The Effects of Short-Term Parenteral Nutrition on Human Liver Protein and Amino Acid Metabolism During Laparoscopic Surgery

Abstract

Background: This study was undertaken to elucidate the specific effects of short-term artificial nutrition on human liver protein metabolism. Methods: Thirty patients undergoing elective laparoscopic cholecystectomy were studied: a control group (n = 16) and a group that received total parenteral nutrition (TPN; n = 14). The nutrition consisted of a balanced IV solution of nutrients (17.5 nonprotein kcal/kg body wt, 50% fat, 50% carbohydrates, and 0.1 gN/kg) that was discontinued when the investigation was finished, after a total infusion time of 8.6 ± 1.0 hours. A liver biopsy specimen was taken as soon as possible after surgery was started, for the determination of the free hepatic amino acid concentrations. In 16 of the patients, L-[²H₅]phenylalanine was given by IV to determine the fractional synthesis rate of total liver protein in a second liver biopsy specimen taken approximately 30 minutes later. Results: The fractional synthesis rate of total liver protein was 15.2% ± 4.7%/d in the TPN group (n = 7), which was not different from that of the control group (17.7% ± 3.8%/d, n = 9). However, the free hepatic concentrations of alanine (p < .05) and the essential amino acids increased (p < .001) in the TPN group, whereas the total hepatic amino acid concentrations were comparable between the groups. Conclusion: Thus short-term TPN induced specific changes of the free hepatic amino acid concentrations, whereas total liver protein synthesis remained unaffected by the nutrition. (Journal of Parenteral and Enteral Nutrition 21:330-335, 1997)

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References

Young GA , Chem C. , Zeiderman MR , et al: Influence of preoperative nutrition upon hepatic protein synthesis and plasma proteins and amino acids. JPEN 13:586-602, 1989

de Feo P. , Horber FF , Haymond MW : Meal stimulation of albumin synthesis: A significant contributor to whole body protein synthesis in humans. Am J Physiol 263:E794-799, 1992

Hunter KA , Ballmer PE , Anderson SE , et al: Acute stimulation of albumin synthesis rate with oral meal feeding in healthy subjects measured with [ring-2H5] phenylalanine. Clin Sci 88:235-242, 1995

Skillman J. , Rosenoer VM , Smith PC , et al: Improved albumin synthesis in postoperative patients by amino acid infusion. N Engl J Med 295:1037-1040, 1976

Ballmer PE , McNurlan MA , Essén P. , et al: Albumin synthesis rates measured with (2H5ring)phenylalanine are not responsive to short-term intravenous nutrients in healthy humans. J Nutr 125:512-519, 1995

Gelfand R. , Glickman MG , Jacob R. , et al: Removal of infused amino acids by splanchnic and leg tissues in humans. Am J Physiol 250:E407-413, 1986

McNurlan MA , Tomkins AM , Garlick PJ : The effect of starvation on the rate of protein synthesis in rat liver and small intestine. Biochem J 178:373-379, 1979

Preedy V. , Paska L. : The effects of surgical stress and short time fasting on protein synthesis . Biochem J 250:179-188, 1988

Leveille G. , Chakrabarty K. : Diurnal variations in tissue glycogen and liver weight of meal-fed rats. J Nutr 93:546-554, 1967

10.

Garlick PJ , Millward DJ , James WPT , et al: The effect of protein deprivation and starvation on the rate of protein synthesis in tissues of the rat. Biochim Biophys Acta 414:71-84, 1975

11.

Conde R. , Scornik OA : Role of protein degradation in the growth of livers after a nutritional shift . Biochem J 158:385-390, 1976

12.

Waterlow JC , Garlick PJ , Millward DJ : The effects of nutrition and hormones on protein turnover in the liver . IN Protein Turnover in Mammalian Tissues and in the Whole Body, Waterlow JC , Garlick PJ , Millward DJ (eds). North Holland, Amsterdam, 1978, pp 697-746

13.

Garlick PJ , Wernerman J. , McNurlan MA , et al: Organ-specific measurements of protein turnover in man. Proc Nutr Soc 50:217-225, 1991

14.

Barle H. , Ahlman B. , Nyberg B. , et al: The concentrations of free amino acids in human liver tissue obtained during laparoscopic surgery. Clin Physiol 16:217-227, 1996

15.

