Adaptive regulation of amino acid metabolism on early parenteral lipid and high-dose amino acid administration in VLBW infants – A randomized, controlled trial

Summary Background & aims An anabolic state can be achieved upon intravenous amino acid administration during the immediate postnatal phase despite a low energy intake. The optimal dosing of amino acid and energy intake has yet to be established. The aim was to quantify the efficacy of early ini...

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Published in:Clinical nutrition (Edinburgh, Scotland) Scotland), 2014-12, Vol.33 (6), p.982-990
Main Authors: Vlaardingerbroek, Hester, Roelants, Jorine A, Rook, Denise, Dorst, Kristien, Schierbeek, Henk, Vermes, Andras, Vermeulen, Marijn J, van Goudoever, Johannes B, van den Akker, Chris H.P
Format: Article
Language:English
Subjects:
Amino Acids - administration & dosage
Amino Acids - metabolism
Biological and medical sciences
Dietary Fats - administration & dosage
Dose-Response Relationship, Drug
Emulsions
Energy Intake
Feeding. Feeding behavior
Female
Fish Oils - administration & dosage
Fundamental and applied biological sciences. Psychology
Gastroenterology and Hepatology
Glucose - administration & dosage
Growth
Humans
Infant Nutritional Physiological Phenomena
Infant, Newborn
Infant, Premature - growth & development
Infant, Very Low Birth Weight - growth & development
Keto Acids - administration & dosage
Leucine - administration & dosage
Leucine - metabolism
Male
Metabolism
Olive Oil
Parenteral Nutrition
Phenylalanine - administration & dosage
Phenylalanine - metabolism
Plant Oils - administration & dosage
Preterm infant
Soybean Oil - administration & dosage
Stable isotopes
Tyrosine - administration & dosage
Tyrosine - metabolism
Vertebrates: anatomy and physiology, studies on body, several organs or systems
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Summary:Summary Background & aims An anabolic state can be achieved upon intravenous amino acid administration during the immediate postnatal phase despite a low energy intake. The optimal dosing of amino acid and energy intake has yet to be established. The aim was to quantify the efficacy of early initiation of parenteral lipids and increased amounts of amino acids on metabolism and protein accretion in very low birth weight infants. Methods 28 very low birth weight infants were randomized to receive parenteral nutrition with glucose and either 2.4 g amino acids/(kg·d) (control group), 2.4 g amino acids/(kg·d) plus 2–3 g lipid/(kg·d) (AA + lipid group), or 3.6 g amino acids/(kg·d) plus 2–3 g lipid/(kg·d) (high AA + lipid group) from birth onward. On postnatal day 2, we performed a stable isotope study with [1-13 C]phenylalanine, [ring-D4 ]tyrosine, [U-13 C6 ,15 N]leucine, and [methyl-D3 ]α-ketoisocaproic acid to quantify intermediate amino acid metabolism. Results The addition of lipids only had no effect on phenylalanine metabolism, whereas the addition of both lipids and additional amino acids increased the amount of phenylalanine used for protein synthesis. In addition, high amino acid intake significantly increased the rate of hydroxylation of phenylalanine to tyrosine, increasing the availability of tyrosine for protein synthesis. However, it also increased urea concentrations. Increasing energy intake from 40 to 60 kcal/(kg·d) did not increase protein efficiency as measured by phenylalanine kinetics. The leucine data were difficult to interpret due to the wide range of results and inconsistency in the data between the phenylalanine and leucine models. Conclusions High amino acid and energy intakes from birth onwards result in a more anabolic state in very low birth weight infants, but at the expense of higher urea concentrations, which reflects a higher amino acid oxidation. Long-term outcome data should reveal whether this policy deserves routine implementation. This trial was registered at www.trialregister.nl , trial number NTR1445, name Nutritional Intervention for Preterm Infants-2.
ISSN:0261-5614
1532-1983
DOI:10.1016/j.clnu.2014.01.002