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Amino acid adequacy in pathophysiological states.
Peter B Soeters1, Marcel C G van de Poll, Wim G van Gemert
1Department of Surgery, Maastricht University, 6200 MD, Maastricht, The Netherlands. pb.soeters@ah.unimaas.nl
The Journal of Nutrition
|June 3, 2004
Summary
Amino acid needs change during illness, with conditionally essential amino acids like glutamine supporting healing and immunity. Protein restriction is often detrimental in critical care settings.
Area of Science:
- Nutritional biochemistry and metabolism.
Background:
- Amino acid utilization and requirements differ significantly between healthy individuals and those in disease states.
- In healthy states, amino acids primarily come from dietary protein digestion and body protein turnover.
- Disease alters amino acid profiles, with increased breakdown of branched-chain amino acids into glutamine and alanine.
Purpose of the Study:
- To highlight the distinct amino acid demands in disease states compared to health.
- To emphasize the importance of specific amino acids for wound healing and immune function in stressed patients.
- To re-evaluate the necessity of protein restriction in renal or liver failure.
Main Methods:
- Review of existing literature on amino acid metabolism in health and disease.
- Analysis of the role of specific amino acids (glutamine, cysteine, taurine) in critical illness.
- Examination of the consequences of protein restriction in patients with organ failure.
Main Results:
- Disease states necessitate different amino acid compositions, prioritizing support for anabolic processes in the liver, immune system, and injured tissues.
- Certain amino acids, including glutamine, cysteine, and taurine, are conditionally essential during critical illness.
- Protein restriction in patients with renal or liver failure can exacerbate malnutrition; protein toxicity is rare.
Conclusions:
- Mimicking continuous amino acid autoinfusion may benefit patients requiring parenteral or enteral nutrition.
- Assessment endpoints in disease should focus on wound healing and immune support rather than solely nitrogen balance and growth.
- Reconsidering traditional protein restriction is crucial for managing malnutrition in critically ill patients.