Amino acids

Bearing in mind the amounts necessary to obtain nitrogen balance in stressed and malnourished patients, the amino acid composition should predominantly consist of essential and semi-essential amino acids (histidine, arginine). Taurine, cystine, and tyrosine are the most important non-essential amino acids. Other constituents, up to the desired nitrogen intake, could include glutamine and glutamic and aspartic acids (the major participants in transamination reactions), serine, proline, and glycine.

Arginine, a conditionally dispensable amino acid, has a potential role in immunomodulation and a positive influence on post-traumatic nitrogen metabolism and the wound-healing process by enhancing collagen deposition. It has been shown to be a unique substrate for production of the biological effector molecule nitric oxide. Nevertheless, there is no evidence that exogenous arginine, even in large doses, modulates the rate of synthesis of nitric oxide.

Glutamine is an important metabolic fuel for the cells of the gut and the immune system. It is also involved in the regulation of muscle and liver protein balance, probably mediated by an increase in cellular hydration, a triggering signal, or protein anabolism.

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