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Original Research Communication |
1 From the UMR INRA, Institut National Agronomique Paris-Grignon, Unité de Physiologie de la Nutrition et du Comportement Alimentaire, Paris, and the Service d'Hépato-Gastroentérologie, Hôpital Avicenne, Bobigny, France.
2 Address reprint requests to S Mahé, INRA, Unité de Physiologie de la Nutrition et du Comportement Alimentaire, Institut National Agronomique Paris-Grignon, 16 rue Claude Bernard, 75231 Paris Cedex 05, France. E-mail: sylvain.mahe{at}inapg.inra.fr.
| ABSTRACT |
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Objective: We aimed to characterize the acute postprandial effect of addition of sucrose on deamination of dietary and endogenous nitrogen, with particular consideration being given to the effects of bioavailability.
Design: Twenty-one subjects equipped with ileal tubes ingested 15N-labeled soy protein combined with [13C]glycine, with (n = 10) or without (n = 11) sucrose. Dietary and endogenous ileal flow of nitrogen were determined from the ileal effluents. The kinetics of dietary amino acid transfer to the blood were characterized by 13CO2 enrichment in breath and 15N enrichment in plasma amino acids. Deamination of dietary and endogenous amino acid was determined from body urea, urinary nitrogen, and 15N enrichment.
Results: 13CO2 recovery in breath and 15N plasma amino acid enrichments were highly correlated (R2
0.95, P < 0.001, for both meals) and markedly delayed by sucrose (half-13CO2 recovery: 274 min compared with 167 min), whereas exogenous and endogenous ileal nitrogen kinetics and balances remained unchanged. Addition of sucrose halved the early (02 h) deamination peak of dietary nitrogen and reduced endogenous nitrogen oxidation over the first 4 h. Both were reduced by 1824% over the 8-h period after the meal.
Conclusions: Without changing the nitrogen absorptive balance, sucrose markedly affected the bioavailability profile, which is governed by gastric emptying. Endogenous and dietary nitrogen were not spared in the same way and over the same periods, showing that the metabolism of endogenous and dietary nitrogen may be affected differently by nutritional modulation, even if the effects are of a similar magnitude over the entire postprandial period.
Key Words: Adults nitrogen isotopes carbon isotopes amino acids pharmacokinetics oxidation intestinal absorption dietary protein dietary carbohydrate protein metabolism nitrogen metabolism sucrose gastric emptying
| INTRODUCTION |
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| SUBJECTS AND METHODS |
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Subjects
The study was performed in 21 healthy volunteers (14 men and 7 women) aged from 20 to 37 y (
± SD: 26 ± 5 y), weighing from 55 to 89 kg (72 ± 11 kg), with body mass indexes (in kg/m2) ranging from 19.6 to 27.5 (23.1 ± 2.3), and total body water [TBW; as estimated by using the equation of Watson et al (17)] ranging from 28.8 to 49.9 L (40.4 ± 7.6 L). The subjects were in good health as determined by a thorough medical examination. Subjects of each sex were randomly assigned to 2 groups: 11 (7 men, 4 women) were given the P meal and 10 (7 men, 3 women) were given the PS meal. The protocol was approved previously by the Institutional Review Board for Saint-Germain-en-Laye Hospital (Saint-Germain-en-Laye, France). All subjects gave their full consent to participate in the study after the experimental protocol had been explained to them in detail.
Clinical protocol
The volunteers were admitted to the hospital on the morning before the day of the study. An intestinal tube was passed through the nose and allowed to descend to the digestive tract, as described previously (18). The intestinal tube was used to 1) perfuse phenol red, a nonabsorbable intestinal marker, into the ileum and 2) collect intestinal samples by continuous suction 20 cm distally from the perfusion site. Volunteers ate dinner at 2000 and then fasted overnight. On the morning of the study, after the position of the intestinal tube at the terminal ileum had been checked by radioscopy, a catheter was inserted into a superficial forearm vein for blood sampling. The subjects then ingested the P or PS meal, and the postprandial sampling period lasted for 8 h. The study was performed while the subjects were resting; they were not allowed to ingest food or fluids until the end. Intestinal aspirates were collected over ice and pooled at 30-min intervals over an 8-h period; the first collection (before the meal) represented the initial period. Ileal effluents were freeze-dried and stored for future analysis. Blood samples were collected hourly during the 8-h period after ingestion of the meal, except for the first 2 postprandial hours when additional samples were taken. A final blood sample was collected the next morning, 22 h after the meal was ingested. Plasma was immediately separated from whole blood by centrifugation (2500 x g for 20 min at 4°C) and frozen at -20°C until analyzed. Breath samples were collected every 30 min and stored until later determination of 13CO2 isotopic enrichment. Urine was collected over a 29-h period (02, 24, 46, 68, 812, 1220, and 2029 h after meal ingestion), treated with thymol crystals and liquid paraffin as preservatives, and stored at 4°C until analyzed.
