The research, published in the journal Nutrients, was a multicenter trial involving four bariatric centers in Italy, namely, Salerno, Siena, Turin and Vigevano.
This trial indicated that combine supplementation, which contained whey protein (40 g), vitamin D (2,000 UI), L-leucine (40 mg), L-isoleucine (20 mg) and L-valine (20 mg), was more effective than protein supplementation (40 g whey protein) alone in mitigating the decrease in FFM and MS without interfering with the clinical status of patients after one month of the surgery.
Sleeve gastrectomy and dietary recommendations
Bariatric and metabolic surgeries (BMS) including SG are surgical procedures to treat individuals with severe to moderate obesity. These treatments provide long-term benefits, particularly in alleviating comorbidities in obese individuals worldwide.
Effective weight management entails a reduction in fat mass (FM) and preservation of metabolically active FFM. Typically, patients experience a substantial loss in both FM and FFM within the first month of SG.
A significant reduction in FFM is associated with multiple adverse conditions including susceptibility to weight regain, elevated risks of sarcopenia and weakened muscles. Therefore, it is imperative to formulate dietary recommendations for effective weight management that helps maintain adequate FFM and MS after BMS.
The majority of the existing dietary recommendations solely concentrate on protein intake. The average protein intake post-BMS should range between 90 g and 120 g or 1.1 g/kg of ideal body weight to lessen the undesired FFM loss. A daily intake of 400 IU of vitamin D has been also been recommended to improve skeletal muscle force by an average of 17%.
Study Details
This study recruited a total of 57 participants (38 females and 19 males; mean age 43 years) with obesity who underwent SG between January and July 2023. All patients were evaluated the day before the SG (baseline) and one month after the surgery. During the follow-up period, participants were advised not to change their physical activity pattern.
A single postoperative isocaloric diet was formulated that ensured all participants from different bariatric centers consumed a similar diet. The selected participants were non-randomly assigned to the P+BCAA+Vit D group (n = 31) and the protein alone group (n = 26), based on their specific conditions.
Each participant’s body composition was measured using a bioelectrical impedance assay (BIA) and a hand dynamometer was used to determine their absolute hand grip strength.
Supplementation with P+BCAA+Vit D was found to be more effective than protein alone in preserving MS and FFM among the participants.
The authors concluded an adequate daily intake of BCAAs and Vit D with whey protein could significantly improve FFM and MS during the first-month post-SG.
Mechanism of action
Isoleucine and valine are two BCAAs that play a crucial role in preserving muscle mass hypertrophy. Leucine is another BCAA that promotes anabolic effects by elevating protein synthesis and decreasing protein degradation, which ultimately fosters a net muscle-protein balance.
The regulatory role of leucine in muscle protein synthesis and the long-term effect on body composition supports leucine intake for healthy muscle tissue. Mechanistically, BCAAs interact with the insulin metabolic pathway, thereby, modifying protein synthesis and preserving FFM during caloric restriction.
Vitamin D supplementation enhances calcium accumulation within the sarcoplasmic reticulum by increasing calcium-binding receptor levels. In addition, it improves the efficacy of calcium-binding sites and facilitates phosphate transport across cell membranes, which facilitates the proliferation and differentiation of muscle cells. A lower vitamin D level is associated with greater losses in FFM and MS.
Source: Nutrients
doi: 10.3390/nu16101448
“Adding Branched-Chain Amino Acids and Vitamin D to Whey Protein Is More Effective than Protein Alone in Preserving Fat Free Mass and Muscle Strength in the First Month after Sleeve Gastrectomy”
Authors: Schiavo et al.