Effect of intestinal resections on arginine metabolism: practical implications for nutrition support.
OBJECTIVE
The present review relates recent developments in the understanding of arginine and citrulline metabolism and complementation after intestinal resection.


RESULTS
Arginine metabolism is disturbed after significant intestinal resection, with reduced fluxes and circulating and tissue concentrations. There is also a reduction in citrulline production, a major source of endogenous arginine by enterocyte metabolism. There is evidence to suggest that arginine or citrulline supplementation may be important in this situation.


CONCLUSIONS
In experimental intestinal resection, arginine availability decreases as intestinal citrulline synthesis decreases. In this setting, there is debate over the efficiency of arginine supplementation on intestinal adaptation, perhaps due to different doses used. In contrast, citrulline, a precursor for arginine synthesis, whether provided enterally or parenterally, is more efficient at 1 g/kg/day than complementation with arginine (at the same dose) in sustaining arginine pools. In addition, citrulline is more effective than arginine in maintaining nitrogen homeostasis. Clinical studies are vital in order to establish the value of citrulline supplementation in short bowel patients.
Crenn
Pascal
P
Laboratoire de Biologie de Nutrition, EA 2498, Université Paris Descartes, Faculté de Pharmacie, Paris, France. pascal.crenn@rpc.aphp.fr
Cynober
Luc
L
D001120:Arginine / Q000008:administration & dosage / Q000378:metabolism*; D002956:Citrulline / Q000008:administration & dosage / Q000378:metabolism*; D019587:Dietary Supplements; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000601:surgery; D018529:Nutritional Support; D011183:Postoperative Complications / Q000178:diet therapy*; D012778:Short Bowel Syndrome / Q000178:diet therapy* / Q000378:metabolism
D002956:Citrulline; D001120:Arginine