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Does Modified Amino Acid Total Parenteral Nutrition Alter Immune‐Response in High Level Surgical Stress
Author(s) -
Nuwer Nancy,
Cerra Frank B.,
Shronts Eva P.,
Lysne Jolynn,
Teasley Kathy M.,
Konstantinides Frank N.
Publication year - 1983
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607183007006521
Subject(s) - parenteral nutrition , medicine , nitrogen balance , lymphocyte , immune system , enteral administration , gastroenterology , immunology , chemistry , organic chemistry , nitrogen
A randomized prospective double‐blinded study was conducted in patients in moderate to high level surgical stress to ascertain the effect of high dose branched‐chain (BcAA) hyperalimentation on skin test reactivity and lymphocyte count. Isocaloric, isonitrogenous balanced total parenteral nutrition solutions were administered to two treatment groups. The study group received the high dose (45% BcAA) solution while the control group received a standard amino acid solution (24.2% BcAA). All patients received 1 to 1.5 g/kg/day of amino acids and 30 nonprotein cal/kg/day, with 30% of them as fat. Immune function was assessed by absolute lymphocyte count and delayed cutaneous hypersensitivity on days 0 and 7 of therapy. Absolute lymphocyte count showed a marked improvement in patients receiving high dose aBcAA ( p < 0.03). All patients were anergic at baseline; a much greater percentage of skin test reactivitry was observed in the BcAA group on day 7 ( p < 0.03). They were also in positive nitrogen balance. The data suggest that improved nitrogen retention and immune‐competence is possible with branched‐chain‐enriched hyperalimentation in high level surgical stress. ( Journal of Parenteral and Enteral Nutrition 7 :521–524, 1983)