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Whole-Body Nitrogen and Tyrosine Metabolism in Surgical Patients Receiving Branched-Chain Amino Acid Solutions
Sukumar P. Desai, MD;
Bruce R. Bistrian, MD, PhD;
Lyle L. Moldawer;
George L. Blackburn, MD, PhD
Arch Surg. 1985;120(12):1345-1350.
Abstract
• Fifteen patients undergoing gastric bypass surgery for morbid obesity received preoperatively a standard crystalline amino acid solution containing 15.6% branched-chain amino acids. During the first five postoperative days, the patients were randomized to receive one of three amino acid solutions (9.0 to 10.3 g of nitrogen per day) of different branched-chain amino acid content. The branched-chain amino acid concentrations of the mixtures were 15.6%, 50%, and 100% by weight with five patients in each group. Whole-body amino acid appearance and oxidation were estimated using a continuous intravenous infusion of L-(U-14C)-tyrosine preoperatively and on the third postoperative day. Daily postoperative nitrogen balance, fractional albumin renewal rate, and whole-body tyrosine appearance, oxidation, and incorporation into protein were not significantly different among the three groups. This study suggests that an adequate nitrogen intake of a balanced amino acid mixture, as well as a solution enriched with branched-chain amino acids, maintains protein homeostasis and supports protein synthesis similarly in well-nourished patients following major abdominal surgery. A diet containing only branched-chain amino acids in isomolar ratios was as effective at maintaining protein retention and whole-body protein synthesis and albumin renewal postoperatively when compared with a standard amino acid formula.
(Arch Surg 1985;120:1345-1350)
Author Affiliations
From the Nutrition/Metabolism Laboratory, Cancer Research Institute, New England Deaconess Hospital/Harvard Medical School, Boston. Dr Desai is now with Brigham and Women's Hospital, Harvard Medical School, Boston.
Footnotes
Accepted for publication Dec 3, 1984.
Reprint requests to Cancer Research Institute, 194 Pilgrim Rd, Boston, MA 02215 (Dr Blackburn).
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