[The effect of the administration of an amino acid solution enriched with branched-chain amino acids on the nutritional assessment of patients with stress who require total parenteral nutrition]. / Influencia de la administración de una solución de aminoácidos enriquecida en aminoácidos de cadena ramificada en la valoración nutricional de pacientes con estrés que precisan nutrición parenteral total.

ABSTRACT

The effects of two solutions of amino acids (AA) were compared in the nutritional assessment of stressed patients requiring total parenteral nutrition (TPN) by finding anthropometric, biochemical and immune parameters on day 0 and day 8. In addition, calculations were made to find the nutritional prognosis index, stress index nitrogenated balance (NB) and net protein use (NPU). A double-blind prospective study was run in which 35 patients with moderate to high stress were divided at random into two groups to receive, for seven days, TPN that was both isonitrogenated (1.56 g/Kg/day of AA) and isocaloric (115.6 +/- 13.6 non-protein Kcal/g. nitrogen), 37% as lipids (LCT), differing only in the AA solution used, one being 15.6% and the other, 45% BCAA. Twenty-eight patients finished the study, 14 in each group. No significant differences were found between the groups in the parameters under study; however, the patients who received the 45% BCAA solution obtained superior development of the parameters evaluating nutritional status and an increase in their NB (p = 0.0213) and NPU (p = 0.0497). Total lymphocytes increased significantly in both groups. Disturbances in hepatic enzymes and alkaline phosphatase (AF) were higher than in the standard group. Gamma glutamyl transferase (GGT) increased in group I (p = 0.0168), while in group II there were increases of GGT (p < or = 0.05), glutamic pyruvic transaminase (GPT) (p < or = 0.025) and AF (p = 0.0213). In the standard group, plasma urea increased (p = 0.0117), and the creatine/size ratio decreased (p = 0.0094). Anthropometric measurements were not valid in this study. The results do not allow the conclusion to be drawn that the 45% BCAA solution is the most effective, but it does make clear that its use is suitable in patients with moderate and high levels of stress, changing to standard AA solutions when the patients improve.