A clinician must decide whether a malnourished patient should receive additional carbohydrates or amino acids to prevent muscle wasting. Based on gluconeogenesis and protein sparing, which intervention is more appropriate and why?

• A. Provide only amino acids because increasing carbohydrate intake will force the body to convert those amino acids into fat, worsening muscle wasting indirectly by reducing protein synthesis.
• B. Provide large amounts of fat exclusively because fats can be turned into glucose rapidly to spare protein without affecting acid–base balance.
• C. Withhold both carbohydrates and amino acids because encouraging gluconeogenesis enhances muscle survival by mobilizing local protein stores in a controlled fashion.
• D. Provide additional carbohydrates because adequate dietary carbohydrate reduces the need for gluconeogenesis from amino acids, thereby preserving body proteins for structural and enzymatic roles instead of being catabolized for glucose.

Answer: (D)