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Amino acids in pediatric and neonatal nutrition.

Abstract

Modern infant formulas contain sufficient indispensable as well as dispensable amino acids to support normal growth of both term and preterm infants. However, current parenteral and specialized enteral amino acid preparations do not appear to be optimal. Many of the problems with parenteral preparations reflect the fact that ingested amino acids (protein) undergo more extensive enteric and hepatic metabolism than parenterally administered amino acids, including conversion to other amino acids (e.g. arginine) that reach the plasma for support of ongoing protein synthesis. Because this important source of amino acids is bypassed when nutrients are delivered parenterally, parenteral requirements of these amino acids are increased. In addition, while ingested phenylalanine and methionine appear to be converted to tyrosine and cysteine, respectively, it seems that parenterally administered phenylalanine and methionine are not. While glutamine, the branched-chain amino acids and arginine appear to be important in stressed infants and infants with compromised gastrointestinal function, specific roles have not been defined. Finally, because some amino acids are insoluble (e.g. tyrosine) and others are unstable in aqueous solution (e.g. glutamine and cysteine), suitable ways to provide these amino acids are needed. Soluble dipeptides of all types are available and have been shown to be both efficacious and safe in adults. This is also likely to be true for pediatric patients but data concerning their efficacy and safety in this population are lacking. Although recent research has been helpful, further research is necessary to define the optimal amino acid requirements of infants who are dependent on specialized nutrition regimens and to investigate whether these needs may differ depending upon the reasons why parenteral nutrition is required (e.g. growth versus response to stress).

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  • Publisher Full Text
  • Authors+Show Affiliations

    Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX 77030-2600, USA.

    Source

    MeSH

    Adult
    Amino Acids
    Child
    Child Nutritional Physiological Phenomena
    Humans
    Infant
    Infant Food
    Infant Nutritional Physiological Phenomena
    Infant, Newborn
    Nutritional Support
    Parenteral Nutrition

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    10565333

    Citation

    Heird, W C.. "Amino Acids in Pediatric and Neonatal Nutrition." Current Opinion in Clinical Nutrition and Metabolic Care, vol. 1, no. 1, 1998, pp. 73-8.
    Heird WC. Amino acids in pediatric and neonatal nutrition. Curr Opin Clin Nutr Metab Care. 1998;1(1):73-8.
    Heird, W. C. (1998). Amino acids in pediatric and neonatal nutrition. Current Opinion in Clinical Nutrition and Metabolic Care, 1(1), pp. 73-8.
    Heird WC. Amino Acids in Pediatric and Neonatal Nutrition. Curr Opin Clin Nutr Metab Care. 1998;1(1):73-8. PubMed PMID: 10565333.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Amino acids in pediatric and neonatal nutrition. A1 - Heird,W C, PY - 1999/11/24/pubmed PY - 1999/11/24/medline PY - 1999/11/24/entrez SP - 73 EP - 8 JF - Current opinion in clinical nutrition and metabolic care JO - Curr Opin Clin Nutr Metab Care VL - 1 IS - 1 N2 - Modern infant formulas contain sufficient indispensable as well as dispensable amino acids to support normal growth of both term and preterm infants. However, current parenteral and specialized enteral amino acid preparations do not appear to be optimal. Many of the problems with parenteral preparations reflect the fact that ingested amino acids (protein) undergo more extensive enteric and hepatic metabolism than parenterally administered amino acids, including conversion to other amino acids (e.g. arginine) that reach the plasma for support of ongoing protein synthesis. Because this important source of amino acids is bypassed when nutrients are delivered parenterally, parenteral requirements of these amino acids are increased. In addition, while ingested phenylalanine and methionine appear to be converted to tyrosine and cysteine, respectively, it seems that parenterally administered phenylalanine and methionine are not. While glutamine, the branched-chain amino acids and arginine appear to be important in stressed infants and infants with compromised gastrointestinal function, specific roles have not been defined. Finally, because some amino acids are insoluble (e.g. tyrosine) and others are unstable in aqueous solution (e.g. glutamine and cysteine), suitable ways to provide these amino acids are needed. Soluble dipeptides of all types are available and have been shown to be both efficacious and safe in adults. This is also likely to be true for pediatric patients but data concerning their efficacy and safety in this population are lacking. Although recent research has been helpful, further research is necessary to define the optimal amino acid requirements of infants who are dependent on specialized nutrition regimens and to investigate whether these needs may differ depending upon the reasons why parenteral nutrition is required (e.g. growth versus response to stress). SN - 1363-1950 UR - https://www.unboundmedicine.com/medline/citation/10565333/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=10565333 DB - PRIME DP - Unbound Medicine ER -