Supplementation with aromatic amino acids improves leucine kinetics but not aromatic amino acid kinetics in infants with infection, severe malnutrition, and edema

Abstract

We investigated whether supplementation with an aromatic amino acid (AAA) cocktail consisting of 0.5 mmol each of phenylalanine, tryptophan, and tyrosine compared with isonitrogenous amounts of alanine (Ala) would improve measures of protein kinetics in 14 (8 with AAA, 6 Ala) children with edematous malnutrition (aged 6-24 mo) during the infected acute malnourished state. Supplementation started immediately after the baseline experiment, 2 d postadmission and continued to the end of the acute phase of treatment. The second (post-supplementation) experiment was done ∼12 d postadmission. We measured leucine kinetics, phenylalanine and tyrosine fluxes, using an i.g. 8-h prime continuous infusion of 2H3-leucine, and an i.v. 6-h prime continuous infusion of 13C-leucine, 2H2- tyrosine, and 2H5-phenylalanine in the fed state. Leucine flux tended to be faster (P = 0.06) in the AAA group compared with Ala group after supplementation (mean difference ± SEM): 22.6 ± 10.9 μmol/ (kg · h). The rate of leucine appearance from protein breakdown [28.1 ± 9.4 μmol/(kg · h)] and the nonoxidative disposal of leucine [i.e., leucine to protein synthesis; 35.4 ± 12.9 μmol/(kg · h)] were faster (P < 0.02) in the AAA group than in the Ala group. There was no significant effect of supplementation on leucine splanchnic metabolism, phenylalanine, and tyrosine fluxes. These findings are consistent with the hypothesis that the blunting of the protein catabolic response to infection in children with edematous malnutrition syndrome is due to limited availability of aromatic amino acids.