Extraction of amino acids, urea, and ammonia from plasma and urine
Urea and ammonia were isolated by using a batch method, as described previously (19). Briefly, for the extraction of amino acids and urea, plasma proteins were pelleted by adding solid 5-sulfosalicylic acid. After centrifugation (2400 x g for 25 min at 4°C), the supernate was collected. Urinary ammonia was first extracted from the urine by using the Na-K form of cation exchange resin (Dowex AG-50X8, mesh 100200; BioRad, Montluçon, France). The supernatant fraction was collected for the further extraction of urea. Urea was extracted from both the plasma supernatant fraction and the ammonia-free urine fraction by conversion into ammonium through hydrolysis with urease (Sigma Chemical Co, Saint-Quentin-Fallavier, France) for 2 h at 30°C on a cation-exchange resin. The part of the plasma fraction not retained in the resin was considered to be the plasma amino acid fraction. Ammonia and urea-derived ammonia were eluted from the resins by adding 2.5 mmol KH2SO4/L.
Analytic methods
The total nitrogen content of samples was determined by using an elemental nitrogen analyzer (NA 1500 series 2; Micromass, Manchester, United Kingdom) with atropine as the standard. Urea was assayed in both plasma and urine by an enzymatic method (urease and glutamate dehydrogenase) on a clinical analyzer (Dimension automate; Dupont de Nemours, Les Ulis, France). Ammonia was measured in urine by using an enzymatic method (glutamate dehydrogenase) on a clinical analyzer (Kone automate; Kone, Evry, France). Creatinine was measured by using a direct colorimetric method on a clinical analyzer (Dimension automate). Glucose was measured in plasma by using a glucose oxidase method (glucose GOD-DP kit; Kone). Insulin was measured in plasma by using a radioimmunoassay method (INSI-PR kit; Cis Bio International, Gif-sur-Yvette, France). The concentration of PEG 4000 in the digesta was measured by a turbidimetric method and that of phenol red by colorimetry, as described previously (12).
Isotopic nitrogen enrichments (15N:14N) were determined by isotope ratio mass spectrometry. An aliquot was burned in an elementary analyzer (NA 1500 series 2; Micromass) at 1020°C, interfaced with an isotope ratio mass spectrometer (Optima; Micromass). The 15N-14N ratios [mass-to-charge ratio (m/z) 28:29:30] were measured with reference to a calibrated 15N-14N tank.
Isotopic CO2 enrichments (13CO2:12CO2) were measured by using a gas chromatograph coupled with an isotope ratio mass spectrometer. Samples were separated by gas chromatography (HP 5890 series II; Hewlett Packard, Les Ulis, France) on a 2.5 m x 3 mm Haysep Q column (Chrompak, Les Ulis, France) at 80°C and isotopic ratios (44:45:46) were determined by isotope ratio mass spectrometry with reference to a calibrated 13CO2-12CO2 tank.
Calculations
Exogenous and endogenous nitrogen flux at the terminal ileum
Assessment of phenol red dilutions between the perfusion solution and samples collected by using the ileal perfusion technique enabled the calculation of flow rates in the ileum (calculation of the average flux for 30 min), as described previously (20). The fraction of exogenous and endogenous nitrogen in ileal samples was calculated from both total nitrogen and the isotopic 15N-14N ratio. Exogenous nitrogen (Nexo-ileal, in mmol) and endogenous nitrogen (Nendo-ileal, in mmol) transiting through the terminal ileum were thus calculated by using the following equations:
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where Ntot-ileal was the total nitrogen transiting through the terminal ileum and Edig and Emeal the total 15N-14N (atoms percent excess; APE) ratio in the sample and in the [15N]meal, respectively.
