Metabolic effects of branched chain amino acids in patients with severe pancreatitis

Twenty-four patients with acute severe pancreatitis were randomised to receive total parenteral nutrition for 7 days with one of two isocaloric (35 kcal/kg/day) and isonitrogenous (0.16 g/kg/day) programmes containing either a low (15.5% w/w (control group)) or a high (57%) content of branched chain amino acids (BCAA (BCAA group)). During treatment, the nitrogen balance was similar in both groups. The concentrations of serum protein, albumin, prealbumin and retinol-binding protein did not differ between the groups. The plasma concentrations of BCAA measured 2 h after discontinuation of amino acid infusions rose in the BCAA group. In urine, only the concentrations of valine increased as compared with those of control patients. Serum glucose levels were higher in the BCAA group than in the control group, although the BCAA group received slightly more insulin than the control group in order to keep the blood glucose concentration below 10 mmol/l. The results suggest that BCAA-enriched solutions may stimulate gluconeogenesis without affecting catabolism.