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Short-term protein intake and stimulation of protein synthesis in stunted children with cystic fibrosis^1,2,3

¹ From the Departments of Pediatric Intensive Care (VG) and of Pediatric Gastroenterology (JT and HH), Emma Children's Hospital, Amsterdam; the Departments of Endocrinology and Metabolism (VG and HS), of Clinical Chemistry (Endocrinology Laboratory) (AR, MA, and EE), and of Clinical Nutrition (CJ-S), Academic Medical Center, Amsterdam; the Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht (JO and CvdE); and the Department of Pediatrics, Medical Center Alkmaar, Netherlands (PS).

Background: Stunted children with cystic fibrosis (CF) have less net protein anabolism than do children without CF, and the result is retarded growth in the CF patients. It is not known whether protein intake above that recommended by the Cystic Fibrosis Foundation would further stimulate whole-body protein synthesis.

Objective: We studied the effects of 3 amounts of protein intake on whole-body protein synthesis and breakdown by using isotopic infusion of [1-¹³C]valine and [¹⁵N₂]urea in children with stable CF who required tube feeding.

Design: In 8 pediatric CF patients, we administered 3 randomly allocated isocaloric diets with normal (NP), intermediate (IP), and high (HP) amounts of protein (1.5, 3, and 5 g · kg^–1 · d^–1, respectively) by continuous drip feeding during a 4-d period at 6-wk intervals. Each patient acted as his or her own control. On the fourth day of feeding, whole-body protein synthesis and breakdown were measured.

Results: Protein synthesis was significantly higher in the HP group ( ± SEM: 1.78 ± 0.07 µmol · kg^–1 · min^–1) than in the IP (1.57 ± 0.08 µmol · kg^–1 · min^–1; P=0.001) and NP (1.37 ± 0.07 µmol · kg^–1 · min^–1; P < 0.001) groups. There were no significant differences in protein breakdown. Net retention of nitrogen was significantly higher in the HP group (12.93 ± 1.42 µmol · kg^–1 · min^–1) than in the IP (7.61 ± 1.40 µmol · kg^–1 · min^–1; P=0.01) and HP (2.48 ± 0.20 µmol · kg^–1 · min^–1; P < 0.001) groups.

Conclusion: In stunted children with CF requiring tube feeding, the highest stimulation of whole-body protein synthesis was achieved with a short-term dietary protein intake of 5 g · kg^–1 · d^–1.

Key Words: Cystic fibrosis • children • protein • isotopes