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

Scholten, Donald J.; Morgan, Roger; Davis, Alan T.; Albrecht, Roxie M.

doi:10.1080/07315724.1990.10720357

Cited by 8 publications

(3 citation statements)

References 18 publications

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“…Thus, as a recommendation to stimulate MPS in older persons, it may be more prudent to focus on total protein delivery but in particular on the leucine content of proteins or amino acid mixtures. Of relevance to the ICU, it is acknowledged that data show the ineffectiveness of BCAA supplementation in various ICU patient groups, 65 – 67 which has been reviewed 68 . However, as pointed out by De Bandt and Cynober, 69 the rationale for using BCAA as a mixture was based on preclinical observations without consideration of the individual effects of the amino acids themselves and ignored the relative contribution of leucine per se over and above valine and isoleucine.…”

Section: Protein Requirements In the Older Icu Patientmentioning

confidence: 99%

Protein Turnover and Metabolism in the Elderly Intensive Care Unit Patient

et al. 2017

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Many intensive care unit (ICU) patients do not achieve target protein intakes particularly in the early days following admittance. This period of iatrogenic protein undernutrition contributes to a rapid loss of lean, in particular muscle, mass in the ICU. The loss of muscle in older (aged >60 years) patients in the ICU may be particularly rapid due to a perfect storm of increased catabolic factors, including systemic inflammation, disuse, protein malnutrition, and reduced anabolic stimuli. This loss of muscle mass has marked consequences. It is likely that the older patient is already experiencing muscle loss due to sarcopenia; however, the period of stay in the ICU represents a greatly accelerated period of muscle loss. Thus, on discharge, the older ICU patient is now on a steeper downward trajectory of muscle loss, more likely to have ICU-acquired muscle weakness, and at risk of becoming sarcopenic and/or frail. One practice that has been shown to have benefit during ICU stays is early ambulation and physical therapy (PT), and it is likely that both are potent stimuli to induce a sensitivity of protein anabolism. Thus, recommendations for the older ICU patient would be provision of at least 1.2-1.5 g protein/kg usual body weight/d, regular and early utilization of ambulation (if possible) and/or PT, and follow-up rehabilitation for the older discharged ICU patient that includes rehabilitation, physical activity, and higher habitual dietary protein to change the trajectory of ICU-mediated muscle mass loss and weakness.

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Section: Protein Requirements In the Older Icu Patientmentioning

confidence: 99%

Protein Turnover and Metabolism in the Elderly Intensive Care Unit Patient

et al. 2017

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“…There have been a number of studies where the provision of BCAA appeared to have no effect on the nutritional status. In patients after surgery, 31,33,65–69 in septic patients, 70 in patients with gastrointestinal cancers undergoing surgery, 71 in rats with peritonitis, 49 and in dogs receiving Escherichia coli endotoxin, 72 the provision of BCAA was associated with increased oxidative decarboxylation of these amino acids in skeletal muscle, but no increase in nitrogen balance, no net release of the branched‐chain keto acids formed by transamination, nor other products such as alanine and glutamine. Naturally there is difficulty in comparing these various trials due to the variable nature of the patients, variable concentrations of BCAA and additional nutrients, and variable methodology and endpoints.…”

Section: Metabolismmentioning

confidence: 99%

Branched‐chain amino acids

Platell

Kong

Mccauley³

et al. 2000

J of Gastro and Hepatol

123

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The branched‐chain amino acids (BCAA), isoleucine, leucine and valine, are unique in that they are principally metabolized extrahepatically in the skeletal muscle. This observation led to the investigation of these nutrients in a number of clinical scenarios. By far the most intensively studied applications for BCAA have been in patients with liver failure and/or patients in catabolic disease states. However, the resulting studies have not demonstrated a clear clinical benefit for BCAA nutritional supplements. In patients with liver failure, the BCAA did improve nitrogen retention and protein synthesis, but their effect on patient outcome was less clear. Similarly, in critically ill septic patients, BCAA did not improve either survival or morbidity. The BCAA are important nutrients, and it seems that any specific benefits associated with their use will be based upon a greater understanding of the underlying cellular biology. Potential areas of further research may include the combination of BCAA supplements with other anabolic factors (e.g. growth hormone) in managing patients with catabolic disease states.

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“…Exogenous administration of BCAA has been proposed to compensate for the altered protein metabolism in the stressed patient by sparing endogenous sources of BCAA, thereby reducing skeletal muscle catabolism and increasing protein synthesis. Unfortunately, the results of numerous clinical studies did not reveal a clear clinical benefit of BCAA supplementation on protein balance in most disease states[32][33][34][35][36][37], and the clinical utility of BCAA still remains an open problem. The positive results of several randomized trials from recent years indicate their favorable effect in chronic forms of liver disease[38][39][40][41][42].…”

mentioning

confidence: 99%

Branched-chain Amino Acid Oxidation in Skeletal Muscle – Physiological and Clinical Importance of its Modulation by Reactant Availability

Holeček¹

2011

CNF

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Enhanced oxidation of branched-chain amino acids (BCAA; valine, leucine and isoleucine) in skeletal muscle is a typical metabolic alteration associated with activated synthesis of glutamine and development of muscle wasting in cachectic illness. The paper demonstrates that the rates of BCAA transamination and decarboxylation in skeletal muscle respond rapidly to changes in BCAA and glutamine availability. Enhanced BCAA availability increases BCAA oxidation and glutamine synthesis, while enhanced availability of glutamine suppresses BCAA oxidation. In physiological conditions, this enables compensation in alterations of amount and composition of food in order to keep optimal levels of BCAA and glutamine in the body. In cachectic illness, enhanced availability of BCAA (resulting mainly from activated proteolysis) and decreased availability of glutamine (resulting from its enhanced release by muscle) account significantly for activated BCAA oxidation and glutamine synthesis in muscle. The clinical importance of the opposite effect of BCAA and glutamine supplementation on BCAA oxidation in the treatment of muscle wasting disorders should be elucidated.

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

Cited by 8 publications

References 18 publications

Protein Turnover and Metabolism in the Elderly Intensive Care Unit Patient

Protein Turnover and Metabolism in the Elderly Intensive Care Unit Patient

Branched‐chain amino acids

Branched-chain Amino Acid Oxidation in Skeletal Muscle – Physiological and Clinical Importance of its Modulation by Reactant Availability

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