Efekti suplementacije novom formulacijom kreatina na mišićnu snagu, mišićni volumen i biohemijske indikatore osoba starijih od 65 godina

Abstract

Uvod: Kreatin je dobro poznat suplement koji za poboljšanje performansi koriste sportisti. U poslednje vreme sve je više istraživanja koja ispituju suplementaciju kreatinom kod starijih osoba zbog brojnih pozitivnih efekata na kontrolu šećera u krvi, lipidni status, mišićno-koštani sistem i potencijalnog neuroprotektivnog delovanja. Cilj ovog istražívanja je da se utvrde efekti suplementacije kombinacije kreatina i prekursora kreatina guanidinosirćetne kiseline (GAA) na mišićnu snagu, mišićnu masu, biohemijske i indikatore tkivno ćelijske bioenergetike, funkcionalne sposobnosti, kvalitet života povezan sa zdravljem i kognitivne funkcije starijih osoba. Materijali i metode: U istraživanju je učestvovala 21 osoba treće životne dobi (starost 69.6±4.9 godina, visina 162.7±7.7cm, telesna masa 73.3±12.4kg, 13 žena). Suplementacija je trajala 8 nedelja u režimu dvostruko-slepe, placebo kontrolisane randomizovane krosover studije. Eksperimentalna grupa je konzumirala kombinaciju kreatina (Cr) i guanidinosirćetne kiseline (GAA) (4 grama dnevno), a placebo grupa ekvivalentnu količinu inulina (4 grama dnevno); doza je rastvorena u mlakoj vodi (250 mL) i uzimana jednom dnevno pre doručka. Inicijalno i po završetku suplementacije sprovedena su a ntropometrijska merenja, dinamometrija stiska šake, analiza sastava tela, testovi funkcionalno-motoričkih sposobnosti, biohemijske analize, magnetna spektroskopija mozga i mišića te upitnici za procenu kvaliteta života povezanog sa zdravljem, sarkopenije, nivoa fizičke aktivnosti i kognitivnih sposobnosti. Rezultati: Statistički značajne razlike na kraju režima suplementacije između grupa utvrđene su za testove motoričkih sposobnosti - 5xTest ustajanja sa stolice (pre 14.3±3.0s vs. Cr+GAA grupa 11.8±2.1s, placebo 12.1±2.4sec; p<0.001) i Timed-Up and Go Test (pre 10.4±2.0s vs. Cr+GAA grupa 9.1±0.0s, placebo 9.6±1.9sec; p<0.001), obim desne (pre 30.5±2.9cm vs. Cr+GAA grupa 31.9±2.8cm, placebo 31.6±3.4cm; p<0.001) i leve nadlaktice (pre 30.1±3.0cm vs. Cr+GAA grupa 31.8±3.1cm, placebo 31.9±0.1cm; p<0.001), vrednosti glukoze u krvi (pre 4.7±0.5mmol/L vs. Cr+GAA grupa 5.1±0.7mmol/L, placebo 4.9±0.5mmol/L; p=0.02), ukupne proteine (pre 78.9±5.7g/L vs. Cr+GAA grupa 73.2±3.8 g/L, placebo 76.6±4.4g/L; p=0.002), stopu bubrežne filtracije (pre 84.4±10.5ml/min vs. Cr+GAA grupa 71.9±12.0ml/min, placebo 75.3±12.9ml/min; p<0.001), vrednosti kreatina (pre 12.9±4.5umol/L vs. Cr+GAA grupa 22.9±12.2umol/L, placebo 18.3±4.2umol/L; p=0.01), GAA (pre 1.9±0.8umol/L vs. Cr+GAA grupa 2.8±0.8umol/L, placebo 2.6±1.4umol/L; p=0.002) i kreatinina (pre 68.5±17.4umol/L vs. Cr+GAA grupa 110.1±27.4umol/L, placebo 118.3±24.7umol/L; p<0.001) u serumu, te dijastolni krvni pritisak (pre 78.4±9.3mm/Hg vs. Cr+GAA grupa 86.9±8.6mm/Hg, placebo 89.7±10.3mm/Hg; p<0.001). Protonska magnetna spektroskopija mišića pokazala je statistički značajno povećanje vrednosti kreatina u Cr+GAA grupi (pre 