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The gut takes nearly all: threonine kinetics in infants^1,2,3

¹ From the Department of Pediatrics, Division of Neonatology (SRDvdS and JBvG) and the Departments of Internal Medicine (DLW), Clinical Genetics (JH), and Clinical Pharmacy (AV), Erasmus MC–Sophia Children's Hospital, Erasmus University, Rotterdam, Netherlands

Background:Threonine is an essential amino acid that is abundantly present in intestinally produced glycoproteins. Animal studies show that intestinal first-pass threonine metabolism is high, particularly during a restricted enteral protein intake.

Objective:The objective of the study was to quantify intestinal first-pass threonine metabolism in preterm infants during full enteral feeding and during restricted enteral intake.

Design:Eight preterm infants ( ± SD birth weight: 1.1 ± 0.1 kg; gestational age: 29 ± 2 wk) were studied during 2 periods. During period A, 40% of total intake was administered enterally and 60% was administered parenterally. Total threonine intake was 58 ± 6 µmol · kg^–1 · h^–1. During period B, the infants received full enteral feeding, and the total threonine intake was 63 ± 6 µmol · kg^–1 · h^–1. Dual stable-isotope tracer techniques were used to assess splanchnic and whole-body threonine kinetics.

Results:The fractional first-pass threonine uptake by the intestine was remarkably high in both periods: 82 ± 6% during partial enteral feeding and 70 ± 6% during full enteral feeding. Net threonine retention was not affected by the route of feeding.

Conclusion:In preterm infants, the splanchnic tissues extract a very large amount of the dietary threonine intake, which indicates a high obligatory visceral need for threonine, presumably for the purposes of synthesis.

Key Words: Threonine • preterm infants • intestine • stable isotopes • nutrition • splanchnic metabolism

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