Introduction
Methods
Study selection criteria
PICOS | Criteria |
---|---|
Participants | Heart failure patients with preserved ejection fraction |
Heart failure patients with reduced ejection fraction | |
Intervention | Dietary protein supplementation for at least 4 weeks |
Dietary essential amino acid supplementation for at least 4 weeks | |
Control | Standard medical care (no change in diet) |
Modification of a control patient’s diet resulting in a lower protein intake, compared to intervention patients | |
Outcomes | Muscle strength |
Muscle performance | |
Study type | Randomised controlled trial |
Cohort study |
Search strategy
Study selection
Data extraction and analysis
Risk of bias and quality appraisal
Results
Study characteristics
Study | Year | Country of publication | Journal | Design | Criteria for CHF | Sample size (n =) | Mean age (years) | SD of age (years) | Number of males (%) | Intervention (I) and control (C) | Supplement duration | Primary outcome(s) | Adverse events |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Aquilani et al. [27] | 2008 | Italy | European Journal of Heart Failure | RCT | ‘Muscle depleted’ patients with clinically stable CHF | I: 21 C: 17 | I: 73 C: 75 | I: 5 C: 3 | I: 13 (62) C: 14 (82) | I: 2 × 4 g essential amino acid drink. C: Standard medical care. | 2 Months | Increase in body mass > 1 kg over 2 months | I: 0 SAE; 1 AE C: 3 SAE; 0 AE |
Rozentryt et al. [28] | 2010 | Poland | Journal of Cachexia Sarcopenia and Muscle | RCT | Cachectic, NYHA II–IV, LVEF ≤ 30%, oedema free weight loss > 7.5% over > 6 months | I: 23 C: 6 | I: 52 C: 49 | I: 10 C: 12 | I: 17 (74) C: 5 (83) | I: 600 kcal (20 g protein, 72 g cho, 26 g fat) divided into two equal doses. C: 12 kcal placebo control meal of similar taste consistency | 3 months | Oedema-free body mass and HRQoL | I: 11 SAE; 16 AE C: 3 SAE; 7 AE |
Pineda-Juarez et al. [29] | 2015 | Mexico | Clinical nutrition | RCT | Stable CHF according to ESC guidelines [34] | I: 29 C: 26 | I: 75 (median) C: 71 (median) | I: 64–84 (range) C: 58–79 (range) | I: 19 (56) C: 14 (44) | I: 2 × 5 g BCAA servings per day. Dietary protein consumption standardised to 20% of total estimated daily energy intake. Resistance exercise training 2 × 1/h per week. C: Dietary protein consumption standardised to 20% of total estimated daily energy intake. Resistance exercise training 2 × 1/h per week | 12 weeks | Not specified | I: 2 SAE; No reported AEs C: 2 SAE; No reported AEs |
Wu et al. [30] | 2015 | USA | Circulation: heart failure | RCT | LVEF ≤ 35% | I: 14 C: 12 | I: 59 C: 56 | I: 3 C: 2 | I: 12 (86) C: 9 (82) | I: 8 g/day L-alanyle-l-glutamine and 6.5 g/day fish oil C: Safflower oil and milk powder of equivalent caloric intake | 6 weeks | Change in CPET, 6MWT and isokinetic and isometric muscle function | I: SAEs; 2 AEs C: SAE; 2 AEs |
George et al. [31] | 2017 | USA | Journal of physiotherapy and physical rehabilitation | RCT | NYHA II–III, HFpEF and/or HFrEF | I: 3 C: 3 | I: 84 C: 75 | I: 1 C: 7 | Not reported | I: Whey isolate powder supplement to increase protein intake to 1.5 g/kg body mass per day and exercise DVD including aerobic and resistance exercise 6 days per week. C: Standard medical care | 6 months | Not specified | Not reported |
Lombardi et al. [32] | 2014 | Italy | Clinical Medicine Insights: Cardiology | Cohort | NYHA II–III, LVEF < 45% | I: 13 | I: 59 | I: 14 | I: 11 (85) | I: 2 × 4 g sachets contain 11 essential and semi-essential amino acid per day | 3 months | CPET and 6MWT distance | Not reported |
