Effects of Xylitol on Urea Synthesis in Normal Humans: Relation to Glucagon

Background: Xylitol exerts a nitrogen-sparing effect in stress catabolic states with hyperglucagonemia, but the mechanism(s) is unknown. We examined the effects of xylitol on urea synthesis during physiologic glucagon concentrations and during hyperglucagonemia. Methods: Urea synthesis was measured independently of blood amino acid concentration by means of functional hepatic nitrogen clearance (FHNC) (ie, the linear slope of the relation between urea synthesis rate and blood α-amino nitrogen concentration during infusion of alanine). FHNC was measured on four separate occasions in each of seven healthy subjects: during constant infusion of alanine alone, alanine superimposed on a constant infusion of xylitol (blood xylitol 1 mmol/L), alanine superimposed on infusion of glucagon, and alanine superimposed on infusions of xylitol and glucagon. Results: During alanine infusion alone, plasma glucagon rose to -170 ng/L, and FHNC was (mean ± sem) 27.9 ± 1.3 L/h. Xylitol did not affect plasma glucagon and only moderately reduced FHNC to 24.3 ± 1.0 L/h (p < .05). Glucagon infusion increased plasma glucagon to -450 ng/L and FHNC twofold to 50.9 ± 6.2 L/h; this increase was totally prevented by the addition of xylitol that reduced FHNC to 27.4 ± 2.6 L/h (p < .01). Conclusions: The results show that xylitol only inhibited FHNC minimally during spontaneous glucagon levels. In contrast, xylitol completely inhibits the increase in FHNC by glucagon. This suggests that the mechanism whereby xylitol reduces nitrogen loss in stress catabolic conditions with hyperglucagonemia involves an effect on liver metabolism. The mechanism is unknown but may be related to depletion of hepatocyte adenine nucleotides. (Journal of Parenteral and Enteral Nutrition 20:139-144, 1996)