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21 - Enteral amino acid and protein digestion, absorption, and metabolism

Published online by Cambridge University Press:  10 December 2009

Patti J. Thureen
Affiliation:
University of Colorado at Denver and Health Sciences Center
David K. Rassin
Affiliation:
Department of Pediatrics, University of Texas Medical Branch at Galveston, Galveston, TX
Karen E. Shattuck
Affiliation:
Department of Pediatrics, University of Texas Medical Branch at Galveston, Galveston, TX
William W. Hay
Affiliation:
University of Colorado at Denver and Health Sciences Center
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Summary

Introduction

The amino acid requirements of neonates continue to be an area of investigation despite numerous studies, due to the complexity of determining these requirements within the ever-changing biochemical environment of the developing infant. In the following discussion some of the issues related to digestibility and absorption, special aspects of development as they impact on requirements – including amino acid metabolism and infant responses to amino acid variations in the diet – will be addressed.

Protein is often assessed for its function in infant nutrition based on its role in supporting growth. However, protein is responsible for supplying some 20 individual amino acids with a variety of specific functions, as well as serving as precursors for a number of biologically active proteins (for example enzymes, cytokines, and immunoglobulins) that have more complex roles than to merely supply the amino acid building blocks for the body's proteins. The major conundrum in determining protein requirements for infants is that human milk proteins are fundamentally different than the proteins supplied in various substitution formulas. Human milk is perfectly satisfactory nutrition for the healthy term infant (and is also usually satisfactory for preterm infants when supplemented with additional nutrients to support the greater requirements of these infants). Thus, the determination of infant protein requirements is often an exercise in comparing human milk protein nutriture to various possible substitutes (adapted cow milk or soy proteins, usually).

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Publisher: Cambridge University Press
Print publication year: 2006

