J.Jpn. Surg. Soc.. 90(3): 343-354, 1989

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Original article

A STUDY OF ADEQUATE ENERGY, AMINO ACID, AND CARBOHYDRATE REQUIREMENTS IN POSTOPERATIVE TOTAL PARENTERAL NUTRITION
―THE EFFECT OF BRANCHED CHAIN AMINO ACID (BCAA) AND CARBOHYDRATE MIXTURE OF GLUCOSE, FRUCTOSE, AND XYLITOL (GFX) ―

This study was performed to elucidate adequate energy and amino acid (AA) requirements for TPN patients after abdominal surgery. The effects of AA formula, rich in BCAA (30% BCAA), as a nitrogen source and the carbohydrate mixture of glucose, fructose, and xylitol (GFX=4:2:1), on nitrogen sparing were also studied. Forty-nine patients having undergohe major abdominal surgeries, were divided into 5groups. The regimens were as follows: G1: 40kcal/kg, standard amino acid (21% BCAA) 1.5g/kg. day, G2: 40kcal/kg,30% BCAA 1.5g/kg.day, G3:3 0kcal/kg, 21% BCAA 1.5g/kg.day, G4: 30kcal/kg, 30% BCAA 1.5g/kg.day, G5: 40kcal/kg, 21% BCAA 1.5g/kg. day. Glucose was the sole carbohydrate energy source in G1 through G4. In G5, GFX was used. (1) Accumulated nitrogen balances during the week immediately after operation were significantly higher in G1 and G2 where higher energy intakes were administered than G3 and G4. (2) The nitrogen balances during the 2nd or 3rd postoperative days in G2 or G4, using 30% BCAA as a nitrogen source, were higher than in G1 or G3 respectively. (3) The changes in serum rapid turnover proteins were not significantly different among these groups. (4) The accumulated nitrogen balance in G5 tended to be higher than that of G1. These results indicate that BCAA rich amino acid formula will induce a more favorable nitrogen sparing effect than a conventional AA formula on TPN patients under surgical stress.

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