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Predictors of muscle protein synthesis after severe pediatric burns
Eva C Diaz1, David N Herndon, Jinhyung Lee
1From the Metabolism Unit (E.C.D., D.N.H., C.P., M.C., O.E.S., L.S.S., E.B.), Shriners Hospitals for Children-Galveston; and Departments of Surgery (E.C.D., D.N.H., C.P., M.C., O.E.S., E.B.), and Internal Medicine (L.S.S.), University of Texas Medical Branch, Galveston, Texas; Arkansas Children's Nutrition Center (E.C.D., M.C., E.B.); Arkansas Children's Hospital Research Institute (E.C.D., M.C., E.B.); and Department of Pediatrics (E.C.D., M.C., E.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas; and Sungkyunkwan University (J.L.), Seoul, South Korea.
Insights
Skeletal muscle protein synthesis remains elevated for at least one year after severe burns in children. Factors like sex, age, and burn size significantly impact this muscle protein turnover response.
Area of Science:
- Biomedical Science
- Metabolic Response to Injury
- Pediatric Physiology
Background:
- Severe burn injury triggers increased skeletal muscle protein breakdown.
- Elevated muscle protein synthesis post-burn is often insufficient to counteract catabolism.
- The long-term metabolic consequences of severe burns in children require further investigation.
Purpose of the Study:
- To quantify muscle protein synthesis rates in children over 24 months post-burn.
- To identify predictors influencing muscle protein synthesis following severe burn injury.
Main Methods:
- A cohort of 87 children with >=40% total body surface area (TBSA) burns were studied.
- Stable isotope infusion techniques were used to measure skeletal muscle protein fractional synthesis rate (FSR) at multiple time points up to 24 months post-injury.
- Generalized estimating equations were employed for statistical analysis, controlling for patient characteristics.
Main Results:
- Muscle protein FSR was elevated for the first 12 months post-burn compared to healthy controls.
- Lower muscle protein FSR was observed in boys, children over 3 years old, and those with burns >80% TBSA.
- Patients presented with large (62% TBSA) and deep (47% third degree) burns.
Conclusions:
- Muscle protein synthesis remains elevated for at least one year, indicating heightened muscle protein turnover as a long-term response to severe burn trauma.
- Sex, age, and burn size are significant determinants of muscle protein synthesis in pediatric burn patients.
- These findings may elucidate variations in net protein balance and lean body mass among different burn patient populations.
Background:
Following a major burn, skeletal muscle protein synthesis rate increases but is often insufficient to compensate for massively elevated muscle protein breakdown rates. Given the long-term nature of the pathophysiologic response to burn injury, we hypothesized that muscle protein synthesis rate would be chronically elevated in severely burned children. The objectives of this study were to characterize muscle protein synthesis rate of burned children over a period of 24 months after injury and to identify predictors that influence this response.
Methods:
A total of 87 children with 40% or greater total body surface area (TBSA) burned were included. Patients participated in stable isotope infusion studies at 1, 2, and approximately 4 weeks after burn and at 6, 12, and 24 months after injury to determine skeletal muscle protein fractional synthesis rate. Generalized estimating equations with log link normal distribution were applied to account for clustering of patients and control for patient characteristics.
Results:
Patients (8 ± 6 years) had large (62, 51-72% TBSA) and deep (47% ± 21% TBSA third degree) burns. Muscle protein fractional synthesis rate was elevated throughout the first 12 months after burn compared with established values from healthy young adults. Muscle protein fractional synthesis rate was lower in boys, in children older than 3 years, and when burns were greater than 80% TBSA.
Conclusion:
Muscle protein synthesis is elevated for at least 1 year after injury, suggesting that greater muscle protein turnover is a component of the long-term pathophysiologic response to burn trauma. Muscle protein synthesis is highly affected by sex, age, and burn size in severely burned children. These findings may explain the divergence in net protein balance and lean body mass in different populations of burn patients.
Level Of Evidence:
Prognostic study, level III.
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