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References

Rassin, D. K., Garofalo, R., Ogra, P. L. Human milk. In Remington, J. S., Klein, J. O., eds. Infectious Diseases of the Fetus and Newborn Infant. 5th edn. Philadelphia, PA: WB Saunders;2001:169–203.Google Scholar
Raiten, D. J., Talbot, J. M., Waters, J. H., eds. Assessment of nutrient requirements for infant formulas. J. Nutr. 1998;128:2110s–27s.Google Scholar
Association of Official Analytical Chemists. Protein efficiency ratio. In Helrich, K., ed. Official Methods of Analysis of the Association of Official Analytical Chemists. 15th edn. Arlington, VA: Association of Official Analytical Chemists; 1990:1095–6.Google Scholar
FAO/WHO. Expert Consultation. Protein Quality Evaluation. Report of a Joint FAO/ WHO Expert Consultation. Rome, Italy: Food and Agriculture Organization; 1990.
Fomon, S. J. Protein. In Craven, L., ed. Nutrition of Normal Infants. St. Louis, MO: Mosby-Year Book; 1993:121–46.Google Scholar
Sarwar, G., Botting, H., Peace, R. W.Amino acid rating method for evaluating protein adequacy of infant formulas. J. Assoc. Official Analyt. Chem. 1989a;72:622–6.Google Scholar
Sarwar, G., Peace, R. W., Botting, H. G.Differences in protein digestibility and quality of liquid concentrate and powder forms of milk-based infant formulas fed to rats. Am. J. Clin. Nutr. 1989b;49:806–13.CrossRefGoogle Scholar
Lönnerdal, B., Hernell, O.Effects of feeding ultrahigh-temperature (UHT) treated infant formula with different protein concentrations or powdered formula as compared with breast-feeding, on plasma amino acids, hematology, and trace element status. Am. J. Clin. Nutr. 1998;68:350–6.CrossRefGoogle ScholarPubMed
Lönnerdal, B.Nutritional and physiologic significance of human milk proteins. Am. J. Clin. Nutr. 2003;77:1537s–43s.CrossRefGoogle ScholarPubMed
Lönnerdal, B., Forsum, E., Hambraeus, L.A longitudinal study of the protein, nitrogen, and lactose contents of human milk from Swedish well-nourished mothers. Am. J. Clin. Nutr. 1976;29:1127–33.CrossRefGoogle ScholarPubMed
Picone, T. A., Benson, J. D., Maclean, W. C. Jr, Sauls, H. S. Amino acid metabolism in human-milk and formula-fed term infants. In Atkinson, S. A., Lonnerdal, B., eds. Protein and Non-Protein Nitrogen in Human Milk. Boca Raton, FL: CRC Press;1989:173–86.Google Scholar
Rassin, D. K. Amino acid and protein metabolism in the premature and term infant. In Hay, W. W. Jr, ed. Neonatal Nutrition and Metabolism. St. Louis, MO: Mosby Year Book; 1991:110–21.Google Scholar
Dupont, C.Protein requirements during the first year of life. Am. J. Clin. Nutr. 2003;77:1544s–9s.CrossRefGoogle ScholarPubMed
Stegink, L. O.Amino acids in pediatric parenteral nutrition. J. Dis. Child. 1983;137:1008.CrossRefGoogle ScholarPubMed
Potsic, B., Holliday, N., Lewis, P.et al.Glutamine supplementation and deprivation: effect on artificially reared rat small intestinal morphology. Ped. Res. 2002;52: 430–6.CrossRefGoogle ScholarPubMed
Malloy, M. H., Rassin, D. K., Gaull, G. E.A method for measurement of free and bound plasma cyst(e)ine. Analyt. Biochem. 1981;113:407–15.CrossRefGoogle Scholar
Picone, T. A., Benson, J. D., Moro, G.et al.Growth, serum biochemistries, and amino acids of term infants fed formulas with amino acid and protein concentrations similar to human milk. J. Pediatr. Gastroenterol. Nutr. 1989;9:351–60.CrossRefGoogle ScholarPubMed
Czarnecki, G. L., Baker, D. H.Urea cycle function in the dog with emphasis on the role of arginine. J. Nutr. 1984;114:581–90.CrossRefGoogle ScholarPubMed
Anderson, T. L., Heird, W. C., Winters, R. W. Clinical and physiological consequences of total parenteral nutrition in the pediatric patient. In Greef, M. 3rd, Soeterz, B., Wesdorp, R. I. C., Fischer, J. B., eds. Current Concepts in Parenteral Nutrition. The Hague, Netherlands: Martinus Nijhoff; 1977:111–27.Google Scholar
Räihä, N. C. R., Suihkonen, J., Development of urea-synthesizing enzymes in human liver. Acta Paediatr. Scand. 1968a;57:121–4.CrossRefGoogle Scholar
Räihä, N. C. R., Suihkonen, J., Factors influencing the development of urea-synthesizing enzymes in rat liver. Biochem. J. 1968b;107:793–7.CrossRefGoogle Scholar
Kretchmer, N., Levine, S. Z., McNamara, H., Barnett, H. L.Certain aspects of tyrosine metabolism in the young, 1. The development of the tyrosine oxidizing system in human liver. J. Clin. Invest. 1956;35:236–44.CrossRefGoogle Scholar