28.1±7.0mM vs. Cr+GAA grupa 36.9±9.2mM; p=0.002) te statistički značajne razlike između muškaraca i žena u Cr+GAA grupi (46.3±0.3mM vs. 30.7±4.6mM; p=). Statistički značajno povećanje N acetil aspartata (NAA) u mozgu zabeleženo je samo na jednom vokselu u beloj masi desnog frontalnog režnja (BM2) (pre 7.2±1.9mM vs. Cr+GAA grupa 8.1±0.7mM; p=0.03), kao i značajne razlike između muških i ženskih ispitanika za vrednosti holina u sivoj masi desne središnje parijetalne regije (SM12) (2.1±0.4mM vs. 1.1±0.1mM; p=0.02). Vrednosti kreatina rasle su u gotovo svim posmatranim vokselima u eksperimentalnoj grupi, ali statistički značajno samo u BM2 (pre 5.8±0.5mM vs. Cr+GAA grupa 6.3±0.4mM; p=0.002). U tri su voksela za kreatin utvrđene statistički značajne razlike između muškaraca i žena u Cr+GAA grupi za desni parijetalni režanj (BM10) (5.5±0.3mM vs.6.3±0.5mM; p=0.01), lijevu (SM11) (11.3±0.4mM vs. 8.0±0.9mM; p=0.01) i desnu središnju parijetalnu regiju sive mase (SM12) (11.3±1.7mM vs. 8.2±1.4mM; p=0.03). Procena kvaliteta života pokazala je statistički značajne razlike u zbirnim skalama fizičkog funkcionisanja (PCS) (pre 52.0±4.6 vs. Cr+GAA grupa 55.7±9.1, placebo 54.6±6.7; p=0.001) i mentalnog zdravlja (MCS) (pre 55.0±3.8 vs. Cr+GAA grupa 66.4±7.1, placebo 63.7±9.9; p<0.001). Zaključak: Unos kreatina i GAA tokom 8 nedelja pokazao je pozitivne efekte na poboljšanje funkcionalnih sposobnosti starih osoba, što može da ima korisne posledice u kontekstu unapređenja pojedinih komponenti zdravlja. Poboljšanje biomarkera tkivne bioenergetike mozga i mišića nakon suplementacije može da ima pozitivne efekte na unapređenje metabolizma kod cerebrovaskularnih i kardiovaskularnih bolesti starijih osoba.

Background: Creatine is a recognized ergogenic agent used by athletes to improve performance. Recently it has been investigated as beneficial for older people due to positive effects on glycemic control, lipid profile, functioning of the musculoskeletal system, and possible neuroprotective action. In this research, the aim was to determine the effects of supplementation with creatine and guanidinoacetic acid on muscle strength, muscle mass, serum biomarkers, and indicators of tissue bioenergetics, quality of life and cognitive functioning of older people. Materials and Methods: A total of 21 subjects participated in this trial (69.6±4.9 years; 162.7±7.7cm; weight 73.3±12.4kg, 13 women). Supplementation protocol lasted for 8 weeks as a double-blind placebo controlled crossover type of study. Experimental group ingested combination of creatine (Cr) + gunidinoacetate acid (Cr+GAA) (4 gr) once a day before breakfast, diluted in water (250 mL); placebo group consumed equivalent of inulin (4 gr). At baseline and after 8 weeks following measurements were performed: antropometry (upper arm, thigh, waist and hip girth, triceps and abdominal skinfold), body composition using bioimpedance, biochemical analyses, muscle and brain proton magnetic resonance spectroscopy, 5x Sit to Stand test, Timed up and Go Test, 4-m Speed Gait Test, and following questionnaires – The Short-form 36 Ouestionnaire, Sarcopenia and Quality of Life, International Physical Activity Questionairre – Short Form and Montreal Cognitive Assesment. Results: Statistically significant differences between groups following supplementation were found for 5x Sit to Stand test (at baseline 14.3±3.0s vs. experimental group 11.8±2.1s, control 12.1±2.4s; p<0.001), Timed-Up and Go Test (at baseline 10.4±2.0s vs. Cr+GAA 9.1±0.0s, control 9.61±1.9s; p<0.001), right (at baseline 30.5±2.9cm vs. Cr+GAA 31.9±2.8cm, control 31.6±3.4cm; p<0.001) and left upperarm girth (at baseline 30.1±3.0cm vs. Cr+GAA 31.8±3.1cm, placebo 31.9±0.01cm; p<0.001), blood glucose level (at baseline 4.7±0.6mmol/L vs. Cr+GAA 5.1±0.7mmol/L, control 4.9±0.5mmol/L; p=0.02), total serum protein (at baseline 78.9±5.7g/L vs. Cr+GAA 73.2±3.8g/L, control 76.6±4.4g/L; p=0.002), glomerular filtration (at baseline 84.4±10.5ml/min vs. Cr+GAA 71.9±12.0ml/min, control 75.3±12.9ml/min; p<0.001), serum creatine level (at baseline 12.9±4.5umol/L vs. Cr+GAA 22.9±12.2umol/L, control 18.3±4.2umol/L; p=0.01), GAA blood concentration (at baseline 1.9±0.8umol/L vs. Cr+GAA 2.8±0.8umol/L; control 2.6±1.4umol/L; p=0.002), serum creatinine level (at baseline 68.5±17.4umol/L vs. Cr+GAA 110.1±27.4umol/L, control 118.3±24.7umol/L; p<0.001) and diastolic blood pressure (at baseline 78.4±9.3mm/Hg vs. Cr+GAA 86.9±8.6mm/Hg, control 89.7±10.3mm/Hg; p<0.001). Proton magnetic resonance spectroscopy of the vastus medialis muscle showed a significant increase in muscle creatine level (at baseline 28.1±7.0mM vs. Cr+GAA 36.9±9.2mM; p=0.002) and significant sex differences (46.3±0.3mM vs. 30.7±4.6mM; p=0.008). N-acetyl aspartate (NAA) brain level significantly increased in right frontal lobe white matter (at baseline 7.2±1.9mM vs. Cr+GAA 8.1±0.7mM; p=0.03), choline showed no significant changes except between men and women in midline right parietal region grey matter (2.1±0.4mM vs. 1.1±0.1mM; p=0.02). Creatine brain level increased in almost all of the voxels but significantly just in the right frontal lobe white matter (at baseline 5.8±0.5mM vs. Cr+GAA 6.3±0.4mM; p=0.002). Significant differences were observed for men and women in the Cr+GAA group in the right parietal lobe white matter (5.5±0.3mM vs. 6.3±0.5mM; p=0.01), left (11.3±0.4mM vs. 8.0±0.9mM; p=0.01) and right midline parietal region grey matter (11.3±1.7mM vs. 8.2±1.4mM; p=0.03). The Short form 36 Quality of Life questionnaire physical component summary (PCS) (at baseline 52.0±4.6 vs. Cr+GAA 55.7±9.1, control 54.6±6.7; p=0.001) and mental component summary (MCS) (at baseline 55.0±3.8 vs. Cr+GAA 66.4±7.1, control 63.7±9.9; p<0.001) showed significant differences post administration in Cr+GAA group. Conclusion: Creatine and GAA 8-week administration demonstrated positive effects on functional abilities of the elderly, having the potential to benefit particular components of health. Improvements in brain and muscle tissue bioenergetics may lead to metabolism promotion preventing cerebrovascular and cardiovascular diseases of older people.