Risk of bias
Duration of protein and essential amino acid supplementation
Daily protein and essential amino acid dose
Combined interventional studies
Control group characteristics
Strength measurements
Study | Sample size (n =) | Measurement of strength | Mean change in strength (SD) | Significant improvement |
---|---|---|---|---|
Pineda-Juarez et al. [29] | I: 29 C: 26 | Handgrip (dominant arm; kg) | I: + 8.0 (− 6.8 to 15.3)a C: + 11.4 (3.6 to 21.4)a | I: No—P > 0.05 C: No—P > 0.05 Inter-group: Not reported |
Wu et al. [30] | I: 14 C: 12 | Isometric leg extension—peak torque/BW (%) | I: 196.0 ± 37.4 to 206.0 ± 41.2 C: 177.0 ± 62.4 to 200.0 ± 69.3 | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No—P > 0.05 |
Isometric leg flexion—peak torque/BW (%) | I: 90.0 ± 18.7 to 90.0 ± 18.7 C: 76.0 ± 20.8 to 90.0 ± 27.7 | I: No–P > 0.05 C: No–P > 0.05 Inter-group: No–P > 0.05 | ||
Isokinetic leg extension–peak torque/BW (%) | I: 153.0 ± 29.9 to 160.0 ± 33.7 C: 147.0 ± 58.9 to 173.0 ± 69.3 | I: No–P > 0.05 C: No–P > 0.05 Inter-group: No–P > 0.05 | ||
Isokinetic leg flexion–peak torque/BW (%) | I: 70.0 ± 18.7 to 77.0 ± 15.0 C: 61.0 ± 20.8 to 76.0 ± 31.2 | I: No–P > 0.05 C: No–P > 0.05 Inter-group: No–P > 0.05 | ||
George et al. [31] | I: 3 C: 3 | Handgrip (right arm; kg) | I: + 1.8 ± 1.6 C: + 2.4 ± 2.1 | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No—P > 0.05 |
Quadriceps Strength (kg) | I: + 5.7 ± 1.0 C: + 10.2 ± 8.7 | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No—P > 0.05 |
Muscle performance measurements
Study | Sample size (n =) | Measurement of muscle function | Change in muscle function (SD) | Significant improvement |
---|---|---|---|---|
Aquilani et al. [27] | I: 21 C:17 | 6MWT (m) | I: 331.0 ± 124.0 to 405.0 ± 130.0 C: 298.0 ± 142.0 to 310.0 ± 155.0 | I: Yes—P < 0.001 C: No—P > 0.05 Inter-group: Yes—P = 0.02 |
Rozentryt et al. [28] | I: 23 C:6 | 6MWT (m) | I: 366.0 ± 110.0 to 410.0 ± 107.0 C: Not Reported | I: Yes—P = 0.020 C: No—P > 0.05 Inter-group: Not reported |
Wu et al. [30] | I: 14 C: 12 | 6MWT (m) | I: Numerical values not reported C: Numerical values not reported | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No—P > 0.05 |
George et al. [31] | I: 3 C: 3 | 6MWT (m) | I: − 49.0 ± 42.0 C: − 43.0 ± 37.0 | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No—P > 0.05 |
Get Up and Go (seconds) | I: + 1.8 ± 2.8 C: + 2.8 ± 4.3 | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No—P > 0.05 | ||
Lombardi et al. [32] | I: 13 C: N/A | 6MWT (m) | I: 439.1 ± 64.3 to 474.2 ± 89.0 C: N/A | I: Yes—P = 0.006 C: N/A Inter-group: N/A |
Body mass measurements
Study | Sample size (n =) | Measurement of body composition | Change in body composition (SD) | Significant improvement |
---|---|---|---|---|
Aquilani et al. [27] | I: 21 C:17 | Arm muscle area (Skin fold measurement-derived; cm2) | I: 31.2 ± 9.9 to 34.9 ± 10.0 C: 34.2 ± 5.0 to 37.1 ± 4.0 | I: Yes—P < 0.020 C: Yes—P < 0.020 Inter-group: P > 0.05 |
Tricep skinfold thickness (mm) | I: 10.4 ± 4.4 to 10.3 ± 3.9 C: 11.9 ± 3.7 to 11.4 ± 3.7 | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No—P > 0.05 | ||
Body mass (kg) | I: 55.9 ± 17.0 to 58.2 ± 7.2 C: 60.8 ± 7.0 to 61.2 ± 6.3 | I: Yes—P < 0.010 C: No—P > 0.05 Inter-group: No—P > 0.05 | ||
