Oral Citrulline Supplementation in COPD Patients With Malnutrition

Effects of Oral Citrulline Supplementation on Fat-free Mass in COPD Patients With Malnutrition

Chronic obstructive pulmonary disease (COPD) is complicated by malnutrition in 20-70% of cases. In COPD, low fat-free mass is associated with a higher risk of morbidity and mortality. L-citrulline is a non-protein amino acid that has a direct effect on muscle protein synthesis. Oral supplementation with L-citrulline (10 g/day) in malnourished patients has shown to increase fat-free mass. The effects of L-citrulline supplementation in malnourished COPD patients are unknown.

The main objective of this prospective, single-centre, randomised, double-blind, placebo-controlled study will be to determine the impact of 45 days of nutritional supplementation with L-citrulline (10 g/day) on lean body mass (fat-free mass index (in kg.m-2) measured by bioelectrical impedance analysis) in malnourished patients (BMI < 20 kg/m2 if < 70 years old or < 22 kg/m2 if ≥ 70 years old) with COPD at stages 3-4 of the GOLD classification.

Inclusion Criteria:

• Men and women aged 50 and over
• COPD stage 3 or 4 according to GOLD criteria
• BMI < 20 kg/m2 if < 70 years old or < 22 kg/m2 if ≥ 70 years old
• Suspicion of sarcopenia marked by a score of 4 or more on the SARC-F questionnaire
• Absence of severe COPD exacerbation for at least 3 months

Exclusion Criteria:

• Main respiratory disease other than COPD
• Daily long-term use of systemic corticosteroids (>6 months per year, whatever the dose)
• Severe and end-stage renal insufficiency (creatinine clearance <30ml/min)
• Patient with severe hypotension, uncontrolled hypertension (at investigator's discretion)
• Contraindication to L-citrulline intake: VKA and/or cancer chemotherapy
• Osmotic diarrhoea
• Severe and/or uncontrolled progressive pathology likely to be life-threatening
• Psychiatric pathology (schizophrenia, dementia, severe bipolar/psychotic disorders, severe depressive syndrome)
• Pacemaker or other implanted electronic device