CHF COPD Sip Feed Anabolic Response

Texas A&M University90 enrolled

Overview

Weight loss commonly occurs in patients with chronic heart failure (CHF) and chronic obstructive pulmonary disorder (COPD), negatively influencing their quality of life, treatment response and survival. Loss of muscle protein is generally a central component of weight loss in CHF and COPD patients, but patients also have reductions in fat mass and bone density, independent of the severity of the disease state. The purpose of this study is to provide detailed insight in disease related gut function by obtaining information on gut permeability, digestion and absorption of glucose, fat and protein in CHF and COPD patients compared to matched healthy controls. This will provide required information that is necessary to implement new strategies to develop optimal nutritional regimen in CHF and COPD.

General aims: * To study the whole-body protein anabolic effect of several dosages of a high-quality protein sip feeding in COPD and CHF subjects as compared to healthy controls. * To investigate the anabolic threshold in subjects with COPD and CHF as compared to healthy controls. Purpose and objectives: Although the Researchers' previous study supports the concept of supplementing high-quality milk proteins in chronic wasting diseases i.e., COPD and CHF, the dose-response anabolic effects of proteins with high EAA levels are still unclear. Furthermore, there is no insight in the actual protein requirements in COPD and CHF. The knowledge gained from this study will benefit insight in terms of promotion of protein gain after feeding in COPD and CHF subjects. Based on the obtained data of protein behavior (protein kinetics) the Researchers will be able to further refine and personalize nutritional supplementation in COPD and CHF subjects in order to stop and even restore progressive muscle wasting.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

Eligibility

Sex: ALLMin age: 45 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion criteria CHF subjects: * Ability to walk, sit down and stand up independently * Age 45 years or older * Ability to lie in supine or elevated position for 8 hours * Diagnosis of CHF; under regular care by cardiologist * Reduced ejection fraction (\<45%) assessed in the past 2 years * NYHA class II-IV * Clinically stable condition; no hospitalization 4 weeks preceding first study day * Willingness and ability to comply with the protocol Inclusion criteria COPD subjects: * Ability to walk, sit down and stand up independently * Age 45 years or older * Ability to lie in supine or elevated position for 8 hours * Diagnosis of moderate to very severe chronic airflow limitation and compliant to the following criteria: FEV1 \< 70% of reference FEV1 * Clinically stable condition and not suffering from a respiratory tract infection or exacerbation of their disease (defined as a combination of increased cough, sputum purulence, shortness of breath, systemic symptoms such as fever, and a decrease in FEV1 \> 10% compared with values when clinically stable in the preceding year) at least 4 weeks prior to the first test day * Shortness of breath on exertion * Willingness and ability to comply with the protocol Inclusion criteria healthy subjects: * Healthy male or female according to the investigator's or appointed staff's judgment * Ability to walk, sit down and stand up independently * Age 45 years or older (older control group) * Age between 20-30 years old (young group) * Ability to lay in supine or elevated position for 8 hours * No diagnosis of CHF or COPD * Willingness and ability to comply with the protocol Exclusion Criteria all subjects: * Any condition that may interfere with the definition 'healthy subject' according to the investigator's judgment (healthy subjects only) * Established diagnosis of malignancy * History of untreated metabolic diseases including hepatic or renal disorder * Presence of acute illness or metabolically unstable chronic illness * Presence of fever within the last 3 days * Body mass index \>40 kg/m2 (healthy subjects only) * Any other condition according to the PI or nurse that was found during the screening visit, that would interfere with the study or safety of the patient * Use of protein or amino acid containing nutritional supplements within 5 days of first study day * Current Use of long-term oral corticosteroids (CHF only) * Use of short course of oral corticosteroids within 4 weeks preceding first study day * Failure to give informed consent or Investigator's uncertainty about the willingness or ability of the subject to comply with the protocol requirements * (Possible) pregnancy * Already enrolled in another clinical trial and that clinical trial interferes with participating in this study When during the period from enrollment to the test day any condition causing the subject to not meet inclusion criteria or to meet exclusion criteria, the subject will be excluded from the study.

Outcomes

Primary Outcomes

Change in net whole-body protein synthesis

Change in whole-body protein synthesis rate after intake of meal

Time frame: 0, 2, 5, 10, 15, 20, 30, 40, 50, 60, 90, 120, 150, 180, 210, 225, 240, 260, 280, 300, 320, 340, 360 ± 5 min

Secondary Outcomes

Body Composition

Body composition as measured by Dual-Energy X-ray Absorptiometry

Time frame: 15 minutes on screening or study day 1

Skeletal muscle strength

handgrip and kin-com 1-leg test

Time frame: on study day 1

Respiratory muscle strength

Maximum inhalation and exhalation pressure

Time frame: on study day 1

Gut function

Digestion of the stable tracers of amino acid

Time frame: In postabsorptive and prandial state every 20 minutes up to 6 hours before each sip feeding on study day

Group differences in state of mood as measured by the Hospital Anxiety and Depression Scale (HADS)

a fourteen item self-assessment scale. Seven of the items related to anxiety and seven relate to depression. Each item on the questionnaire is scored from 0-3 and this means that a person can score between 0 (no symptoms) and 21 (severe symptoms) for either anxiety or depression.