EXPERIMENTAL AND CLINICAL STUDY OF NUTRITION IN STRESS SITUATION --EFFECTS OF BRANCHED CHAIN AMINO ACIDS ON ENERGY AND PROTEIN METABOLISM--

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1. EXPERIMENTAL STUDYTHE PURPOSE OF THIS STUDY WAS TO COMPARE THE EFFICACIES OF TWO TYPES OF BRANCHED CHAIN AMINO ACID-ENRICHED NUTRIENT SOLUTIONS DIFFERING IN THEIR LEUCINE AND VALINE CONTENTS IN STRESS SITUATION.METHODS: A MODEL OF SURGICAL STRESS WAS PRODUCED BY CECAL LIGATION AND RESECTION OF THE NECROTIC CECUM 12 HOURS LATER IN THE RAT. AFTER THESE PROCEDURES, THE RATS WERE ADMINISTERED LEUCINE-ENRICHED TPN (GROUP L; 45% BCAA, LEU:VAL:ILE=2:1:1) OR VALINE-ENRICHED TPN (GROUP V; 45% BCAA, VAL:LEU:ILE=2:1:1) FOR 30 HOURS. BOTH OF THESE TPN PREPARATIONS WERE ISOCALORIC AND ISONITROGENOUS (250ML/KG/DAY, 1KCAL/ ML, KCAL/N=135). DURING THE LAST 6 HOURS OF THE INFUSION PERIOD, THE EXTENTS OF LEUCINE AND VALINE UTILIZATION WERE COMPARED BY RI TECHNIQUE. AFTER ADMINISTRATION OF <^(14)C> -LEU (GROUP L) OR <^(14)C> -VAL (GROUP V), CUMULATIVE RADIOACTIVITY IN EXPIRED <CO_2> WAS MEASURED. RADIOACTIVITY TAKEN IN LIVER AND MUSCLE PROTEINS WAS ALSO MEASURED.RESULTS: THE FINAL YIELDS OF <^(14)CO_2> IN BOTH GROUPS WERE 40-44% OF ADMINISTERED <^(14)C> RADIOACTIVITY. THE RADIOACTIVITY LEVEL DERIVED FROM <^(14)C> -LEU WAS SIGNIFICANTLY HIGHER THAN THAT FROM <^(14)C> -VAL IN BOTH LIVER AND MUSCLE PROTEINS. THESE RESULTS INDICATE THAT LEUCINE IS AS WELL OXIDIZED AS VALINE AND HAS A MORE IMPORTANT ROLE IN PROTEIN METABOLISM IN STRESS SITUATION.2. CLINICAL STUDYTHE METABOLIC AND CLINICAL EFFECTS OF THE BCAA THERAPY WERE STUDIED IN 10 SEPTIC PATIENTS WHO RECEIVED BCAA ENRICHED SOLUTION AS THE NITROGEN SOURCE OF TOTAL PARENTERAL NUTRITION (BCAA-TPN). MODERATE SUPPRESSION OF THE PROTEIN CATABOLISM AND IMPROVEMENT OF DERANGED AMINO ACID PATTERNS TO NEAR NORMAL RANGE WERE OBSERVED AFTER THE BCAA-TPN THERAPY. SEPTIC ENCEPHALOPATHY WAS ALSO IMPROVED IN THREE OF FIVE PATIENTS WHO HAD SHOWN CLINICAL SIGNS OF ENCEPHALOPATHY.