title: The effect of short-term high versus normal protein intake on whole-body protein synthesis and balance in children following cardiac surgery: a randomized double-blind controlled clinical trial.
abstract: BACKGROUND
  Infants undergoing cardiac surgery are at risk of a negative protein balance, due to increased proteolysis in response to surgery and the cardiopulmonary bypass circuit, and limited intake. The aim of the study was to quantify the effect on protein kinetics of a short-term high-protein (HP) diet in infants following cardiac surgery.
  
  
  METHODS
  In a prospective, double-blinded, randomized trial we compared the effects of a HP (5 g · kg(-1) · d(-1)) versus normal protein (NP, 2 g · kg(-1) · d(-1)) enteral diet on protein kinetics in children <24 months, on day 2 following surgical repair of congenital heart disease. Valine kinetics and fractional albumin synthesis rate (FSRalb) were measured with mass spectrometry using [1-(13)C]valine infusion. The Mann-Whitney U test was used to investigate differences between group medians. Additionally, the Hodges-Lehmann procedure was used to create a confidence interval with a point estimate of median differences between groups.
  
  
  RESULTS
  Twenty-eight children (median age 9 months, median weight 7 kg) participated in the study, of whom in only 20 subjects isotopic data could be used for final calculations. Due to underpowering of our study, we could not draw conclusions on the primary outcome parameters. We observed valine synthesis rate of 2.73 (range: 0.94 to 3.36) and 2.26 (1.85 to 2.73) μmol · kg(-1) · min(-1) in the HP and NP diet, respectively. The net valine balance was 0.54 (-0.73 to 1.75) and 0.24 (-0.20 to 0.63) μmol · kg(-1) · min(-1) in the HP and NP group. Between groups, there was no difference in FSRalb. We observed increased oxidation and BUN in the HP diet, compared to the NP diet, as a plausible explanation of the metabolic fate of surplus protein.
  
  
  CONCLUSIONS
  It is plausible that the surplus protein in the HP group has caused the increase of valine oxidation and ureagenesis, compared to the NP group. Because too few patients had completed the study, we were unable to draw conclusions on the effect of a HP diet on protein synthesis and balance. We present our results as new hypothesis generating data.
  
  
  BACKGROUND
  Dutch Trial Register NTR2334.
authors.affiliation: Pediatric Intensive Care Department H8-190, Emma Children's Hospital (EKZ), Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. v.g.geukers@amc.uva.nl.|Department of Pediatrics, EKZ, AMC, Amsterdam, The Netherlands. v.g.geukers@amc.uva.nl.
authors.forename: Vincent G
authors.initials: VG
authors.lastname: Geukers
authors.affiliation: Department of Clinical Nutrition, AMC, Amsterdam, The Netherlands. m.e.dijsselhof@amc.uva.nl.
authors.forename: Monique E
authors.initials: ME
authors.lastname: Dijsselhof
authors.affiliation: Pediatric Intensive Care Department, Wilhelmina Children's Hospital (WKZ), University Medical Center Utrecht (UMCUtrecht), Lundlaan 6, 3584, EA, Utrecht, The Netherlands. N.J.G.Jansen@umcutrecht.nl.
authors.forename: Nicolaas J G
authors.initials: NJ
authors.lastname: Jansen
authors.affiliation: Department of Pediatric Cardiology, WKZ, UMCUtrecht, Utrecht, The Netherlands. H.Breur@umcutrecht.nl.
authors.forename: Johannes M P J
authors.initials: JM
authors.lastname: Breur
authors.affiliation: Department of Pediatrics, EKZ, AMC, Amsterdam, The Netherlands. d.vanharskamp@amc.uva.nl.
authors.forename: Dewi
authors.initials: D
authors.lastname: van Harskamp
authors.affiliation: Department of Pediatrics, EKZ, AMC, Amsterdam, The Netherlands. h.schierbeek@amc.uva.nl.
authors.forename: Henk
authors.initials: H
authors.lastname: Schierbeek
authors.affiliation: Department of Pediatrics, EKZ, AMC, Amsterdam, The Netherlands. h.vangoudoever@amc.uva.nl.|Department of Pediatrics, VU University Medical Center, Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands. h.vangoudoever@amc.uva.nl.
authors.forename: Johannes B
authors.initials: JB
authors.lastname: van Goudoever
authors.affiliation: Pediatric Intensive Care Department H8-190, Emma Children's Hospital (EKZ), Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. a.p.bos@ziggo.nl.|Department of Pediatrics, EKZ, AMC, Amsterdam, The Netherlands. a.p.bos@ziggo.nl.
authors.forename: Albert P
authors.initials: AP
authors.lastname: Bos
authors.affiliation: Department of Endocrinology and Metabolism (emeritus), AMC, Amsterdam, The Netherlands. h.p.sauerwein@planet.nl.
authors.forename: Hans P
authors.initials: HP
authors.lastname: Sauerwein
mesh_terms: D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006330:Heart Defects, Congenital / Q000178:diet therapy / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D007328:Insulin / Q000097:blood; D008297:Male; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D014176:Protein Biosynthesis; D012709:Serum Albumin / Q000378:metabolism; D014633:Valine / Q000008:administration & dosage / Q000097:blood
chemical_list: D004041:Dietary Fats; D004044:Dietary Proteins; D007328:Insulin; D012709:Serum Albumin; D014633:Valine