Amino acid composition in parenteral nutrition: what is the evidence?

• Type of Material: Article
• Authors: Shadi S. Yarandi, Emory University; Vivian M. Zhao, Emory University; Gautam Hebbar, Emory University; Thomas R. Ziegler, Emory University
• Language: English
• Date: 2011-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Lippincott Williams & Wilkins; © 2010 Wolters Kluwer Health
• Final Published Version (URL): http://dx.doi.org/10.1097/MCO.0b013e328341235a
• Title of Journal or Parent Work: Current Opinion in Clinical Nutrition and Metabolic Care
• ISSN: 1363-1950
• Volume: 14
• Issue: 1
• Start Page: 75
• End Page: 82
• Grant/Funding Information: Funding for this work was received from National Institutes of Health grants U01 DK069322, K24 RR023356 (to T.R.Z.), and UL1 RR025008 (Atlanta Clinical and Translational Science Institute).
• Keywords: cysteine; glutamine; arginine; amino acids; taurine
• Research Categories: Health Sciences, Nutrition; Health Sciences, Health Care Management

Abstract

Purpose of review Complete parenteral nutrition solutions contain mixed amino acid products providing all nine essential amino acids and a varying composition of nonessential amino acids. Relatively little rigorous comparative efficacy research on altered parenteral nutrition amino acid composition has been published in recent years. Recent findings Limited data from randomized, double-blind, adequately powered clinical trials to define optimal doses of total or individual amino acids in parenteral nutrition are available. An exception is the growing number of studies on the efficacy of glutamine supplementation of parenteral nutrition or given as a single parenteral agent. Parenteral glutamine appears to confer benefit in selected patients; however, additional data to define optimal glutamine dosing and the patient subgroups who may most benefit from this amino acid are needed. Although some promising studies have been published, little data are available in the current era of nutrition support on the clinical efficacy of altered doses of arginine, branched chain amino acids, cysteine, or taurine supplementation of parenteral nutrition. Summary Despite routine use of parenteral nutrition, surprisingly little clinical efficacy data are available to guide total or specific amino acid dosing in adult and pediatric patients requiring this therapy. This warrants increased attention by the research community and funding agencies to better define optimal amino acid administration strategies in patient subgroups requiring parenteral nutrition.