Randomized, controlled study of branched chain amino acid-enriched total parenteral nutrition in malnourished patients with gastrointestinal cancer undergoing surgery.
The objective of this study was to investigate the potential benefit of branched chain amino acid (BCAA)-enriched total parenteral nutrition (TPN) for malnourished surgical patients with gastrointestinal cancer. Sixty-four malnourished patients with gastrointestinal cancer with elective surgical intervention were equally allocated into two groups to receive isonitrogenous and isocaloric TPN. All of them must have received TPN soon after surgery and were subsequently randomized and divided into either BCAA-enriched TPN (30% BCAA; intervention group) or standard TPN (24% BCAA; control group). Patient biochemical data, nutritional parameters, and clinical outcome were collected to analyze the significance of BCAA-enriched TPN. After a period of TPN, laboratory data, including white blood cell (WBC), C-reactive protein (CRP), alkaline phosphatase (ALK-P), and gamma-glutamyltransferase (gamma-GT) levels, were significantly different between these two groups (all P < 0.05). Decreasing white blood cell and C-reactive protein levels were observed in the intervention group that might partially explain the reduced numbers of infectious complications. Furthermore, elevating alkaline phosphatase and gamma-glutamyltransferase levels being also less prominent might indicate a lesser hepatic burden by using BCAA-enriched TPN. The BCAA-enriched TPN can maintain a patient's serum visceral protein (albumin and prealbumin) and positive nitrogen balance better than standard TPN (all P < 0.05). Furthermore, a prominently decreased frequency of postoperative morbidity was also found in the BCAA-enriched TPN group (P = 0.021) despite no difference regarding surgical mortality. Our observations show that BCAA-enriched TPN may be beneficial in improving the nutritional status and reducing postoperative complications for malnourished patients with gastrointestinal cancer undergoing major surgery.
Sun
Li-Chu
LC
Nutrition Support Team, Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Shih
Ying-Ling
YL
Lu
Chien-Yu
CY
Hsieh
Jan-Sing
JS
Chuang
Jui-Fen
JF
Chen
Fang-Ming
FM
Ma
Cheng-Jen
CJ
Wang
Jaw-Yuan
JY
D000368:Aged; D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000209:etiology* / Q000628:therapy*; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D016896:Treatment Outcome
D000597:Amino Acids, Branched-Chain