Abstract
Although very low birth weight infants are subjected to severe stress and glutamine is now considered a conditionally essential amino acid that may attenuate stress-induced protein wasting in adults, current amino acid solutions designed for neonatal parenteral nutrition do not contain glutamine. To determine whether a short-term supplementation with i.v. glutamine would affect protein metabolism in very low birth weight infants, 13 preterm neonates (gestational age, 28–30 wk; birth weight, 820–1610 g) receiving parenteral nutrition supplying 1.5 g · kg−-1 · d−1 amino acids and approximately 60 nonprotein kcal · kg−1 · d−1 were randomized to receive an i.v. supplement made of either 1) natural l-glutamine (0.5 g · kg−1 · d−1; glutamine group), or 2) an isonitrogenous glutamine-free amino acid mixture (control group), for 24 h starting on the third day of life. On the fourth day of life, they received a 2-h infusion of NaH13CO3 to assess the recovery of 13C in breath, immediately followed by a 3-h l-[1-13C]leucine infusion. Plasma ammonia did not differ between the groups. Glutamine supplementation was associated with 1) higher plasma glutamine (629 ± 94 versus 503 ± 83 μM, mean ± SD;p < 0.05, one-tailed unpaired t test), 2) lower rates of leucine release from protein breakdown (−16%, p < 0.05) and leucine oxidation (−35%, p < 0.05), 3) a lower rate of nonoxidative leucine disposal, an index of protein synthesis (−20%, p < 0.05), and 4) no change in protein balance (nonoxidative leucine disposal − leucine release from protein breakdown, NS). We conclude that although parenteral glutamine failed to enhance rates of protein synthesis, glutamine may have an acute protein-sparing effect, as it suppressed leucine oxidation and protein breakdown, in parenterally fed very low birth weight infants.
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Abbreviations
- BLeu:
-
leucine release from protein breakdown
- Eco2:
-
13CO2 enrichment
- EiLeu:
-
isotopic enrichment in infusate 13C-leucine
- EpKIC:
-
isotopic enrichment in plasma KIC at steady state
- F13co2:
-
appearance of 13CO2 in expired air
- Fio2:
-
inspired air oxygen fraction
- GC-IRMS:
-
gas chromatography-isotope ratio mass spectrometry
- GCMS:
-
gas chromatography-mass spectrometry
- ibicarb:
-
rate of [13C]bicarbonate infusion
- iLeu:
-
rate of [13C]leucine infusion
- KIC:
-
α-keto-isocaproate
- NOLD:
-
nonoxidative leucine disposal
- OxLeu:
-
leucine oxidation
- RaLeu:
-
appearance rate of leucine into plasma
- IUGR:
-
intrauterine growth retardation
- Vco2:
-
CO2 production
- VLBW:
-
very low birth weight
- PNLeu:
-
exogenous leucine from parenteral nutrition
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Acknowledgements
The authors thank the parents of the infants who agreed to participate in this study, and the nurses of the Neonatology Unit for their superb help. We also thank Pascale Maugère and Odile Desfontaines for their excellent technical help, and Dr Philippe Mauran, Dr Isabelle Falconi, and Professor Françoise Ballereau of the Pharmacie Hôtel-Dieu, Nantes, for the preparation of the stable isotope solutions and natural glutamine solutions for i.v. administration.
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Supported in part by a Programme Hospitalier de Recherche Clinique (PHRC) grant from the Ministry of Health, Paris, France, and the Délégation à la Recherche Clinique, CHU de Nantes. C.d.R. was supported, in part, by fellowship grants from the Fondation pour la Recherche Médicale (FRM), France, and the IPSEN Laboratories, France. O.L.B. was supported by a fellowship grant from the Ministère de la Recherche, France.
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Des Robert, C., Le Bacquer, O., Piloquet, H. et al. Acute Effects of Intravenous Glutamine Supplementation on Protein Metabolism in Very Low Birth Weight Infants: A Stable Isotope Study. Pediatr Res 51, 87–93 (2002). https://doi.org/10.1203/00006450-200201000-00016
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DOI: https://doi.org/10.1203/00006450-200201000-00016
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