BMI (kg/m2) | I: 22.5 ± 2.1 to 23.4 ± 1.9 C: 23.2 ± 1.4 to 23.6 ± 1.5 | I: Yes—P < 0.010 C: No—P > 0.05 Inter-group: No—P > 0.05 | ||
Rozentryt et al. [28] | I: 23 C:6 | Lean body mass (DXA; kg) | I: 45.0 ± 12.5 to 45.5 ± 11.2 C: Not reported | I: Yes—P = 0.019 C: No—P > 0.05 Inter-group: Not reported |
Fat mass (DXA; kg) | I: 15.6 ± 8.9 to 16.6 ± 8.9 C: Not reported | I: Yes—P = 0.003 C: No—P > 0.05 Inter-group: Not reported | ||
Body mass (DXA; kg) | I: 63.9 ± 9.4 to 65.5 ± 10.3 C: Not reported | I: Yes—P = 0.003 C: No—P > 0.05 Inter-group: Not reported | ||
Pineda-Juarez et al. [29] | I: 29 C:26 | Body mass (kg) | I: − 0.6 (− 4.4 to 2.1)a C: -0.5 (− 2.4 to 2.7)a | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No—P > 0.05 |
BMI (kg/m2) | I: − 0.4 (− 2.7 to 2.2)a C: − 0.7 (− 2.1 to 2.3)a | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No P > 0.05 | ||
Arm circumference (% change) | I: − 2.0 (− 7.4 to 3.3)a C: − 4.0 (− 7.6 to 0.2)a | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No P > 0.05 | ||
Hip circumference (% change) | I: − 3.1 (− 6.6 to − 1.1) C: − 1.5 (− 3.7 to − 1.8) | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No P > 0.05 | ||
Waist circumference (% change) | I: − 0.7 (− 3.2 to − 3.3) C: − 1.7 (− 3.7 to − 1.8) | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No P > 0.05 | ||
Wu et al. [30] | I: 14 C: 12 | Lean body mass (DXA; kg) | I: 54.4 ± 2.8 to 56.1 ± 2.5 C: 52.4 ± 11.1 to 53.8 ± 12.8 | I: Yes—< 0.05 C: No—P > 0.05 Inter-group: Yes P = 0.040 |
Fat mass (DXA; kg) | I: 27.0 ± 7.5 to 26.0 ± 7.5 C: 25.0 ± 6.9 to 26.0 ± 6.9 | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No P > 0.05 | ||
BMI (DXA; kg/m2) | I: 30.0 ± 1.0 to 30.0 ± 1.0 C: 28.0 ± 2.0 to 29.0 ± 2.0 | I: No - P > 0.05 C: No - P > 0.05 Inter-group: No P > 0.05 | ||
Lombardi et al. [32] | I: 13 C: N/A | BMI (kg/m2) | I: 25.7 ± 3.2 to 25.4 ± 2.8 C: N/A | I: No C: N/A Inter-group: N/A |
Body mass index measurements
Fat mass measurements
Lean mass measurements
Aerobic fitness measurements
Study | Sample size (n =) | Measurement of aerobic fitness | Change in aerobic fitness (SD) | Significant improvement |
---|---|---|---|---|
Aquilani et al [27] | I: 21 C:17 | V̇O2peak (ml/kg/min) | I: 13.5 ± 1.7 to 14.9 ± 1.9 C: 12.9 ± 2.7 to 13.0 ± 3.5 | I: Yes—P < 0.050 C: No—P > 0.050 Inter-group: Yes—P < 0.050 |
Peak power output (w) | I: 80.0 ± 28.0 to 95.0 ± 25.0 C: 85.0 ± 24.0 to 88.0 ± 22.0 | I: Yes—P < 0.020 C: No—P > 0.050 Inter-group: Yes—P < 0.010 | ||
Rozentryt et al. [28] | I: 23 C:6 | V̇O2peak (ml/kg/min) | I: 14.5 ± 2.9 to 14.9 ± 3.1 C: Not reported | I: No—P = 0.320 C: No—P > 0.050 Inter-group: Not reported |
Pineda-Juarez et al. [29] | I: 29 C:26 | Estimated V̇O2peak (% change) | I: + 16.6 (0.2 to 38.5)a C: 50.1 (− 11.2 to 94.0)a | I: No—P > 0.05 C: No—P > 0.05 Inter-group: No—P > 0.05 |
Wu et al. [30] | I: 14 C: 12 | V̇O2peak (ml/kg/min) | I: + 7.9 ± 17.6 C: + 0.1 ± 2.6% | I: No—No—P > 0.05 C: No—P > 0.05 Inter-group: No—P = 0.260 |
Lombardi et al. [32] | I: 13 C: N/A | V̇O2peak (ml/kg/min) | I:14.8 ± 3.9 to 16.8 ± 5.1 C: N/A | I: Yes—P = 0.008 C: N/A Inter-group: N/A |
VAT (ml/kg/min) | I: 9.0 ± 3.8 to 12.4 ± 3.9 C:N/A | I: Yes—P = 0.002 C: N/A Inter-group: N/A | ||
V̇E/VCO2 slope | I: 37.1 ± 6.9 to 37.4 ± 7.7 C: N/A | I: No - P = 0.754 C: N/A Inter-group: N/A | ||
Peak power output (w) | I: 100.9 ± 32.4 to 104.8 ± 28.4 | I: No—P = 0.380 C: N/A Inter-group: N/A |