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

Nutrition Journal

Hans P. Sauerwein⁶  Albert P. Bos³  Johannes B. van Goudoever⁴  Henk Schierbeek³  Dewi van Harskamp³  Johannes M. P. J. Breur¹  Nicolaas J. G. Jansen²  Monique E. Dijsselhof⁵  Vincent G. Geukers³ 

[1] Department of Pediatric Cardiology, WKZ, UMCUtrecht, Utrecht, The Netherlands;Pediatric Intensive Care Department, Wilhelmina Children’s Hospital (WKZ), University Medical Center Utrecht (UMCUtrecht), Lundlaan 6, Utrecht, 3584, EA, The Netherlands;Department of Pediatrics, EKZ, AMC, Amsterdam, The Netherlands;Department of Pediatrics, VU University Medical Center, Boelelaan 1117, Amsterdam, 1081, HV, The Netherlands;Department of Clinical Nutrition, AMC, Amsterdam, The Netherlands;Department of Endocrinology and Metabolism (emeritus), AMC, Amsterdam, The Netherlands

关键词: Intensive care;    Congenital heart defect;    Child;    Isotopes;    Proteins;   

Others  :  1222617
DOI  :  10.1186/s12937-015-0061-9

 received in 2015-04-10, accepted in 2015-07-17,  发布年份 2015

【 摘 要 】

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 (FSR _alb ) 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 ⁻¹in 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 ⁻¹in the HP and NP group. Between groups, there was no difference in FSR _alb . 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.

Trial registration

Dutch Trial Register NTR2334.

【 授权许可】

   
2015 Geukers et al.

【 图 表 】

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