A quick and improvement effect of leucine enriched dietary supplement on malnutrition in acute stroke patients receiving enteral tube feeding

Abstract Background:Malnutrition often occurs in acute stroke patients receiving enteral tube feeding (ETF). Unless malnutrition is improved, their clinical outcome is poor. However, strategies to improve malnutrition in these patients have not been established. Branched-chain amino acids (BCAA) may enhance protein synthesis and attenuate inflammation. Our study aimed to investigate whether a leucine enriched BCAA dietary supplement (LEBDs) could quickly improve a patient's nutritional status during the early stage of malnutrition. Methods: We retrospectively analyzed acute stroke patients who 1) were admitted between December 2016 and July 2017; 2) underwent ETF for seven days or longer after admission; 3) who underwent blood examination on admission, the 5th day, and seventh day; 4) in whom transthyretin (TTR) was less than 15 mg/dl on the 5th day, and 5) received LEBDs containing 1.44 g leucine per 200 kcal twice a day on the 5th day. We evaluated patients' features, serum albumin (Alb) (g/dl), transthyretin (TTR) (mg/dl), and high sensitive C-reactive protein (CRP) (mg/dl) on admission, the fifth day, and the seventh day. Results: Fifteen patients met our inclusion criteria. Their median age, body mass index (BMI), body weight (BW), serum blood glucose (BG), Alb, TTR, and CRP were 82 years, 21.8 kg/m2, 50 kg, 150 mg/dl, 3.5 g/dl, 12.7 mg/dl, and 1.02 mg/dl, respectively. Their median calorie intake was 1,200 kcal/day. On the 5th day, their median Alb and TTR decreased to 2.6 g/dl (p<0.0001) and 11.8 mg/dl (p<0.01), respectively, and their median CRP increased to 5.24 mg/dl (p<0.01). On the 7th day, TTR increased to 15.7 mg/dl (p<0.001), and CRP decreased to 4.77 mg/dl (p<0.05), whereas their median Alb was 2.6 g/dl (ns) and did not significantly change. ConclusionThe leucine enriched BCAA dietary supplement had a quick and improvement effect on the transthyretin and CRP level.