Abstract
A previous study indicated increased urea production and low nitrogen (N) retention on a free amino acid elemental formula (FAA; Vivonex-HN). The limitations of this earlier study were: irregular nitrogen absorption in the malabsorption patients, high nitrogen intake, and failure to match FAA to control formula (hydrolyzed casein; CAS; Criticare-HN) with respect to kcal/nitrogen. A more critical test of FAA quality was sought in the current study. Four healthy males received the minimal daily nitrogen requirements (0.6 g protein/kg) from either FAA or CAS in a 10-day balance study; a second balance on the alternate formula followed. Maintenance energy, minerals, and vitamins were supplied in each period. The results indicated a higher apparent nitrogen absorption (p < 0.05) from FAA relative to CAS in the first 5 days of the balance, although these differences were no longer present in the remaining 5 days of the period. Urinary total nitrogen increased on FAA, most of which could be accounted for by urea nitrogen; urinary creatinine nitrogen, ammonia nitrogen, and uric acid nitrogen were nearly identical between formulas. The unmeasured fraction of urinary nitrogen was markedly diminished on FAA while the urea nitrogen to total nitrogen ratio was significantly increased (p < 0.05) compared to CAS. During the initial 5 days of study nitrogen balance was lower on FAA than on CAS and this difference became significant during the last 5 days of the period (X ± SD for FAA = -0.42 ± 0.59 g/D vs CAS = 0.98 ± 0.30 g/day, p < 0.001). Hyperglycinemia was consistently present during FAA infusion. Hence the low biologic value of FAA and associated metabolic effects persist under stringent study conditions. (Journal of Parenteral and Enteral Nutrition
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