
BMI(kg/m2)43.2 +4.137.1 +4.3– 6.2 +1.0<0.0001
LBM(kg)52.8 +7.245.4 +4.5– 7.4 +4.3<0.0001
RMR(kcal/24 hr)1806.6+277.11526.3+166.5-280.3+231.2<0.0001

Independent t test was used to compare the difference in means in weight, BMI, LBM and RMR in experimental vs. control group. The results are shown in the table below.

Experiment (N=12)Control (N=15)
VariableBaseline8 weekBaseline8 week
Weight(kg)113.3 +11.597.7 +11.7112.3 +12.596.6 +12.7
BMI(kg/m2)43.8 +4.537.7 +4.744.5 +4.538.2 +4.4
LBM(kg)51+4.943.6 +4.454.4 +6.346.1 +4.3
RMR(kcal/24 hr)1764.3+238.71507.7+198.91840.4+308.31541+142.1

Note: p>0.05 for above values between experimental vs. control. Similar results were observed for O2 consumption and CO2 production.

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

Session: Podium Presentation

Program Number: S058

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