EFFECT OF ENTERAL AND PARENTERAL-NUTRITION ON AMINO-ACID LEVELS IN CANCER-PATIENTS

Background: The syndrome of cancer cachexia can have a significant imp act on response to therapy as well as on survival in cancer patients. Therapies directed at metabolic perturbations in cachectic patients ar e dependent on nutritional repletion and maintenance of adequate amino acid substrate levels. This study compares the ability of oral feedin g, enteral nutrition, and total parenteral nutrition to alter plasma a mino acid levels in cancer patients. Methods: Patients with esophageal cancer were stratified by weight loss. Patients with < 20% weight los s were randomized to continue an ad libitum oral diet (group I) or to receive total parenteral nutrition (group II) for 2 weeks; patients wi th > 20% weight loss were randomized to receive either enteral nutriti on (group III) or total parenteral nutrition (group IV) for 2 weeks. P lasma amino acid levels were measured before the study and again after 2 weeks of nutrition support. Results: Before therapy, there was no d ifference between the groups in total or essential amino acid levels; however, patients in all groups had significantly lower total amino ac id levels compared with those of normal controls. After 2 weeks of tre atment, patients in groups I and III showed no difference in individua l, essential, or total amino acid levels. However, patients in groups II and IV showed significant increases in a number of individual amino acids as well as in essential and total amino acid levels after 2 wee ks of TPN. Conclusions: Patients with esophageal cancer demonstrated s ignificant alterations in amino acid profiles compared with those of n ormal controls. Total parenteral nutrition was superior to ad libitum oral feeding and jejunostomy feeding in repleting plasma amino acid le vels.