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Amino acid composition in parenteral nutrition: what is the evidence?

Yarandi, Shadi Sa; Zhao, Vivian Mb; Hebbar, Gautama; Ziegler, Thomas Ra,b

Current Opinion in Clinical Nutrition & Metabolic Care: January 2011 - Volume 14 - Issue 1 - p 75–82
doi: 10.1097/MCO.0b013e328341235a
Protein, amino acid metabolism and therapy: Edited by Erich Roth and Olav Rooyackers

Purpose of review Complete parenteral nutrition solutions contain mixed amino acid products providing all nine essential amino acids and a varying composition of nonessential amino acids. Relatively little rigorous comparative efficacy research on altered parenteral nutrition amino acid composition has been published in recent years.

Recent findings Limited data from randomized, double-blind, adequately powered clinical trials to define optimal doses of total or individual amino acids in parenteral nutrition are available. An exception is the growing number of studies on the efficacy of glutamine supplementation of parenteral nutrition or given as a single parenteral agent. Parenteral glutamine appears to confer benefit in selected patients; however, additional data to define optimal glutamine dosing and the patient subgroups who may most benefit from this amino acid are needed. Although some promising studies have been published, little data are available in the current era of nutrition support on the clinical efficacy of altered doses of arginine, branched chain amino acids, cysteine, or taurine supplementation of parenteral nutrition.

Summary Despite routine use of parenteral nutrition, surprisingly little clinical efficacy data are available to guide total or specific amino acid dosing in adult and pediatric patients requiring this therapy. This warrants increased attention by the research community and funding agencies to better define optimal amino acid administration strategies in patient subgroups requiring parenteral nutrition.

aDepartment of Medicine, Emory University School of Medicine, USA

bNutrition and Metabolic Support Service, Emory University Hospital, Emory University, Atlanta, Georgia, USA

Correspondence to Thomas R. Ziegler, MD, Suite GG-23, Atlanta Clinical and Translational Science Institute, Emory University Hospital, 1364 Clifton Road, Atlanta, GA 30322, USA Tel: +1 404 727 7351; fax: +1 404 727 5563; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.