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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

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 (...

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Autores principales: Geukers, Vincent G., Dijsselhof, Monique E., Jansen, Nicolaas J. G., Breur, Johannes M. P. J., van Harskamp, Dewi, Schierbeek, Henk, van Goudoever, Johannes B., Bos, Albert P., Sauerwein, Hans P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517637/
https://www.ncbi.nlm.nih.gov/pubmed/26215396
http://dx.doi.org/10.1186/s12937-015-0061-9
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author Geukers, Vincent G.
Dijsselhof, Monique E.
Jansen, Nicolaas J. G.
Breur, Johannes M. P. J.
van Harskamp, Dewi
Schierbeek, Henk
van Goudoever, Johannes B.
Bos, Albert P.
Sauerwein, Hans P.
author_facet Geukers, Vincent G.
Dijsselhof, Monique E.
Jansen, Nicolaas J. G.
Breur, Johannes M. P. J.
van Harskamp, Dewi
Schierbeek, Henk
van Goudoever, Johannes B.
Bos, Albert P.
Sauerwein, Hans P.
author_sort Geukers, Vincent G.
collection PubMed
description 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(−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 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.
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spelling pubmed-45176372015-07-29 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 Geukers, Vincent G. Dijsselhof, Monique E. Jansen, Nicolaas J. G. Breur, Johannes M. P. J. van Harskamp, Dewi Schierbeek, Henk van Goudoever, Johannes B. Bos, Albert P. Sauerwein, Hans P. Nutr J Research 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(−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 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. BioMed Central 2015-07-28 /pmc/articles/PMC4517637/ /pubmed/26215396 http://dx.doi.org/10.1186/s12937-015-0061-9 Text en © Geukers et al. 2015 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Geukers, Vincent G.
Dijsselhof, Monique E.
Jansen, Nicolaas J. G.
Breur, Johannes M. P. J.
van Harskamp, Dewi
Schierbeek, Henk
van Goudoever, Johannes B.
Bos, Albert P.
Sauerwein, Hans P.
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
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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517637/
https://www.ncbi.nlm.nih.gov/pubmed/26215396
http://dx.doi.org/10.1186/s12937-015-0061-9
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