Acute effects of intravenous glutamine supplementation on protein metabolism in very low birth weight infants: a stable isotope study.
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 x kg(-1) x d(-1) amino acids and approximately 60 nonprotein kcal x kg(-1) x d(-1) were randomized to receive an i.v. supplement made of either 1) natural L-glutamine (0.5 g x kg(-1) x 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 NaH(13)CO(3) to assess the recovery of (13)C in breath, immediately followed by a 3-h L-[1-(13)C]leucine infusion. Plasma ammonia did not differ between the groups. Glutamine supplementation was associated with 1) higher plasma glutamine (629 +/- 94 versus 503 +/- 83 microM, 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.
des Robert
Clotilde
C
Service de Néonatologie et Réanimation Pédiatrique, Hôpital Mère et Enfant, CHU de Nantes, INSERM U.539, Centre de recherche en nutrition humaine, France.
Le Bacquer
Olivier
O
Piloquet
Hugues
H
Rozé
Jean-Christophe
JC
Darmaun
Dominique
D
D001944:Breath Tests; D004044:Dietary Proteins / Q000378:metabolism*; D008401:Gas Chromatography-Mass Spectrometry; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight
D004044:Dietary Proteins; D005973:Glutamine