Amino Acid Supplementation in Recovery From Severe Burn (ExAA)

• Muscle protein metabolism [ Time Frame: 6 weeks of intervention (study visits at beginning and end of 6 weeks of supplementation and +/- exercise) ] [ Designated as safety issue: No ]
  Muscle protein synthesis and breakdown
• Insulin sensitivity [ Time Frame: 6 weeks of intervention (study visits at beginning and end of 6 weeks of supplementation and +/- exercise) ] [ Designated as safety issue: No ]

Severe burns result in persistent and extensive fat deposition in liver and muscle tissue. This may be related to the prolonged insulin resistance observed following burn. In this study the investigators will test the hypothesis that essential amino acids act in synergy with exercise to improve liver steatosis and muscle lipid metabolism, and thus also affect insulin sensitivity. Children with burns will participate in six weeks of exercise training with/without amino acid supplementation. Before and after the intervention, measurements will be done to determine muscle and liver fat content, muscle fat and protein metabolism, and insulin sensitivity.

• Dietary Supplement: Dietary Supplement: Amino acids for six weeks
  Amino acids in drinks between meals for six weeks.
• Dietary Supplement: Placebo
  Placebo supplementation as drinks in between meals for six weeks

• Active Comparator: Amino acids
  Amino acid supplementation for six weeks
  Intervention: Dietary Supplement: Dietary Supplement: Amino acids for six weeks
• Placebo Comparator: Placebo
  Supplementation of placebo (inert components) for six weeks
  Intervention: Dietary Supplement: Placebo

Inclusion Criteria:

1. Male or female
2. 7-17 years old
3. Body weight >20 kg (based on blood requirements)
4. ≥30% TBSA
5. Wounds 95% healed

Exclusion Criteria:

1. Respiratory insufficiency
2. Multiple fractures
3. History of Cancer in the last 5 years
4. Diabetes Mellitus
5. Bilirubin > 3 mg/dl
6. Associated head injuries requiring specific therapy
7. Associated injuries to chest or abdomen requiring surgery
8. Serum creatinine > 3 mg/dl after fluid resuscitation
9. Receipt of any experimental drug other than the ones supplied within two months of this study
10. Any metal in body including rods, neurofibrilators, pacemakers, etc
11. Orthopedic casting which would prevent placement of patient in MRI machine
12. Hepatitis
13. Abnormal EKG
14. Electrical burns
15. Patients unable to lie still without heavy sedation will be excluded from MRI portion.