Fat-free mass change after nutritional rehabilitation in weight losing COPD: Role of insulin, C-reactive protein and tissue hypoxia

Simonetta Baldi, Roberto Aquilani, Gian Domenico Pinna, Paolo Poggi, Angelo de Martini, Claudio Bruschi

Research output: Contribution to journalArticlepeer-review


Background: Fat-free mass (FFM) depletion marks the imbalance between tissue protein synthesis and breakdown in chronic obstructive pulmonary disease (COPD). To date, the role of essential amino acid supplementation (EAAs) in FFM repletion has not been fully acknowledged. A pilot study was undertaken in patients attending pulmonary rehabilitation. Methods: 28 COPD patients with dynamic weight loss > 5% over the last 6 months were ran-domized to receive EAAs embedded in a 12-week rehabilitation program (EAAs group n = 14), or to the same program without supplementation (C group n = 14). Primary outcome measures were changes in body weight and FFM, using dual X-ray absorptiometry (DEXA). Results: At the 12th week, a body weight increment occurred in 92% and 15% of patients in the EAAs and C group, respectively, with an average increase of 3.8 ± 2.6 kg (P = 0.0002) and -.1 ± 1.1 kg (P = 0.81), respectively. A FFM increment occurred in 69% and 15% of EAAs and C patients, respectively, with an average increase of 1.5 ± 2.6 kg (P = 0.05) and -.1 ± 2.3 kg (P = 0.94), respectively. In the EAAs group, FFM change was significantly related to fasting insulin (r2 0.68, P <0.0005), C-reactive protein (C-RP) (r2 = 0.46, P <0.01), and oxygen extraction tension (PaO2x) (r2 = 0.46, P <0.01) at end of treatment. These three variables were highly correlated in both groups (r &gt; 0.7, P <0.005 in all tests). Conclusions: Changes in FFM promoted by EAAs are related to cellular energy and tissue oxygen availability in depleted COPD. Insulin, C-RP, and PaO2x must be regarded as clinical markers of an amino acid-stimulated signaling to FFM accretion.

Original languageEnglish
Pages (from-to)29-39
Number of pages11
JournalInternational Journal of COPD
Issue number1
Publication statusPublished - 2010


  • Branched chain amino acids
  • COPD
  • Insulin
  • Pulmonary rehabilitation
  • Systemic inflammation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Public Health, Environmental and Occupational Health
  • Health Policy


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