title: Effect of branched chain amino acid enrichment of total parenteral nutrition on nitrogen sparing and clinical outcome of sepsis and trauma: a prospective randomized double blind trial.
abstract: Administration of extra branched chain amino acids (BCAA) has been associated with a nitrogen sparing effect in septic and traumatized patients. Whether nitrogen sparing is associated with decreased morbidity and mortality rates is unknown. We therefore undertook a prospective, randomized, double blind trial investigating the effects of BCAA enrichment of a total parenteral nutrition (TPN) regimen on nitrogen balance, 3-methylhistidine excretion, morbidity as evidenced by disturbances in organ function, severity of sepsis and mortality. One hundred and one patients entered the study; 52 received a standard TPN solution and 49 a BCAA-enriched solution. Both groups received 30 kcal kg-1 body-weight, 15 per cent fat calories and 0.17 g nitrogen kg-1 body-weight. In the BCAA-enriched group, patients received 0.56 g BCAA kg-1 body-weight (50.2 per cent BCAA). Standard group patients received 0.18 g BCAA kg-1 body-weight (15.6 per cent BCAA). Nitrogen balances and 3-methylhistidine excretion were not significantly different between groups. Although morbidity scores tended to decrease during the study no difference was observed between groups. Mortality (early or late), sepsis or stress-related, did not differ significantly between groups. We were not able to confirm the reported beneficial effects of BCAA-enriched TPN solutions for use in septic and traumatized patients.
authors.affiliation: Department of Surgery, University Hospital Maastricht, The Netherlands.
authors.forename: M F
authors.initials: MF
authors.lastname: von Meyenfeldt
authors.forename: P B
authors.initials: PB
authors.lastname: Soeters
authors.forename: J P
authors.initials: JP
authors.lastname: Vente
authors.forename: C L
authors.initials: CL
authors.lastname: van Berlo
authors.forename: M M
authors.initials: MM
authors.lastname: Rouflart
authors.forename: K P
authors.initials: KP
authors.lastname: de Jong
authors.forename: C J
authors.initials: CJ
authors.lastname: van der Linden
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage* / Q000378:metabolism; D001424:Bacterial Infections / Q000378:metabolism / Q000628:therapy; D004311:Double-Blind Method; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D008297:Male; D008762:Methylhistidines / Q000652:urine; D009104:Multiple Trauma / Q000378:metabolism / Q000628:therapy; D009584:Nitrogen / Q000378:metabolism*; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000378:metabolism; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic
chemical_list: D000597:Amino Acids, Branched-Chain; D008762:Methylhistidines; C028118:3-methylhistidine; D009584:Nitrogen