Training and Education

Find out more to download a pdf copy of the
Abound Product Monograph.

 

Abound® is a therapeutic nutrition product intended for people who have non-healing wounds. Abound® is intended for use in concert with a complete and balanced diet (oral food intake,
oral nutrition supplements, enteral tube feedings, or some combination) along with optimal management of the wound (debridement, moisture control, wound dressings, and
infection control).

Abound® and its ingredients

Abound® is a therapeutic nutrition product that combines 3 key active ingredients—arginine, glutamine, and HMB—with other ingredients affording flavor and stability of the blend.

  • Abound® supports wound healing.1
  • Abound® supports immune function to help prevent or recover from
    complicating infections.2
  • The ingredients of Abound—HMB, arginine, and glutamine—play multiple roles:
    o    Slow protein breakdown
    o    Facilitate synthesis of collagen and other proteins involved in wound healing
    o    Promote function of numerous cells involved in immune responses
     

HMB, a leucine metabolite. Leucine is a member of the branched-chain amino acid family,
along with valine and isoleucine. The branched-chain amino acids play a role in maintaining
nitrogen balance in adults, especially in conditions such as sepsis, trauma, and burns; they
support protein synthesis after injury and decrease muscle proteolysis.1 Beta-hydroxy-betamethylbutyrate (HMB) occurs naturally in the body as a leucine metabolite; HMB has been
shown to inhibit muscle proteolysis and modulate protein turnover.3-7

Muscle converts approximately 5% of available leucine to HMB.4 A 70 kg person would thus
produce 0.2 to 0.4 g of HMB each day, a quantity that is insufficient to support metabolic needs
during times of rapid growth and healing.4

Arginine. Arginine is a conditionally-essential amino acid; it is made by the body in sufficient
quantities under usual conditions, but a dietary source becomes necessary during periods
of healing.8 Recognized to play a wide range of roles in wound-healing processes, arginine:

  • Induces secretion of the anabolic hormones insulin and growth hormone
  • Stimulates T-lymphocyte responses for wound healing
  • Serves as a metabolic precursor for nitric oxide, which in turn mediates bacterial killing by macrophages
  • Is catabolized to ornithine and converted to proline, which is used for collagen synthesis.1, 9,10

Glutamine. Glutamine is the most abundant amino acid in the body, and it has numerous
metabolic roles. Glutamine is conditionally-essential during times rapid tissue growth, especially
during wound healing.1,10,11 Glutamine is a nitrogen donor for synthesis of amino acids and
amino sugars, and it is a precursor for synthesis of nucleotides in cells such as fibroblasts and
macrophages, thereby supporting cell proliferation and function. Glutamine serves as a source
of metabolic energy for lymphocytes and macrophages (immune cells), and it is also converted
in the liver to glucose, which ultimately serves as an energy source for wound healing in the
periphery.1 In addition, glutamine is a metabolic fuel for cells of the intestinal mucosa, thereby
playing an important role to maintain gut integrity and function, including gut immune function.12,13

In conditions such as trauma, infection, wound healing, and burns, the inflammatory processes
involved in recovery increase needs for energy and for specific nutrients, particularly the
conditionally-essential amino acid glutamine. If adequate glutamine is not available, muscle
proteins will be broken down to meet the body’s energy needs. Supplemental glutamine has
been shown to:
  • Help maintain muscle protein during stress
  • Support and regulate synthesis of proteins, including collagen,
    as needed for wound healing
  • Helps maintain function of gut cells, including gut-associated
    lymphoid tissues (immune cells)
     
Abound Proof-of-concept Study

A double-blind, randomized study examined the effect of HMB, arginine, and glutamine (Abound) supplementation on wound collagen accumulation. A total of 35 healthy, volunteers 70 years or older were enrolled.14 Eighteen volunteers (mean age 75.4 years; 2 men, 16 women) were randomized to receive daily supplementation of 14 g arginine, 3 g CaHMB, and 14 g glutamine (total nitrogen 3.59 g) in two divided doses. The control group (n = 17; mean age 75.3 years;
6 men, 11 women) received an isonitrogenous, isocaloric mixture of nonessential amino acids. Supplementation with HMB, arginine, and glutamine (Abound) led to a significant increase in collagen deposition (as reflected by hydroxyproline content). This provides a safe nutritional means for increasing wound repair in patients.
 

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References:

1. Williams JZ, Barbul A. Nutrition and wound healing. Surg Clin North Am. 2003;83: 571-596.
2. Clark RH, Feleke G, Din M, et al. Nutritional treatment for acquired immunodeficiency virus-associated wasting using beta-hydroxy beta-methylbutyrate, glutamine, and arginine: a randomized, double-blind, placebo-controlled study. J Parenter Enteral Nutr. 2000;24:133-139.
3. Alon T, Bagchi D, Preuss HG. Supplementing with beta-hydroxy-beta-methylbutyrate (HMB) to build and maintain muscle mass: a review. Res Commun Mol Pathol Pharmacol. 2002;111:139-151.
4. Nissen S, Sharp R, Ray M, et al. Effect of leucine metabolite beta-hydroxy-betamethylbutyrate on muscle metabolism during resistance-exercise training. J Appl Physiol. 1996;81:2095-2104.
5. Gallagher P, Carrithers J, Godard M, Schulze K, Trappe S. β−hydroxy−β−methylbutyrate ingestion, Part I: effects on strength and fat free mass. Med Sci Sport Exerc. 2000;32:2109-2115.
6. Smith HJ, Mukerji P, Tisdale MJ. Attenuation of proteasome-induced proteolysis in skeletal muscle by {beta}-hydroxy-{beta}-methylbutyrate in cancer-induced muscle loss. Cancer Res. 2005;65:277-283.
7. Smith HJ, Wyke SM, Tisdale MJ. Mechanism of the attenuation of proteolysis-inducing factor stimulated protein degradation in muscle by beta-hydroxy-beta-methylbutyrate. Cancer Res. 2004;64:8731-8735.
8. Matarese LE. Enteral feeding solutions. Gastrointest Endosc Clin N Am. 1998;8:593-609.
9. Stechmiller J, Childress B, Cowan L. Arginine supplementation and wound healing. Nutr Clin Pract. 2005;20:52-61.
10. Arnold M, Barbul A. Nutrition and wound healing. Plast Reconst Surg. 2006;117:42S-58S.
11. Scholl D, Langkamp-Henken B. Nutrient recommendations for wound healing. J Intraven Nurs. 2001;24:124-132.
12. Wilmore DW. The effect of glutamine supplementation in patients following elective surgery and accidental injury. J Nutr. 2001;131:2543S-2549S; discussion 2550S-2541S.
13. Holecek M. Relation between glutamine, branched-chain amino acids, and protein metabolism. Nutrition. 2002;18:130-133.
14. Williams JZ, Abumrad N, Barbul A: et al: Effect of a specialized amino acid mixture on human
collagen deposition. Ann Surg 2002;3:369-375.