Effect of immuno-nutrition on systemic inflammation andmusclemass in a haemodialysis population: a feasibility study

Abstract Background and Aims Decreased skeletal muscle mass (SMM) and systemic inflammation are frequent complications associated with poor outcomes in people receiving haemodialysis. Although these problems are widely acknowledged, it has become clear that simply providing conventional oral nutritional supplements (ONS) is often not effective in increasing SMM. This is partly because systemic inflammation causes “anabolic resistance”, a condition that inhibits optimal rates of muscle protein synthesis being achieved despite adequate protein intake/availability. Immuno-nutrition supplements are high in energy and protein (similar to conventional ONS), but also contain a unique combination of nutrients that have shown to reduce inflammation in people with cancer. Therefore, the purpose of this feasibility study is to explore the potential effect of immuno-nutrition on systemic inflammation and SMM in a haemodialysis population. Method This was a single-centre, non-randomised, interventional feasibility study where 14 haemodialysis patients received 1 sachet per day (74 g dissolved in 125 ml of water) of a commercially available immuno-nutrition supplement (Oral Impact®, Nestlé) for 6 weeks. C reactive protein (CRP), skin autofluorescence (SAF, a marker of systemic inflammation), body composition assessment using bioelectrical impedance analysis (InBody 770), weight, body mass index (BMI), handgrip strength (HGS), routine biochemical variables (pre-dialysis), and energy, protein and fat intake were measured at baseline and after the 6-week intervention. Results Mean participant age was 69 ± 13 years and median dialysis vintage was 26 (interquartile range 9 to 94) months. Twelve participants (86%) were male and of white ethnicity. Diabetes and heart disease were present in 9 (64%) and 7 (50%) participants, respectively. Adherence to the intervention was high (98%). Participants reported that the taste of the supplement was nice and acceptable. No safety issues were observed in terms of development of hyperkalaemia or fluid overload. We observed a significant increase in HGS and urea. Fat-free body mass and SMM remained stable, while body weight, BMI and body fat mass tended to increase, though changes did not reach statistical significance. Markers of systemic inflammation and dietary intake did not show any significant change (Table 1). Conclusion In this interventional feasibility study, we observed that provision of an immuno-nutrition supplement was associated with an improvement in muscle strength, as well as maintenance of SMM. This suggests that immuno-nutrition may be effective in preventing SMM loss over time in people on haemodialysis. The findings of this feasibility study will help design a randomised controlled clinical trial investigating whether immuno-nutrition supplementation can improve SMM and other nutritional markers, and to evaluate the impact on long-term outcomes, including quality of life.