Nitrogen retention in critically ill patients is proportional to the branched chain amino acid load

Cerra, Frank B.; Mazuski, John E.; Teasley, Kathleen M.; Nuwer, Nancy; Lysne, Jolynn; Shronts, Eva P.; Konstantinides, Frank N.

doi:10.1097/00003246-198310000-00003

Cited by 82 publications

(20 citation statements)

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“…We found it unlikely that our patients differed in this respect compared with previous studies on more or less similar surgical patients. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] In those patients who were subjected to retroperitoneal dissections, the need for blood components was due to the leakage of plasma and lymph juice in the abdomen postoperatively. From the strict aspect of nitrogen balance, it is obvious that plasma proteins located intraabdominally take principal part in the nitrogen exchange of that patient.…”

Section: Resultsmentioning

confidence: 99%

Is it Possible to Evaluate the Efficacy of Amino Acid Solutions after Major Surgical Procedures or Accidental Injuries? Evaluation in a Randomized and Prospective Study

Lundholm

Bennegård

Wickström

et al. 1986

J Parenter Enteral Nutr

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Two unbalanced amino acid solutions (essential amino acids, branched-chain amino acids) were compared to a complete and balanced amino acid solution with regard to efficacy of nitrogen balance. Patients were randomized to receive the amino acid solutions over 3 days for each regimen. The patients were examined postoperatively or directly after accidental trauma. Nonprotein calories were given as 40 kcal/kg/day consisting of 50% fat and 50% glucose. Nitrogen was given at the amount of 0.15 g N/kg/day. Unbalanced amino acid solutions gave a 2-fold more negative nitrogen balance than a balanced and complete amino acid solution. However, this difference disappeared and nitrogen balance approached equilibrium irrespective of the amino acid composition of the infused solutions when nitrogen in blood products was accounted for. All patients received a considerable amount of blood products in a comparable but unpredictable way. Blood products corresponded to around 40% of the daily nitrogen intake. Our study demonstrates that it is not possible to test the efficacy of amino acids for nitrogen retention in patients who are in the need of blood-product transfusions. It is likely that amino acids in blood proteins serve as a significant amino acid source that is utilized for resynthesis of body proteins especially in flow-phase patients with high protein breakdown. This fact has not been sufficiently accounted for in the previous literature.

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Section: Resultsmentioning

confidence: 99%

Is it Possible to Evaluate the Efficacy of Amino Acid Solutions after Major Surgical Procedures or Accidental Injuries? Evaluation in a Randomized and Prospective Study

Lundholm

Bennegård

Wickström

et al. 1986

J Parenter Enteral Nutr

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“…Based on this premise, numerous projects studying the effect of BCAA in the critically ill have been published [1][2][3][4][5][6][7][11][12][13][14][15][16][17]. A majority of these studies have used nitrogen balance as their gold standard in terms of evaluating the benefit of BCAA.…”

Section: Discussionmentioning

confidence: 99%

“…A majority of these studies have used nitrogen balance as their gold standard in terms of evaluating the benefit of BCAA. With this as a criterion, several studies have shown a positive effect for BCAA in critically ill patients [1][2][3][4][5][6][7], while others have shown no beneficial effects [11][12][13][14][15][16][17]. It is worth noting that in none of these studies were detrimental effects of BCAA documented.…”

Section: Discussionmentioning

confidence: 99%

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Failure of BCAA supplementation to promote nitrogen retention in injured patients.

Scholten

Morgan

Davis³

et al. 1990

Journal of the American College of Nutrition

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The purpose of this study was to determine if supplementing total parenteral nutrition (TPN) with lipids or the branched chain amino acids (BCAA) leucine, isoleucine, and valine influences nitrogen balance in the injured patient. Four TPN study solutions were used, with each patient receiving two of the solutions for 4 days each. Group A received solutions consisting of 19% and 44% BCAA, with nonnitrogen calories supplied by 100% carbohydrate. Group B received a 7:3 carbohydrate-to-lipid ratio of nonnitrogen calories as a fuel source. Neither BCAA supplementation nor varying fuel substrates promoted a difference in nitrogen retention. The added cost of BCAA supplementation, along with the lack of an effect upon nitrogen accretion, indicates that greater benefits must be demonstrated before widespread use of BCAA supplementation can be recommended in the injured patient.

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“…2,3 Moreover, parenteral nutrition (PN) had become widely available, and new stress formulas of PN appeared to have potential to prevent the MOF cascade to death. 4 NSTs, using a novel, multidisciplinary model of physician, nurse specialist, pharmacist, and dietitian, were developed to safely administer PN and to study its effectiveness. From its inception, A.S.P.E.N.…”

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confidence: 99%

Developing Research Programs in Clinical and Translational Nutrition

Moore

Ziegler

Heyland

et al. 2010

J Parenter Enteral Nutr

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Most clinicians believe that nutrition support therapy improves outcome in hospitalized patients. Unfortunately, few patients receive optimal nutrition management. A lack of strong, well-designed research studies may prevent the medical/surgical community from fully embracing the practice. More quality research is needed. This article discusses 3 potential strategies to improve research activity in clinical nutrition: increase funding of nutrition research, foster young physician training in nutrition and research, and attract nutrition researchers to our national nutrition society meetings. The best chance for this process to succeed is for the national nutrition societies to partner with medical and surgical subspecialty societies to develop larger scale clinical and translational research programs.

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Nitrogen retention in critically ill patients is proportional to the branched chain amino acid load

Cited by 82 publications

References 0 publications

Is it Possible to Evaluate the Efficacy of Amino Acid Solutions after Major Surgical Procedures or Accidental Injuries? Evaluation in a Randomized and Prospective Study

Is it Possible to Evaluate the Efficacy of Amino Acid Solutions after Major Surgical Procedures or Accidental Injuries? Evaluation in a Randomized and Prospective Study

Failure of BCAA supplementation to promote nitrogen retention in injured patients.

Developing Research Programs in Clinical and Translational Nutrition

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