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Amino acid adequacy in pathophysiological states.

Abstract

Amino acid utilization and, therefore, demand differ between the healthy state and various disease states. In the healthy state most circulating amino acids are derived from dietary proteins that are stored and broken down in the gut and released gradually into the portal circulation, and from continuous turnover of body protein. In disease states, the amino acid composition of amino acids derived from periferal protein breakdown and released in the circulation, is different, for example because a substantial part of the branched-chain amino acids is broken down to yield glutamine and alanine, which are released in the circulation. It appears to be advantageous to mimic this continuous autoinfusion in patients, dependent of parenteral of enteral tube feeding. In disease, different endpoints should be used to assess the adequacy of the administered amino acid mix. Maintenance of a positive nitrogen balance and growth is less important than support of wound healing and immune function. Several amino acids such as glutamine, cysteine, and taurine are shown or suggested to be conditionally essential in disease, and to form substrate in the stressed patient for anabolic processes in liver, immune system, and injured sites. Amino acid toxicity is rare, and protein restriction for patients with renal or liver failure is obsolete because this only aggravated malnutrition. A true example of protein toxicity consists of gastrointestinal hemorrhage that precipitates hepatic encephalopathy in liver insufficiency, most likely because hemoglobin is an unbalanced protein because it lacks the essential amino acid isoleucine.

Authors+Show Affiliations

,

Department of Surgery, Maastricht University, 6200 MD, Maastricht, The Netherlands. pb.soeters@ah.unimaas.nl

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Source

The Journal of nutrition 134:6 Suppl 2004 Jun pg 1575S-1582S

MeSH

Amino Acids
Disease
Health
Humans
Nutritional Status

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

15173433

Citation

Soeters, Peter B., et al. "Amino Acid Adequacy in Pathophysiological States." The Journal of Nutrition, vol. 134, no. 6 Suppl, 2004, 1575S-1582S.
Soeters PB, van de Poll MC, van Gemert WG, et al. Amino acid adequacy in pathophysiological states. J Nutr. 2004;134(6 Suppl):1575S-1582S.
Soeters, P. B., van de Poll, M. C., van Gemert, W. G., & Dejong, C. H. (2004). Amino acid adequacy in pathophysiological states. The Journal of Nutrition, 134(6 Suppl), 1575S-1582S.
Soeters PB, et al. Amino Acid Adequacy in Pathophysiological States. J Nutr. 2004;134(6 Suppl):1575S-1582S. PubMed PMID: 15173433.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Amino acid adequacy in pathophysiological states. AU - Soeters,Peter B, AU - van de Poll,Marcel C G, AU - van Gemert,Wim G, AU - Dejong,Cornelis H C, PY - 2004/6/3/pubmed PY - 2004/7/9/medline PY - 2004/6/3/entrez SP - 1575S EP - 1582S JF - The Journal of nutrition JO - J. Nutr. VL - 134 IS - 6 Suppl N2 - Amino acid utilization and, therefore, demand differ between the healthy state and various disease states. In the healthy state most circulating amino acids are derived from dietary proteins that are stored and broken down in the gut and released gradually into the portal circulation, and from continuous turnover of body protein. In disease states, the amino acid composition of amino acids derived from periferal protein breakdown and released in the circulation, is different, for example because a substantial part of the branched-chain amino acids is broken down to yield glutamine and alanine, which are released in the circulation. It appears to be advantageous to mimic this continuous autoinfusion in patients, dependent of parenteral of enteral tube feeding. In disease, different endpoints should be used to assess the adequacy of the administered amino acid mix. Maintenance of a positive nitrogen balance and growth is less important than support of wound healing and immune function. Several amino acids such as glutamine, cysteine, and taurine are shown or suggested to be conditionally essential in disease, and to form substrate in the stressed patient for anabolic processes in liver, immune system, and injured sites. Amino acid toxicity is rare, and protein restriction for patients with renal or liver failure is obsolete because this only aggravated malnutrition. A true example of protein toxicity consists of gastrointestinal hemorrhage that precipitates hepatic encephalopathy in liver insufficiency, most likely because hemoglobin is an unbalanced protein because it lacks the essential amino acid isoleucine. SN - 0022-3166 UR - https://www.unboundmedicine.com/medline/citation/15173433/full_citation DB - PRIME DP - Unbound Medicine ER -