Amino acid metabolism during total parenteral nutrition in healthy volunteers: evaluation of a new amino acid solution

Abstract

The aim of this study was to determine the metabolism and the tolerance of a new amino acid (AA) solution administered under conditions mimicking cyclical parenteral nutrition (PN) in humans. Eight healthy volunteers received peripheral PN for 10 h providing 10.5 mg N·kg−1·h−1and 2.0 kcal·kg−1·h−1(glucose-to-lipids ratio: 70/30%). For adaptation, a non-protein energy intake was increased progressively for 90 min; thereafter, AA infusion was started and maintained at a constant rate for 10 h. Plasma and urine concentrations of all the AAs were measured before, during and after the PN. For each given AA, the relation between plasma variations at the steady-state and infusion rate, plasma clearance (Cl), renal clearance (Clr), re-absorption rate (Reab) and, retention rate (Reten) were determined. The nitrogen balance (ΔN) was calculated during the PN period. The results are presented as means±sem. All plasma AA concentrations decreased during the starting period of non-protein energy intake. The plasma AA concentrations reached a steady-state within 3 h upon AA infusion, except for glycine and lysine (6 h). At the steady state, the plasma concentrations of the infused AAs were closely correlated to their infusion rate (y=−18.3+1.5 x, r2=0.92). The plasma glutamine concentration was maintained during the PN, which indicates that the solution might stimulate the de novo synthesis of this AA. When the PN was stopped, plasma levels of the AAs decreased, most of them returning to their basal levels, or significantly below for lysine (P<0.05), alanine (P<0.05), proline (P<0.01) and glutamine (P<0.05). No volunteer showed any adverse effect during the infusion period. ΔN was: 0.8±0.5 gN/10 h. Metabolic characteristics for essential AAs were: Cl<0.5 l min−1, Clr <1.5 ml·min−1Reab ⩾ 99%, Reten ⩾99% and for non-essential AAs: Cl <0.6 l·min−1except aspartate (2.8±0.3 l·min−1), Clr < 3 ml·min−1except glycine (6.8±0.7), aspartate (8.2±3.5) and histidine (8.8±1.3); Reab ⩾ 98% except glycine (95±1), aspartate (94±2) and histidine (94±1), Reten ⩾97% except histidine (94±1), glycine (95±3). These results indicate that in healthy subjects, the amounts of AAs provided by the new solution were well balanced for an intravenous administration, and so were well utilized without excessive urinary excretion. The present study provides useful metabolic parameters for a further evaluation in disease.