Pasini E, Corsetti G, Aquilani R, Romano C, Picca A, Calvani R, Dioguardi FS.
Nutrients. 2018 Mar 22;10(4). pii: E391. doi: 10.3390/nu10040391. Review.
PMID:29565819
Link: https://www.ncbi.nlm.nih.gov/pubmed/29565819
Abstract
Proteins are macro-molecules crucial for cell life, which are made up of amino acids (AAs). In healthy people, protein synthesis and degradation are well balanced. However, in the presence of hypercatabolic stimulation (i.e., inflammation), protein breakdown increases as the resulting AAs are consumed for metabolic proposes. Indeed, AAs are biochemical totipotent molecules which, when deaminated, can be transformed into energy, lipids, carbohydrates, and/or biochemical intermediates of fundamental cycles, such as the Krebs' cycle. The biochemical consequence of hyper-catabolism is protein disarrangement, clinically evident with signs such as sarcopenia, hypalbuminemia, anaemia, infection, and altered fluid compartmentation, etc. Hypercatabolic protein disarrangement (HPD) is often underestimated by clinicians, despite correlating with increased mortality, hospitalization, and morbidity quite independent of the primary disease. Simple, cheap, repeatable measurements can be used to identify HPD. Therefore, identification and treatment of proteins' metabolic impairment with appropriate measurements and therapy is a clinical strategy that could improve the prognosis of patients with acute/chronic hypercatabolic inflammatory disease. Here, we describe the metabolism of protein and AAs in hypercatabolic syndrome, illustrating the clinical impact of protein disarrangement. We also illustrate simple, cheap, repeatable, and worldwide available measurements to identify these conditions. Finally, we provide scientific evidence for HPD nutritional treatment.
In questo editoriale si spiega come in molte malattie croniche, ed in particolare in quelle cardiologiche, esista un nemico nascosto del paziente, troppo spesso non identificato e quindi ignorato nella terapia: la “sindrome ipermetabolica”.
Questa situazione affianca tante malattie croniche, ma è particolarmente importante in cardiologia, perché la terapia attuale è in grado di controllare molte delle alterazioni che danneggiano il cuore, mentre il paziente muore per sarcopenia/wasting/cachessia (consunzione dei muscoli prima, ma anche tessuto adiposo, particolarmente evidente e pericolosa nel paziente anziano).
La sindrome ipercatabolica alla base della consunzione del paziente è multifattoriale, può essere trattata se diagnosticata precocemente ( ed il marcatore principale suggerito per sospettarla è la ipoalbuminemia), e richiede l’uso di supplementi dietetici che fortifichino l’apporto di amino acidi essenziali la cui necessità è enormemente aumentata in questi pazienti.
