Abstract
PurposeCritically low skeletal muscle mass and strength, observed in 20% of people with chronic heart failure (CHF), reduces functional capacity, quality of life (QoL) and survival. Protein and essential amino acid (EAA) supplementation could be a viable treatment strategy to prevent declines in muscle strength and performance, and subsequently improve QoL and survival. This systematic review (PROSPERO: CRD42018103649) aimed to assess the effect of dietary protein and/or EAA supplementation on muscle strength and performance in people with CHF.MethodsSearches of PubMed, MEDLINE and Embase identified studies that reported changes in strength or muscle performance following protein and/or EAA supplementation in patients with CHF. Following PRISMA guidelines and using predefined inclusion/exclusion criteria relating to participants, intervention, control, outcome and study design, two reviewers independently screened titles, abstracts and full manuscripts for eligibility. Risk of bias was assessed using Cochrane Risk of Bias Tool (RCTs) or Mixed Methods Appraisal Tool (cohort studies). Data were extracted for analysis using predefined criteria.ResultsFive randomised controlled trials (RCT) and one cohort study met our inclusion criteria. All RCTs had a high risk of bias. The methodological quality of the cohort study was moderate. Heterogeneity of extracted data prevented meta-analyses, qualitative synthesis was therefore performed. Data from 167 patients with CHF suggest that protein and/or EAA supplementation does not improve strength, but may increase six-minute walk test distance, muscle mass and QoL.ConclusionsThe limited quality of the studies makes firm conclusions difficult, however protein and/or EAA supplementation may improve important outcome measures related to sarcopenia. High-quality randomised controlled studies are needed.
Highlights
Chronic heart failure (CHF) affects 11.8% of people over the age of 60 years [1] and is a leading cause of death and disability [2]
The primary aim of this systematic review was to assess the effects of dietary protein and/or essential amino acid (EAA) supplementation on skeletal muscle strength and performance in people with CHF
The primary aim of this systematic review was to assess the effects of dietary protein and/or EAA supplementation on skeletal muscle strength, and performance in patients with CHF
Summary
Chronic heart failure (CHF) affects 11.8% of people over the age of 60 years [1] and is a leading cause of death and disability [2]. A key phenotype of CHF is reduced cardiac output (Q) and arterial compliance, which collectively inhibit haemodynamic perfusion of skeletal muscle during physical activity [3] Such impaired cardiovascular function may contribute to exercise intolerance; CHF causes profound adverse changes to skeletal muscle physiology, which plays a significant role in mediating physical disability [3]. Changes in skeletal muscle physiology occur in CHF patients who have either reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction (LVEF) [4,5,6,7,8] These changes have been described in detail elsewhere [4, 9] and include a decrease in the number of type I muscle fibres, a decrease in the oxidative capacity and cross-sectional area of type II muscle fibres, a reduction in mitochondrial volume within muscle fibres, a reduction in enzymes required for aerobic metabolism and an increase in glycolytic enzymes. Treatments that are capable of reversing or preventing the development of sarcopenia in patients who have CHF are needed
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