Herbert JD Coulson RA Hernandez T. : Free amino acids in the caiman and the rat. Comp Biochem Physiol 17:583-.598. 1966

16.

Bergström J. , Fürst P. , Norée L-G. , et al: The intracellular free amino acid concentration in human muscle tissue. J Appl Physiol 36:690-697, 1974

17.

Ahlman B. Leijonmarck C-E. Lind C. , et al: Free amino acids in biopsy specimens from the human colonic mucosa. J Surg Res 55:647-653, 1993

18.

Hammarqvist F. , Wernerman J. , Ali MR et al: Addition of glutamine to total parenteral nutrition after elective abdominal surgery spares free glutamine in muscle, counteracts the fall in muscle protein synthesis, and improves nitrogen balance . Ann Surg 209:455-461, 1989

19.

Ahlman B. Free Amino Acids in the Human Intestinal Mucosa. Karolinska Institute, Stockholm, 1994. PhD thesis

20.

Lunn PG , Whitehead RG , Baker BA : The relative effects of a low protein high carbohydrate diet on the free amino acid composition of liver and muscle. Br J Nutr 36:219-230, 1976

21.

Roth E. , Mühlbacher F. , Karner J. , et al: Liver amino acids in sepsis. Surgery 97:436-442, 1985

22.

Barle H. , Nyberg B. , Essén P. , et al: The synthesis rates of total liver protein and plasma albumin determined simultaneously in vivo in man. Hepatology 25:154-158, 1997

23.

Calder AG , Anderson SE , Grant I. , et al: The determination of low d5-phenylalanine enrichment (0.002-0.09 atom percent excess), after conversion to phenylethylamine, in relation to protein turnover studies by gas chromatography/mass spectrometry. Rapid Comm Mass Spec 6:421-424, 1992

24.

McNurlan MA , Essén P. , Thorell A. , et al: Response of protein synthesis in human skeletal muscle to insulin: An investigation with L-[2R3]-phenylalanine. Am J Physiol 267:E102-108, 1994

25.

Schmidt F. : Die enzymatische Bestimmung von Glucose und Fructose nebeneinander . Klin Wochenschr 39:1244-1247, 1961

26.

Garlick PJ , Wemerman J. , McNurlan MA , et al: Measurement of the rate of synthesis in muscle of postabsorptive young men by injection of a flooding dose of (1-13C) leucine. Clin Sci 77:329-336, 1989

27.

Elwyn DH , Parikh HC , Shoemaker WC : Amino acid movements between gut, liver and periphery in unanesthetized dogs . Am J Physiol 215:1260-1275, 1968

28.

Munro H. , Elwyn DH : Free amino acid pools and their role in regulation and the role of the liver in regulation of amino acid and protein metabolism. IN Mammalian Protein Metabolism, Vol IV, Munro H , Allison JB (eds). Academic Press, New York and London, 1970, pp 299-385, 523-557

29.

Mortimore G. , Mondon CE : Inhibition by liver of valine turnover in liver. J Biol Chem 245:2375-2383, 1970

30.

Woodside K. , Mortimore GE : Suppression of protein turnover by amino acids in the perfused rat liver. J Biol Chem 247:6474-6481, 1972

31.

Lund J. , Stjemström H. , Vinnars E. , et al: The influence of abdominal surgery on the splanchnic exchange of amino acids. Acta Chir Scand 152:191-197, 1986

32.

Souba WW , Smith RJ , Wilmore DW : Glutamine metabolism by the intestinal tract. JPEN 9:608-617, 1985

33.

McAnema O. , Moore FA , Moore EE , et al: Selective uptake of glutamine in the gastrointestinal tract: Confirmation in a human study. Br J Surg 78:480-482, 1991

34.

Felig P. , Wahren J. , Raf L. : Evidence of inter-organ amino acid transport by blood cells in humans . Proc Natl Acad Sci USA 70:1775-1779, 1973

35.

Gelfand R. , deFronzo RA , Gusberg R. : Metabolic alterations associated with major injury or infection. IN New Aspects of Clinical Nutrition, Kleinberger G , Deutsch EC (eds). Karger, Basel, 1983, pp 221-239

36.

Stryer L. : Amino acid degradation and the urea cycle. IN Biochemistry , Stryer L (ed). WH Freeman, New York, 1995, pp 629-652