The Potential Role of β−Hydroxy−β−Methylbutyrate (HMB) in the Management of Lean Body Mass Loss in Older Adults with Heart Failure and Cardiac Cachexia

Peter A McCullough, Christina B Berberich, Carolyn Alish and Refaat A Hegazi

The loss of muscle mass and strength is a consequence of the aging process and can occur during periods of bed rest, inactivity, trauma, illness as well. For older adults with advanced heart failure (HF)- associated cachexia, disease-related loss of muscle mass and strength is a complication of the disease state and is associated with deconditioning and frailty. As patients with HF progress, the likelihood of developing malnutrition and cachexia increases. Cachexia is associated with lean body mass (LBM) loss and is correlated with a worsening prognosis in HF. Nutrition interventions beyond simple caloric replacement could be an important adjuvant therapy for a better clinical outcome. Specifically, nutrients that improve muscle protein synthesis and decrease degradation are of special consideration for the management of cardiac cachexia. Dietary protein intake, oral nutrition supplements and β-hydroxy β- methyl butyrate (HMB) are few examples. HMB is the active metabolite of the essential amino acid leucine and is found in trace amounts in some foods. It has been shown to inhibit muscle proteolysis and modulate protein turnover. It is also been shown to stabilize muscle cell walls through the production of cholesterol within the muscle tissue. In the following review, we will focus on HMB as a potential nutritional compound that could help address the HF-associated loss of LBM and its consequences.