EFFECT OF AN ORAL ELEMENTAL DIET ON NITROGEN BALANCE AND PLASMA AMINO ACIDS

Abstract

Five infants between 7 and 16 weeks of age with severe intractable diarrhea were fed an oral elemental diet (Vivonex^R) consisting of crystalline amino acids, glucose, electrolytes and vitamins for 4 weeks by continuous NG drip. Each infant received a “low” nitrogen diet (LND) supplying 2.25gm of protein/Kg/day for 2 weeks and a “high” nitrogen diet (HND) supplying 4.58gm of protein/Kg/day for 2 weeks. Each diet supplied 110cal/Kg/day. The weight gain on the LND averaged 17.0 ± 14.7 gm/day and on the HND 28.6±13.5gm/day. Concomitantly, the nitrogen balance on the LND averaged +163±75mgm/Kg/day and on the HND +332±82mgm/Kg/day. The plasma levels of 22 amino acids were measured before beginning the diet, during the feeding of each diet and after the cessation of treatment. Pretreatment levels were normal except for decreased proline (-58%) and threonine (-36%). On the LND there was no appreciable change in the amino acid levels. On the HND the plasma levels of 6 amino acids increased more than 2 times the upper limits of normal (ULN): methionine (6.5×ULN), glycine (2.6×ULN), tryosin (2.4×ULN), phenylalanine (2.2×ULN), threonine (2.2×ULN) and ornithine (2.1×ULN). The oral elemental diet proved effective in controlling severe intractable diarrhea and resulted in weight gain and positive nitrogen balance proportional to the amount of protein supplied.

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