Exogenous and endogenous nitrogen in the body urea pool
Total-body urea nitrogen (Ntot-urea) was calculated as the product of the plasma urea concentration and its volume of distribution on the assumption that urea was distributed throughout the TBW:
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where [Nurea] was the plasma urea nitrogen concentration (mmol/L) and 0.92 was the corrective factor for the proportion of water in plasma.
Exogenous and endogenous nitrogen incorporated in the body urea pool (Nexo-urea and Nendo-urea, in mmol) were calculated by using the following formulas:
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where Eurea was the 15N-14N ratio (APE) in plasma urea.
Urinary exogenous and endogenous nitrogen
Exogenous and endogenous nitrogen incorporated in urinary nitrogen (Nexo-urinary and Nendo-urinary, mmol N) were calculated by using the following formulas:
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where Ntot-urinary was the quantity of urinary nitrogen (in the form of either total, urea, or ammonia nitrogen) and Eurinary was the 15N-14N ratio (APE) in urinary nitrogen (in the form of either total, urea, or ammonia nitrogen).
13CO2 excretion
Parameters related to 13CO2 excretion were calculated according to the technique developed by Maes et al (16). Briefly, percentages of 13CO2 recovered in breath were fitted onto a gamma curve of equation y = atbe-ct where t is time and a, b, and c are the regression-estimated constants. From these regression-estimated constants, 3 parameters characterizing gastric emptying rate were obtained, according to the following formulas:
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where f is the density of the gamma law, and
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Exogenous and endogenous deamination
The endogenous (as well as dietary) deamination fluxes were computed every 2 h for the mean periods 02, 24, 46, and 68 h after meal ingestion by summing the urinary endogenous (or dietary) nitrogen excreted during the period and variation in endogenous (or dietary) body urea nitrogen.
Curve fitting and other curve estimates
Different model curves were used during the postprandial period to fit the experimental quantity of 1) cumulative exogenous nitrogen transiting at the terminal ileum; 2) cumulative PEG 4000 transiting at the terminal ileum; 3) exogenous nitrogen excreted in the urine as total nitrogen, urea, or ammonia; and 4) exogenous urea present in the body.
For 1, 2, and 3, the curve took the form y = b/[1+ec(t-a)] + d, where t is time and a, b, c, and d are regression-estimated constants. For 4, the curve took the form y =
e1/2 [ln ß(t/t0)]2 where t is time and
, ß, and t0 are regression-estimated constants.
Because cumulative protein deamination is taken as the sum of cumulative total dietary nitrogen excreted in the urine and dietary urea nitrogen retained in TBW, a mathematical estimate of dietary nitrogen deamination flux was given by the time derivative of the sum of the 2 fitted equations (3 + 4).
Curve fitting of experimental data was performed by using SIGMA PLOT 5.0 (SPSS Inc, Erkrath, Germany). Curve study and time derivatives were computed by using an algebraic calculation software program (MAPLE V, release 4; Waterloo Maple Inc, Waterloo, Canada).
Statistical analyses
Results are expressed as means ± SDs. Comparisons within a single meal group, between the initial values and the absorptive values, or between 2 absorptive values, were performed by using Student's t tests (SAS/STAT, version 6.03; SAS Institute, Cary, NC). Comparisons between meals were assessed by a multivariate analysis of variance procedure for unbalanced designs that takes account of the fact that time is a repeated factor (GLM procedure with repeated statement, SAS/STAT). A probability of P < 0.05 was considered significant. The correlation coefficients between time series were computed by using a statistical software program for time-series analysis (tsMETRIX, RER Inc, San Diego).
| RESULTS |
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Dietary glucose and amino acids entering the blood
A second important feature was the kinetics of nutrient transfer to the blood, ie, glucose and amino acids. Plasma glucose concentrations of both groups are given in Figure 2
. The plasma glucose concentration of the P meal group was stable for 4 h, fell significantly between 4 and 5 h, and remained significantly lower than the initial concentration for the remaining 4 h. The plasma glucose concentration of the PS meal group showed a rapid increase and remained significantly higher than the basal value during the first 3 h. After meal ingestion, plasma glucose concentrations were always significantly higher in the PS meal group than in the P meal group.
