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

Departments of Anesthesiology and Intensive Care, Huddinge University Hospital, Karolinska Institute, Stockholm

B. Nyberg, MD, PHD

Department of Surgery, Huddinge University Hospital, Karolinska Institute, Stockholm

K. Andersson, PHD

Departments of Anesthesiology and Intensive Care, Huddinge University Hospital, Karolinska Institute, Stockholm

P. Essén, MD, PHD

Departments of Anesthesiology and Intensive Care, Huddinge University Hospital, Karolinska Institute, Stockholm

M.A. McNurlan, PHD

Department of Surgery, Health Sciences Center, State University of New York at Stony Brook

Jan Wernerman, MD, PHD

Departments of Anesthesiology and Intensive Care, Huddinge University Hospital, Karolinska Institute, Stockholm

Peter J. Garlick, PHD

Department of Surgery, Health Sciences Center, State University of New York at Stony Brook

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)

Journal of Parenteral and Enteral Nutrition, Vol. 21, No. 6, 330-335 (1997)
DOI: 10.1177/0148607197021006330


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