Kretchmer, N., Levine, S. Z., McNamara, H.The in vitro metabolism of tyrosine and its intermediates in the liver of the premature infant. J. Dis. Child. 1957;93:19–20.Google Scholar
Del Valle, J. A., Greengard, O.Phenylalanine hydroxylase and tyrosine aminotransferase in human fetal and adult liver. Pediatr. Res. 1976;11:2–5.Google Scholar
Rassin, D. K., Gaull, G. E., Räihä, N. C. R., Heinonen, K.Milk protein quantity and quality in low birth-weight infants. IV. Effects on tyrosine and phenylalanine in plasma and urine. J. Pediatr. 1977;90:356–60.CrossRefGoogle ScholarPubMed
Bell, E. F., Filer, L. J. Jr, Wong, A. P., Stegink, L. D.Effects of a parenteral nutrition regimen containing dicarboxylic amino acids on plasma, erythrocyte, and urinary amino acid concentrations of young infants. Am. J. Clin. Nutr. 1983;37:99–107.CrossRefGoogle ScholarPubMed
Roberts, S. A., Ball, R. O., Filler, R. M., Moore, A. M., Pencharz, P. B.Phenylalanine and tyrosine metabolism in neonates receiving parenteral nutrition differing in pattern of amino acids. Pediatr. Res. 1998;44:907–14.CrossRefGoogle ScholarPubMed
Sturman, J. A., Gaull, G. E., Räihä, N. C. R.Absence of cystathionase in human fetal liver. Is cysteine essential?Science 1970;169:74–6.CrossRefGoogle ScholarPubMed
Pascal, T. A., Gillam, B. M., Gaull, G. E.Cystathionase: immunochemical evidence for absence from human fetal liver. Pediatr. Res. 1972;6:773–8.CrossRefGoogle ScholarPubMed
Malloy, M. H., Rassin, D. K., Richardson, C. J.Total parenteral nutrition in sick preterm infants: the effects of cysteine supplementation with nitrogen intakes of 240 and 400 mg/kg. J. Pediatr. Gastroenterol. Nutr. 1984;3:239–44.CrossRefGoogle ScholarPubMed
Meister, A.New aspects of glutathione biochemistry and transport-selective alteration of glutathione metabolism. Nutr. Res. 1984;42:397–410.Google ScholarPubMed
Gaull, G. E., Rassin, D. K., Räihä, N. C. R., Heinonen, K.Milk protein quantity and quality in low-birth-weight infants, III. Effects on sulfur-containing amino acids in plasma and urine. J. Pediatr. 1977;90:348–55.CrossRefGoogle Scholar
Sturman, S. A., Won, G. V., Wisnlewski, H. M., Neurlnger, M. D.Retinal degeneration in primates raised on a synthetic human infant formula. Int. J. Dev. Neurosci. 1984;2:121–9.CrossRefGoogle ScholarPubMed
Sturman, S. A., Moretz, H. C., French, I. H., Wisniewski, H. M.Postnatal taurine deficiency in the kitten results in a persistence of the cerebellar external granule cell layer: correction by taurine feeding. J. Neurosci. Res. 1985;13:521–8.CrossRefGoogle Scholar
Watkins, J. B., Järvenpää, A.-L., Szczepanik-Van Leeuwen, P.et al.Feeding the low-birth weight infant: V. Effects of taurine, cholesterol, and human milk on bile acid kinetics. Gastroenterology 1983;85:793–800.Google ScholarPubMed
Kurpad, A., Young, V. R., What is apparent is not always real: lessons from lysine requirement studies in adult humans. J. Nutr. 2003;133:1227–30.CrossRefGoogle Scholar
Cho, F., Bhatia, J., Rassin, D. K.Amino acid responses to dietary intake in the first 72 hours of life. Nutrition 1990;6:449–55.Google Scholar
Kashyap, S., Schulze, K. F., Abildskov, K., Ramakrishnan, R., Heird, W. C.Effect of protein (P) and energy (E) intakes on plasma amino acid concentrations (arachidonic acid) of low birth weight (LBW) infants. Pediatr. Res. 2003;53:442A.Google Scholar
Rassin, D. K. Essential and non-essential amino acids in neonatal nutrition. In Räihä, N. C. R., ed. Protein Metabolism during Infancy. New York, NY: Raven Press; 1994:183–92.Google Scholar
Bhatia, J., Rassin, D. K., Cerreto, M. C., Bee, B. F.Effect of protein/energy ratio on growth and behavior of premature infants: preliminary findings. J. Pediatr 1991;119:103–10.CrossRefGoogle ScholarPubMed
American Academy of Pediatrics Work Group on Breastfeeding. Breast feeding and the use of human milk. Pediatrics 1997;100:1035–9.CrossRef
Sapsford, A. L. Human milk and enteral nutrition products. In Groh-Wargo, S., Thompson, M., Cox, J. H., eds. Nutritional Care for High-Risk Newborns. 3rd edn. Chicago, IL: Precept Press; 2000:265–302.Google Scholar
American Academy of Pediatrics. Formula feeding of term infants. In Kleinman, R. E., ed. Pediatric Nutrition Handbook. 4th edn. Elk Grove Village, IL: American Academy of Pediatrics; 1998:29–42.Google Scholar
