Early curbing of protein hypercatabolism in postoperative patients by nutritional support with glucose plus amino acids, but not with glucose alone

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 1997-04, Vol.16 (2), p.67-73
• Main Authors: López-Hellin, J., López-Lara, M., Mercader, S., Gemar, E., García-Arumi, E., Sabín, P., Baena, J.A., Schwartz, S.
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Emergency and intensive postoperative care (general aspects). Pathophysiology of surgery; Intensive care medicine; Medical sciences
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/S0261-5614(97)80025-8

This work attempts to determine if there are differences in protein metabolism in post-surgical patients who receive parenteral nutrition with amino acids plus glucose (G+AA) or conventional gluco-salinal solution (GS). Eighteen patients submitted to gastrointestinal surgery were randomized and double-blindly administered either G+AA (1 g AA/kg.d and 28 kJ/kg.d), or GS (28 kJ/kg.d). Protein metabolism was determined 12 h after surgery (day 0) and after 5 days of nutritional support. On day 0, protein breakdown was simillarly elevated, with respect to reference values, in both groups (GS: 4.62 ± 0.25; G+AA: 5.25 ± 0.50 g prot/kg.d) as a result of surgical stress. These values increased significantly at day 5 ( P < 0.03) with the administration of GS to 6.93 ± 1.00 g prot/kg.d, while they decreased ( P < 0.002, 3.30 ± 0.42 g prot/kg.d) with G+AA. Protein synthesis was increased (5.69 ± 0.86 g prot/kg.d) with GS ( P < 0.02), and was decreased (2.79 ± 0.44 g prot/kg.d) with G+AA ( P < 0.0002). Both synthesis and breakdown were inside normal reference values after 5 days for group G+AA. In both groups, nitrogen balance did not change significantly at day 5 compared to day 0. G+AA is effective in curbing the hypermetabolism produced by postoperative stress, achieving normal protein metabolism in 5 days, while GS increases the protein breakdown and synthesis. Nitrogen balance does not detect these modifications of the protein metabolism. Undernutrition on prognosis is not yet fully recognized.