Essential Amino Acid Profile in Parenteral Nutrition Mixtures: Does It Meet Needs?

Abstract

Background and Aims: The study compares the essential amino acid (EAA) composition of different parenteral nutrition (PN) mixtures with whey protein EAA profile and the theoretical daily EAA requirements (set by WHO/FAO/UNU or IAAO method). According to the individual EAA profile, the potential effect of several PN mixtures was evaluated on the skeletal muscle mass (SMM) of patients on home PN. Methods: Eight AA solutions and fifteen complete PN mixtures were considered. Twenty-nine clinically stable patients with short bowel syndrome on home total PN were retrospectively evaluated. SMM was estimated by bioelectrical impedance analysis. Results: The prescribed doses of EAA that showed a significant increase in home PN patients muscle mass were considerably greater than the theoretical ones, showing an EAA profile similar to whey protein. At the daily dose of 1 g of total AA s/kg body weight (BW), the considered PN mixtures mostly failed to improve SMM. Only prescribed doses which included more than 0.25 g/kg BW of total BCAA with at least 0.10 g/kg BW leucine, 0.08 g/kg BW isoleucine, and 0.06 g/kg BW methionine showed a significant increase in SMM. Conclusions: The theoretical daily requirement for each EAA was met by all considered PN solutions when the prescribed daily dose of total AAs was set at 1 g/kg BW. Nevertheless, our data suggest that only an increase in total BCAA, also richer in single AA leucine, isoleucine, and methionine, is associated with the maintenance and/or increase of SMM. According to these preliminary observations, we support the prescription of an EAA composition of PN mixtures close to that of whey protein for the preservation of SMM in patients on long-term total PN.

Impact on Isoleucine and Valine Supplementation When Decreasing Use of Medical Food in the Nutritional Management of Methylmalonic Acidemia

“…Leucine (LEU) is essential to growth and whole-body amino acid metabolism, arguably more than other amino acids. The importance of LEU in activating protein synthesis in skeletal muscle has been widely described [9,10]. Additionally, human tissue and food-derived proteins contain larger amounts of leucine than any other amino acid.…”

Macronutrients in Parenteral Nutrition: Amino Acids

“…In specific clinical conditions, such as AA disorders (e.g., inborn errors in the metabolism of some AAs), preterm born, and critically ill patients, specialized AA solutions may be required [20]. In recent work, we showed that commercially available standard PN mixtures, even with the same total AA content, have very different EAA/AA ratios, and in particular, an unlikely EAA profile (Tables 1 and 2, and [21]). Although all evaluated mixtures at the usual dose of 1 g/kg of body weight per day meet the EAA doses for unstressed healthy subjects suggested by the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), and the United Nations University (UNU), in most cases their EAA content was insufficient to guarantee a significant muscle mass increase in patients on PN; thus, to obtain an effective dose of EAA, it would be necessary to increase the daily dose of total AAs considerably.…”

“…Although all evaluated mixtures at the usual dose of 1 g/kg of body weight per day meet the EAA doses for unstressed healthy subjects suggested by the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), and the United Nations University (UNU), in most cases their EAA content was insufficient to guarantee a significant muscle mass increase in patients on PN; thus, to obtain an effective dose of EAA, it would be necessary to increase the daily dose of total AAs considerably. In the AA mixtures for PN, the EAAs should be at least 50% of the total AA support and, in particular, leucine, isoleucine, and methionine content should exceed a fixed threshold to obtain a gain of muscle mass in PN patients [21].…”

Análise de custos de nutrição parenteral

“…Parenteral nutrition (PN) is classified as a solution or emulsion composed of carbohydrates, amino acids, lipids, vitamins, electrolytes and minerals, and must be pyrogenic, sterile and packaged in glass or plastic containers. [1][2] It is known that there are two types of PN, total and partial, and total parenteral nutrition (TPN) means that all essential nutrients are supplied in adequate amounts for the maintenance of life and cell and tissue growth, including carbohydrates, lipids, amino acids, electrolytes, minerals, trace elements and vitamins. The administration is made through the insertion of a central venous catheter, which allows the administration of hyperosmolar solutions and which have the least possible inconvenience.…”

“…The administration is made through the insertion of a central venous catheter, which allows the administration of hyperosmolar solutions and which have the least possible inconvenience. [2][3] Partial parenteral nutrition (PPN) is used to complement oral intake and part of the daily nutritional needs, and should be composed of solutions of low hyperosmolarity, including the nutritional intake for a given time. [1][2][3][4] PN is indicated to patients who should not or can not be fed orally or enterally, to patients with basic disease in food intake, digestion or absorption, malnutrition with loss of body mass greater than 20%, in hypermetabolic states such as large burns, septic patients, extensive polytrauma, and acute pancreatitis, highthroughput intestinal fistulas, based on intravenous feeding.…”