Relative value of glucose and amino acids in preserving exercise capacity in the postoperative period

The value of crystalline amino acids compared with glucose in maintaining functional muscle mass (maximum exercise capacity) in the perioperative period was studied. Twelve surgical patients received 100 g of glucose (Group 1) for 7 to 10 days perioperatively, and 12 (Group 2) received 90 g of crystalline amino acids for a similar period. Maximum exercise capacity, nitrogen balance, and serum albumin were studied. The use of amino acids instead of glucose spared nitrogen. Net nitrogen loss was 64.7 +/- 6.7 g in Group 1 compared with 34.7 +/- 4 g in Group 2 (p less than or equal to 0.001). Exercise capacity decreased 13.8 +/- 4.5 percent in Group 1 and 13.3 +/- 2.9 percent in group 2. The serum albumin level decreased by 0.30 +/- 0.2 g/100 ml in Group 1 compared with 0.34 +/- 0.15 g/100 ml in Group 2. These differences were not significant. Changes in serum albumin were correlated with changes in exercise capacity (r = 0.7, p less than or equal to 0.002), but neither was significantly correlated with nitrogen loss. We concluded that the use of amino acids instead of glucose during moderate periods of semi-starvation associated with moderate trauma will not influence loss of exercise capacity significantly, although some nitrogen will be spared; patients undergoing moderately severe surgical procedures accompanied by moderate periods of semistarvation will lose approximately 14 percent of their exercise capacity; and loss of exercise capacity is not correlated with loss of nitrogen under these conditions but is loosely correlated with changes in serum albumin levels.