Controlled study of enteral arginine supplementation in burned children: impact on immunologic and metabolic status.
OBJECTIVE
We compared the effects of an arginine-supplemented diet with those of an isocaloric isonitrogenous diet on immune and metabolic response of children with burns.


METHODS
This was a double-blind, randomized, placebo-controlled trial in a burn treatment center of a pediatric hospital in Santiago, Chile. All children (1-5 y of age) admitted within 48 h of a moderate to deep burn injury covering 10% to 40% of total body surface area were evaluated. Twenty-eight children met the criteria and were randomly assigned to receive an arginine-supplemented diet (AG; n = 14) or an isocaloric isonitrogenous diet (CG; control, n = 14) for 14 d. Samples were collected at admission (baseline) and on days 7 and 14 for lymphoproliferative response to mitogens, plasma interleukins (interleukin-1, interleukin-6, tumor necrosis factor-alpha), plasma arginine and ornithine levels, serum C-reactive protein, prealbumin, albumin, glucose, and total urinary nitrogen.


RESULTS
The AG enhanced lymphoproliferative responses (analysis of variance, P < 0.05), which were 72% of normal at baseline in both groups; by day 7 responses increased to 144% in the AG group and decreased to 56% in the CG group; both groups returned to normal by day 14. Baseline interleukin-6 was significantly increased in all children. There were no differences in plasma concentrations of interleukin-1, interleukin-6, tumor necrosis factor-alpha, C-reactive protein, prealbumin, albumin, or glucose between the AG and CG groups. On day 7 plasma ornithine levels increased significantly in the AG versus CG group (P < 0.05); arginine levels showed no change.


CONCLUSIONS
An exclusively AG improves mitogen-stimulated lymphocyte proliferation in burned children. The benefits of arginine for the immune system do not appear to be related to a metabolic response. The biological significance of this finding remains to be determined.
Marin
Veronica B
VB
INTA, University of Chile, Santiago, Chile; Department of Pediatrics, University of Chile, Santiago, Chile. vmarin@uec.inta.uchile.cl
Rodriguez-Osiac
Lorena
L
Schlessinger
Liana
L
Villegas
Jorge
J
Lopez
Marcelo
M
Castillo-Duran
Carlos
C
D000596:Amino Acids / Q000097:blood; D001120:Arginine / Q000008:administration & dosage*; D001786:Blood Glucose / Q000032:analysis; D002056:Burns / Q000178:diet therapy / Q000276:immunology* / Q000378:metabolism*; D002097:C-Reactive Protein / Q000032:analysis; D002675:Child, Preschool; D004311:Double-Blind Method; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D007223:Infant; D015850:Interleukin-6 / Q000097:blood; D008213:Lymphocyte Activation; D009952:Ornithine / Q000097:blood; D010919:Placebos; D011228:Prealbumin / Q000032:analysis; D012709:Serum Albumin / Q000032:analysis; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D000596:Amino Acids; D001786:Blood Glucose; D015850:Interleukin-6; D010919:Placebos; D011228:Prealbumin; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D001120:Arginine; D009952:Ornithine