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Intravenous Branched Chain Amino Acid Trial in Marrow Transplant Recipients
Author(s) -
Lenssen Polly,
Cheney Carrie L.,
Aker Saundra N.,
Cunningham Beth A.,
Darbinian Jeanne,
Gauvreau Jean M.,
Barale Karen V.
Publication year - 1987
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 - 10.1177/0148607187011002112
Subject(s) - parenteral nutrition , nitrogen balance , medicine , creatinine , transplantation , enteral administration , calorie , gastroenterology , total body irradiation , surgery , chemotherapy , nitrogen , chemistry , cyclophosphamide , organic chemistry
Branched chain amino acids (BCAA) improve nitrogen balance and end‐organ function in surgical patients, but are untested in marrow transplant recipients. We compared nitrogen balance, urinary 3‐methylhistidine‐to‐creatinine ratio, upper arm anthropometry, serum prealbumin, and day to peripheral engraftment in a randomized, double‐blinded trial between 45% (high‐leucine) and 23% BCAA intravenous solutions in 40 adult leukemia patients for 1 month following allogeneic marrow transplantation. Nutritional support, provided at approximately 30 nonprotein calories/kg and 0.21 g nitrogen/kg ideal weight, did not differ between groups. Despite greater nitrogen loss and muscle breakdown evidenced by increased 3‐methylhistidine‐to‐creatinine ratio and loss of arm muscle area by study end in the 45% BCAA, no statistical differences were observed when nitrogen balance was compared by week and within stress level as defined by organ and infectious complications. It is likely the patients in the 45% BCAA experienced greater metabolic stress by study end. Serum prealbumin and day posttransplant to peripheral engraftment also did not differ between groups. The chances (power) of this study exceeded 85% in detecting a difference in nitrogen balance of 2.5 g during study week 1 and 4.0 g during week 2. The power during week 3 was 77% for detecting a difference of 4.0 g, and it is unlikely that the true difference exceeds this magnitude. Thus, we did not find any evidence that intravenous BCAA‐enriched solutions improved nitrogen balance during the first month after marrow transplantation. ( Journal of Parenteral and Enteral Nutrition 11: 112–118, 1987)