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Nutritional Intervention High in Vitamins, Protein, Amino Acids, and  3 Fatty Acids Improves Protein Metabolism During the Hypermetabolic State After Thermal Injury
Marc G. Jeschke, MD;
David N. Herndon, MD;
Christoph Ebener, MD;
Robert E. Barrow, PhD;
Karl-Walter Jauch, MD,PhD
Arch Surg. 2001;136:1301-1306.
Hypothesis Characteristic of the hypermetabolic response to a thermal injury is the massive protein catabolism and compromised structure and function of essential organs. Nutrition has been suggested to affect protein metabolism and clinical outcome after a severe injury but published studies show controversial data. The purpose of this study was to determine the effect of enriched nutritional support during the postburn hypermetabolic state on protein metabolism in serum, liver, muscle, and skin.
Setting Laboratory.
Intervention Twenty-two rats were given burns covering 60% of their total body surface area and randomized to receive either standard rat chow (control) or a diet high in vitamins, protein, amino acids, and  3 fatty acids.
Main Outcome Measures Five weeks after injury, body weight, serum, muscle, and hepatic protein content, insulin-like growth factor I concentration, and wound healing (reepithelization) were determined.
Results Rats receiving the enriched diet showed a gradual improvement in body weight 1, 2, 3, 4, and 5 weeks postburn compared with controls (P<.001). Diet-fed rats demonstrated higher protein and insulin-like growth factor 1 content in serum, muscle, and liver 5 weeks after trauma (P<.001). Serum protein, albumin, and transferrin levels were significantly increased in rats receiving the diet compared with control rats (P<.001). Reepithelization was accelerated in rats receiving the enriched diet 4 (diet-fed, mean ± SD, 23% ± 1% vs controls, 17% ± 1%; P<.001) and 5 (diet-fed, 24% ± 1% vs controls, 18% ± 1%; P<.001) weeks postburn compared with control rats.
Conclusions Nutritional intervention high in protein, vitamins, amino acids, and 3 fatty acids improves protein net balance during the hypermetabolic response to thermal injury. Compromised organ function and structure and clinical outcome during the hypermetabolic response may be improved.
From the Klinik und Poliklinik für Chirurgie, Klinikum der Universität Regensburg, Regensburg, Germany (Drs Jeschke, Ebener, and Jauch); and the Shriners Hospital for Children and Department of Surgery, University of Texas Medical Branch, Galveston (Drs Jeschke, Herndon, and Barrow).
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