Branched‐Chain Amino Acids Metabolic Support in Surgical Patients: A Randomized, Controlled Trial in Patients with Subtotal or Total Gastrectomy in 16 Japanese Institutions

Abstract

A prospective, randomized, controlled trial of nutritional effects of branched-chain-enriched amino acid (BCAA) solution was undertaken in 173 surgical patients with gastric cancer. Eighty-six and 87 patients underwent subtotal and total gastrectomy, respectively. The effects were evaluated in total parenteral nutrition (TPN) in an isocaloric/isonitrogenous setting where the major difference between the group was the amount of BCAA received. Each 80 patients in the control and the BCAA groups completed the trial. The group receiving BCAA-enriched amino acid solution demonstrated a statistically significant improvement on days 2 and 3 in nitrogen balance in patients with total gastrectomy. Three-methyl-histidine excretion gradually decreased after day 1, and the values on day 7 were significantly lower than those on day 1 in the BCAA group in both those receiving subtotal and total gastrectomy. There were no significant differences of serum albumin and rapid turnover proteins between the control and BCAA groups in both those receiving subtotal and total gastrectomy. Plasma BCAA level and BCAA to aromatic amino acid (AAA) ratio were significantly higher, and AAA level was significantly lower in the BCAA group than in the control group. There were no serious complications encountered during the observation period in both groups. These results indicated that a BCAA-enriched amino acid solution can improve metabolism and maintains good nitrogen retention without increasing side effects as compared with a conventional amino acid solution for nutritional support of patients who have received subtotal or total gastrectomy.

Scavenging of Reactive Oxygen Species by Eriobotrya japonica Seed Extract

“…amino acids themselves, and various physiological functions, such as antioxidative action, are exhibited through absorption into the body. 23,24) Based on the above information, caffeic acid derivatives and polyphenols that capture · OOH, · OH and · O 2 Ϫ as radical scavengers, and b-sitosterol, which exerts a preventive action by inhibiting the excess production of active oxygen by various cells, may be involved in the antioxidative action of ESE in a complex manner.…”

Failure of BCAA supplementation to promote nitrogen retention in injured patients.

“…Based on this premise, numerous projects studying the effect of BCAA in the critically ill have been published [1][2][3][4][5][6][7][11][12][13][14][15][16][17]. A majority of these studies have used nitrogen balance as their gold standard in terms of evaluating the benefit of BCAA.…”

“…A majority of these studies have used nitrogen balance as their gold standard in terms of evaluating the benefit of BCAA. With this as a criterion, several studies have shown a positive effect for BCAA in critically ill patients [1][2][3][4][5][6][7], while others have shown no beneficial effects [11][12][13][14][15][16][17]. It is worth noting that in none of these studies were detrimental effects of BCAA documented.…”

“…However, some animal studies have failed to show a significant effect of BCAA on nitrogen balance [8][9][10]. Perhaps more importantly, numerous human studies have also shown equivocal results in this regard [11][12][13][14][15][16][17]. In a randomized, crossover, 8-day study of 10 critically ill patients by Vanderwoude et al, there was no significant difference between standard total parenteral nutrition (TPN) solutions and BCAA-supplemented solutions with respect to nitrogen balance [16].…”

Metabolic alteration in patients with cancer: Nutritional implications

“…95 High BCAA-enriched TPN has been widely used in postoperative and critically ill patients, and has usually shown an improvement of amino acid utilization and nitrogen balance, as well as protein metabolism. 98,99 Although TPN supplemented with specific nutrients has also been shown to improve the nutritional status in patients with noncancerous diseases, the effects of these specific nutrients in patients with cancer should be carefully evaluated, since it is possible that the administration of these specific nutrients, which are beneficial to the host, might also be beneficial for tumor growth. Although some animal studies have shown that the continuous administration of BCAA to tumor-bearing rats caused a significant increased in survival time and a significant reduction in tumor size, 100 no substantial data in human patients with cancer have been provided regarding the metabolism of the host and tumor.…”