Table 4.
RCTs evaluating effects of oral nutrient supplementation on body composition and cachexia among patients with RA.
| First author | Design | Participants | Intervention(s) | Comparator(s) | duration | Outcomes | Results |
|---|---|---|---|---|---|---|---|
| Wilkinson94 | Parallel RCT | N=40 patients with RA | Creatine ONS [20 g of Cr monohydrate (MyProtein, 4×5 g/day for the initial 5 days (loading dose) followed by 3 g/day for the remainder of the 12-week period (maintenance dose)], mixed with a mango-flavoured drink powder (Foster Clark Products) to improve taste (n=15 ) | Placebo ONS (flavoured drink powder) (n=20 ) | 12 weeks | Body composition (DXA and BIS), strength, aerobic capacity (Vo2max) and physical function | ONS with creatine increased total and appendicular LM, but failed to improve isometric knee extensor and handgrip strength, or objectively assessed physical function. |
| Marcora95 | Parallel RCT | N=40 patients with RA | ONS with 3 g HMB (calcium salt), 14 g ARG and 14 g GLN, diluted in 240 mL of water, drank twice/daily (n=20 ) | ONS with placebo (nitrogen (7.19 g/day) and calorie (180 kcal/day) balanced mixture of ARG (11 g), GLN (1.75 g), L-glycine (6.10 g) and L-serine (4.22 g), diluted in 240 mL of water, drank twice/daily (n=20 ) | 12 weeks | Body composition and physical function | Dietary ONS with HMB/GLN/ARG was not superior to placebo in the treatment of RC. Both amino acid mixtures increased FFM, TBP, arms and legs LM, and some measures of physical function. |
| Lovell97 | Parallel RCT | N=198 children and adolescents with juvenile RA | ONS with 1,000 mg of Ca and 400 IU of vitamin D (n=103 ) | ONS with matched placebo tablets and 400 IU of vitamin D (n=95 ) | 24 months | BMD (DXA) | At 24 months, the mean BMD among those receiving Ca was greater, independently of sex, Tanner stage, adherence to medication, etc. |
| Aryaeian96 | Parallel RCT | N=62 patients with active RA | ONS with 6 capsules of 500 mg barberry extract (n=31 ) | ONS with placebo (HPMC) (n=31 ) | 3 months | FPG, TG, LDL and HDL levels, BMI, SBP, DBP, anthropometry | BW, BMI, and conicity index increased in both groups, but this was significant only in the placebo group. BF (% of BW), LDL, hips circumference, FPG, and SBP were all decreased in the intervention arm. |
ARG: L-arginine; BF: body fat; BIS: bioelectrical impedance spectroscopy; BMD: bone mineral density; BMI: body mass index; BW: body weight; DAS28: disease activity score (28 joints); DBP: diastolic blood pressure; DXA: dual x-ray absorptiometry; ESR: erythrocyte sedimentation rate; FFM: fat-free mass; FM: fat mass; FPG: fasting plasma glucose; GLN: L-glutamine; HDL: high-density lipoprotein; HMB: beta-hydroxy-beta-methylbutyrate; HPMC: hydroxypropyl methylcellulose; IGF: insulin-like growth factor; LDL: low-density lipoprotein; LM: lean mass; ONS: oral nutrient supplementation; RA: rheumatoid arthritis; RC: rheumatoid cachexia; RCT: randomized controlled trial; SBP: systolic blood pressure; TBP: total body protein; TG: triglycerides.