Harrison, G. G., Graver, E. J., Vargas, M., et al.Growth and adiposity of term infants fed whey-predominant or casein-predominant formulas or human milk. J. Pediatr. Gastroenterol. Nutr. 1987;6:739–47.CrossRefGoogle ScholarPubMed
American Academy of Pediatrics Committee on Pediatric AIDS. Human milk, breastfeeding and transmission of human immunodeficiency virus in the United States. Pediatrics 1995;96:977–9.
American Academy of Pediatrics Committee on Infectious Diseases. Recommendations for care of children in special circumstances: human milk. In 2003 Red Book: Report of the Committee on Infectious Diseases. 26th edn. Elk Grove Village, IL: American Academy of Pediatrics; 2003:118–20.
American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137–50.
Bailey, B., Ito, S., Breast-feeding and maternal drug use. Pediatr. Clin. N. Am. 1997;44:41–54.CrossRefGoogle ScholarPubMed
Howard, C. R., Lawrence, R. A.Drugs and breastfeeding. Clin. Perinatol. 1999;26:447–78.CrossRefGoogle ScholarPubMed
Lawrence, R. A., Howard, C. R.Given the benefits of breastfeeding: are there any contraindications?Clin. Perinatol. 1999;26:479–90.CrossRefGoogle ScholarPubMed
World Health Organization. Consensus statement from the WHO/UNICEF consultation on HIV transmission and breast feeding. Geneva, Switzerland; April 20–May 1, 1992.
Atkinson, S. A., Hanning, R. A. Amino acid metabolism and requirements of the premature infant: is human milk the “Gold Standard”? In Atkinson, S. A., Lonnerdal, B., eds. Protein and Non-Protein Nitrogen in Human Milk. Boca Raton, FL: CRC Press; 1989:187–209.Google Scholar
Cheung, M. W., Pratt, E. L., Fowler, D. I.Total amino acid composition in mature human milk. J. Pediatr. 1953;12:353–7.Google ScholarPubMed
Davis, T. A., Nguyen, H. V., Garcia-Bravo, R.et al.Amino acid composition of human milk is not unique. J. Nutr. 1994;124:1126–32.CrossRefGoogle Scholar
Diehm, K., ed. Documenta Geigy: Scientific Tables. 6th edn. Ardsley, NY: Geigy Pharmaceuticals; 1962:514.Google Scholar
FAO/WHO/UNU. Expert Consultation. Energy and Protein Requirements. Geneva, Switzerland: WHO; 1985.
Janas, L. M., Picciano, M. F.Quantities of amino acids ingested by human milk-fed infants. J. Pediatr. 1986;109:802–7.CrossRefGoogle ScholarPubMed
Janas, L. M., Picciano, M. F., Hatch, T. F.Indices of protein metabolism in term infants fed either human milk or formulas with reduced protein concentration and various whey/casein ratios. J. Pediatr. 1987;110:838–48.CrossRefGoogle ScholarPubMed
, Järvenpää A.-L., Räihä, N. C. R., Rassin, D. K., Gaull, G. E.Milk protein quantity and quality in the term infant. I. Metabolic responses and effects on growth. Pediatrics 1982;70:214–20.Google Scholar
Järvenpää, A.-L., Räihä, N. C. R., Rassin, D. K., Gaull, G. E.Milk protein quantity and quality in the term infant. II. Effects on acidic and neutral amino acids. Pediatrics 1982;70:221–30.Google ScholarPubMed
Macy, I. G.Composition of human colostrum and milk. Am. J. Dis. Child. 1949;78:589–603.Google ScholarPubMed
Miller, S., Ruttinger, V.Essential amino acids in mature human milk. Proc. Soc. Exp. Biol. Med. 1951;77:96–9.CrossRefGoogle ScholarPubMed
Räihä, N. C. R., Heinonen, K., Rassin, D. K., Gaull, G. E.Milk protein quantity and quality in low-birthweight infants. I. Metabolic responses and effects on growth. Pediatrics 1976;57:659–74.Google ScholarPubMed
Roberts, S. A., Ball, R. O., Filler, R. M., Moore, A. M., Penchar, P. B.Phenylalanine and tyrosine metabolism in neonates receiving parenteral nutrition differing in pattern of amino acids. Pediatr. Res. 1998;44:907–14.CrossRefGoogle ScholarPubMed
Sarwar, G., Darling, P., Ujiie, M., Botting, H. G., Pencharz, P. B.Use of amino acid profiles of preterm and term human milks in evaluating scoring patterns for routine protein quality assessment of infant formulas. J. Assoc. Official Analyt. Chem. int. 1996;79:498–502.Google ScholarPubMed
Soupart, P., Moore, S., Bigwood, E. J., Amino acid composition of human milk. J. Biochem. 1954;206:699–704.Google ScholarPubMed
Svanberg, U., Gebre-Medhin, M., Ljungqvist, B., Olsson, M.Breast milk composition in Ethiopian and Swedish mothers. III. Amino acids and other nitrogenous substances. Am. J. Clin. Nutr. 1977;30:499–507.CrossRefGoogle ScholarPubMed

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