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The transfer of amino acids to the blood was measured from the 15N enrichment of amino acids in blood and 13CO2 enrichment in breath (Figure 3
). With the P meal, [15N]amino acid enrichment rose rapidly, peaked at 2 h, and then decreased significantly every subsequent hour measured. With the PS meal, the peak was smoother and appeared later (around 3 h). Compared with that after the P meal, enrichment after the PS meal was significantly lower at 1 h and significantly higher from 5 to 8 h. The shape of the curve of 13CO2 enrichment in breath was different after the P and PS meals. Except when the curves crossed each other (time 150 and 180 min), the differences were always significant. For both meals, plasma amino acid 15N enrichment and 13CO2 excretion in breath showed very similar profiles. These 2 variables were highly correlated (R2 = 0.949 and 0.958 for P and PS meals, respectively; P < 0.001 for both meals).
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| DISCUSSION |
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The first result of this study was that gastric emptying markedly modified nitrogen absorption kinetics without affecting the overall ileal digestibility of dietary nitrogen. Indeed, as expected (21), the addition of sucrose to the meal induced a marked delay in the gastric-emptying profile. The excretion of 13CO2 arising from [13C]glycine oxidation was shown to closely reflect gastric emptying of the liquid phase of a meal (22). In this experiment, we showed that gastric emptying was markedly reduced by sucrose because the half-recovery time for 13CO2 was delayed by 108 min after the PS meal compared with the P meal. As mentioned above, 13CO2 excretion is considered to be governed solely by gastric emptying, other events (glycine absorption, oxidation, and excretion of carbon dioxide from the blood) being rapid and not limiting. Conversely, 15N plasma amino acid enrichments were expected to depend on gastric emptying, absorption kinetics, and first-pass metabolism in the splanchnic area. However, 15N plasma amino acid enrichments were highly correlated with 13CO2 excretion, thus showing that gastric emptying was the major determinant of the shape of the plasma amino acid enrichment. These results confirmed, at least for highly digestible protein, that gastric emptying is the limiting step in the absorption process and that nitrogen is principally absorbed in the proximal part of the intestine (23).
Despite this initial delay in gastric emptying with sucrose ingestion, no delay persisted at the ileal level. Both liquid phase and exogenous nitrogen showed identical passage profiles at the terminal ileum and were passed completely 8 h after the 2 meals. This implies that with the addition of sucrose, the initial delay was gradually reduced as the meal moved through the intestine; thus, the reduction in intestinal residence time entirely made up for the delay in gastric emptying. These findings agree with other reports showing that changes in small bowel transit time and gastric emptying may occur independently and even in opposite directions (24, 25). This effect may depend on the type of protein because ileal passage was shown to be delayed when the same amount of sucrose was added to a milk protein concentrate meal (9).
Although gastroileal nitrogen transit was changed considerably by the presence of sucrose, we showed that dietary nitrogen absorption was the same from both meals. This agrees with various reports indicating that digestibility is not very sensitive to variations in meal composition, gastric release, or intestinal transit (9, 2628). Assessing digestibility at the terminal ileum presents many advantages. It avoids the need to take into account colonic transformations that are of minimal nutritional value (29). It also avoids the long-term collection of feces necessary to assess dietary nitrogen recovery, which may be biased by recycling (30). However, the recycling of 15N into gastrointestinal secretions might have introduced inaccuracies into the estimation of endogenous and dietary ileal nitrogen flow. This potential methodologic problem was discussed previously (19), and it is likely that our estimates of endogenous and dietary ileal nitrogen flux may be slightly low and high, respectively. In our study, the presence of sucrose in the meal did not affect the true ileal digestibility of purified soy protein, which reached 9192%. The addition of sucrose could have modified the efficiency of absorption according to 2 different and opposing mechanisms. First, nitrogen delivery in the upper intestine is markedly slowed by sucrose, whereas it is accelerated further along the intestinal tract. This modification is likely to favor absorption in the upper tract, which is considered to be the principal site for absorption. Second, it has long been thought that the presence of a high load of sucrose may alter amino acid absorption (31, 32).
