[Prospective comparative study of different amino acid and lipid solutions in parenteral nutrition of patients undergoing bone marrow transplantation].

The patient who will undergo a bone marrow transplant (BMT) has a high protein catabolism in the time period after the infusion of the marrow, and therefore there is a need for an adequate nutritional support. The objective of our study is to analyze the behavior of nutritional assessment parameters, the lipid metabolism, the number of days of mucositis, the number of infections, the number of days to recovery, and the number of hospitalization days when using different parenteral nutrition solutions: 22.5% and 45% branched chain amino acid solutions, and lipid solutions with long chain triglycerides (LCT), vs. medium chain triglycerides (MCT).

METHODS

We have carried out a prospective, randomized study in patients who underwent a BMT who received parenteral nutrition. The supply of nitrogen was 1.5 +/- 0.3 g of AA/kg/day (either in standard solution or in a 45% branched chain AA solution). The caloric supply was similar in all the groups, with a proportion of 60% coming from carbohydrates and 40% from lipids, either LCT or MCT/LCT. The nutritional assessment parameters were studied, as well as of the lipid metabolism, and also clinical evolutive data: number of days of mucositis, number of days of PN, number of days hospitalized, number of infections, rate of infection density. All the data were measured and/or quantified 4 times: pretransplant, on day--of the transplant, and after 7 and 14 days after the transplant.

RESULTS

62 patients were studied. Group A: 19 patients treated with 22.5% branched chain amino acids + 20% LCT. Group B: 26 patients (45% branched chain amino acids + 20% LCT). Group C: 17 patients, (45% branched chain amino acids + 20% MCT/LCT). There is a quicker recover of the marrow in groups B + C: 14.4 vs. 11.7 and 11.1, with a p < 0.05. The nitrogen balance improves significantly in groups B and C (p < 0.05). The retinol-binding protein increases significantly from day 0 to day 7 (p < 0.01) in the LCT group (Group B). The phospholipids decrease in group B after one day (p < 0.05), and after the 7th day (p < 0.05). The triglycerides increase in group C between 7 and 14 days. The LDL/HDL quotient increases in group B after 14 days (p < 0.05). The triglycerides increase in group C between 7 and 14 days. The LDL/HDL quotient will increase in the B group after 14 days (p < 0.05). There are no differences in the number of days of mucositis, the total number of infections, the number of infections per 100 days of hospitalization, or in the number of hospitalization days.

CONCLUSIONS

In patients who are given parenteral nutrition in the period immediately after the BMT, we found an improvement in the catabolic metabolism parameters when using a solution with a high proportion of branched chain amino acids (45%) and a smaller alteration of the metabolism of the plasmatic lipoproteins when we use MCT/LCT enriched solutions.