The branched-chain amino acid requerement in neonates

Growth during the earliest stages of life is an important determinant of an individual’s later health and risk of chronic disease. Substantial evidence shows that growth in the first 2 years of life, especially high early weight gain, is associated with adverse health outcomes later in life, including increased blood pressure, increased weight gain and body fat deposition and increased risk of diabetes. Higher protein intake for infants who are formula fed may play a role with these health outcomes because formula-fed children reach a higher body weight and weight for length at one year of age compared to those fed breast milk. A lower protein intake in infant formula is associated with lower weight up at 2 years of age which might be beneficial because the slower pattern of growth in breastfed infants might be protective for the development of the metabolic syndrome. In preterm infants, however, a higher protein intake in the first month of life correlates with improved neurodevelopment. Preterm infants have higher protein turnover rates and protein losses than terms and thereby higher protein requirements. Excessive intake of amino acids has been shown to reduce (brain) growth and to influence neurotransmitter concentrations in the brain of rats which might put the developing brain at risk. Inadequate amino acid intake impairs protein synthesis, which is pivotal for growth. The growth rate of the preterm infant should mimic at least the growth rate of the intrauterine fetus at the same gestational age. Achieving appropriate growth and nutrition accretion of preterm neonates is often difficult during hospitalization because of metabolic and gastrointestinal immaturity and other complicating medical conditions. Many preterm neonates require total parental nutrition for their initial nutritional support but this is associated with several complications, including the increased risk of infection, mucosal atrophy and cholestatic jaundice. Therefore, transition to full enteral feeding and the cessation of TPN are accomplished as soon as feasible and safe, taking in consideration that enteral feeding is associated with a detrimental morbidity like necrotising enterocolitis. Enteral nutrition can be initiated immediately after birth by introducing small amounts to enhance the development of the gastro-intestinal tract and for this reason is referred to as “trophic”, “priming” or “minimal enteral feeding”

Acute stress response in children with meningococcal sepsis: important differences in the growth hormone/insulin-like growth factor I axis between nonsurvivors and survivors

Septic shock is the most severe clinical manifestation of meningococcal disease and is predominantly seen in children under 5 yr of age. Very limited research has been performed to elucidate the alterations of the GH/IGF-I axis in critically ill children. We evaluated the GH/IGF-I axis and the levels of IGF-binding proteins (IGFBPs)

Branched-chain amino acid requirements for enterally fed term neonates in the first month of life

Background: Knowledge of essential amino acid requirements in infants is important because excessive intake of protein can lead to increased long-term morbidity such as obesity. A deficient intake may lead to suboptimal growth and impaired neurodevelopment. The current recommended branched-chain amino acid requirements in infants aged 0-1 mo are based on the amino acid content of human milk. Objective: We quantified the requirements for isoleucine, leucine, and valine for term neonates by using the indicator amino acid oxidation method with [1-13C]phenylalanine as the indicator. Design: Fully enterally fed term infants received randomly graded amounts of isoleucine (5-216 mg · kg-1 · d-1), leucine (5-370 mg · kg -1 · d-1), or valine (5-236 mg · kg -1 · d-1) as part of an elemental formula. Data are expressed as means ± SDs. Results: Eighty-three Asian, term neonates (mean ± SD birth weight: 3.3 ± 0.4 kg; gestational age: 39.4 ± 1.3 wk) were studied at a postnatal age of 13 ± 5 d. Mean requirements for isoleucine, leucine, and valine (measured in boys only) were 105 mg · kg-1 · d-1 (r2 = 0.61, P < 0.001), 140 mg · kg-1 · d-1 (r 2 = 0.26, P < 0.01), and 110 mg · kg-1 · d-1 (r2 = 0.35, P = 0.001), respectively. Conclusions: Current human milk-based recommendations for isoleucine and valine in term infants aged 0-1 mo are correct. However, the current recommendation for leucine (166 mg · kg-1 · d-1) is higher than the mean requirement of 140 mg · kg-1 · d-1 that we determined in this study. This trial was registered at www.trialregister. nl as NTR1610