We showed that the endogenous nitrogen flux at the terminal ileum did not vary with time or between meals. This indicates that during the absorptive period, the endogenous contribution to total nitrogen inflow was not modified by sucrose. Nitrogen entering the colon is considered an important route for nitrogen and amino acid losses, with meaningful consequences for amino acid homeostasis (33). The mean endogenous nitrogen flux was 5.8 mmol N/h, and it could be seen that over a 24-h period
12 g (N x 6.25) endogenous protein entered the colon. Thus, the endogenous nitrogen escaping absorption in the small intestine may be an important factor influencing the net nitrogen balance. In this experiment, we showed that the absorptive balances of both endogenous and dietary nitrogen were not modified by sucrose.
In addition to quantifying the modulation of bioavailability and its consequences on systemic dietary amino acid concentrations, our study was designed to precisely quantify endogenous and dietary nitrogen utilization. Estimations of exogenous (or endogenous) deamination were calculated from serial measures of both exogenous (and endogenous) body urea and exogenous (and endogenous) urinary nitrogen. In fact, this assessment of deamination differs from net amino acid catabolism because of the disposal and salvage of urea nitrogen. Because we assumed that both of these fluxes were constant over the 8 postprandial hours and between groups, our calculation of deamination should closely reflect net amino acid catabolism. Furthermore, if a variation occurs, we see no reason under the conditions of the present experiment why this should apply differently to endogenous or exogenous nitrogen or to different meals, and it should not affect the validity of any of the comparisons that we present.
We found that the deamination of dietary nitrogen peaked during the first 2 h and then began a slow decline. Early deamination was halved when sucrose was added. This suggests that the first-pass effect is a major determinant of both total dietary amino acid retention within the body and any subsequent improvement in retention when carbohydrates are present. Other studies have provided indications of the important role of the splanchnic area in dietary nitrogen sparing by carbohydrates. Using an intraduodenal diet infusion, Krempf et al (14) reported that carbohydrates decreased the splanchnic uptake of dietary leucine and lowered whole-body leucine oxidation. This effect, which is not present for phenylalanine, may be dependent on the amino acid studied, particularly for amino acids that are taken up differently by the splanchnic area (34). Furthermore, because the diet was infused intraduodenally, the carbohydrate-modified bioavailability kinetics were not considered and the effect under investigation corresponded to the specific action of carbohydrates. Data on pigs support the role of the gut in the sparing of dietary amino acids by the splanchnic area (35, 36). It was shown in catheterized pigs that the addition of carbohydrates to a meal increased intestinal amino acid retention (37), an effect attributed to the stimulation by insulin of protein retention in the gut. Furthermore, according to recent studies in piglets conducted by Stoll et al (38, 39), the gut mucosa oxidizes rather than incorporates dietary amino acids, as reflected by a portal ammonia balance accounting for 18% of total nitrogen intake; portal amino acids are mainly utilized by the liver for synthetic purposes. These studies suggest that the diversion of dietary amino acids from intestinal deamination, whether this is achieved through increased intestinal synthesis or through increased gut output of amino acids taken up by the liver or extrasplanchnic tissues, may be crucial to dietary nitrogen sparing. Although the present study did not directly address intestinal or liver protein metabolism, our findings are in line with these hypotheses because they show that deamination occurs very early and that sucrose acts by lowering this early deamination peak.
Our findings show that the sparing of dietary nitrogen occurred alongside a sparing effect on endogenous nitrogen that was of similar importance over the entire 8-h period (a reduction of 24% compared with a reduction of 18% in deamination). However, endogenous and exogenous sparing effects did not display the same pattern, and thus, the mechanisms may not be totally shared. The reduction in endogenous nitrogen deamination took place during the first 4 h of hyperinsulinemia and hyperglycemia, and is likely to be linked to the following mechanisms. First, insulin stimulation, by inhibiting protein catabolism, reduces the intracellular concentration of endogenous amino acids and thus their oxidation (6, 40, 41). Furthermore, gluconeogenesis may be reduced by sucrose and by the inhibition of glucagon release (42, 43). We observed that the amount of sparing of endogenous nitrogen matched the blood insulin and glucose profiles. These factors may also account for the sparing of dietary nitrogen during the first hours after a meal. Nevertheless, compared with endogenous sparing, sparing of exogenous nitrogen appeared to be more effective during the first 2 postprandial hours but less effective later. We suggest that this difference originates with the kinetics of amino acid inflow and the hyperinsulinemic profile. During the first 2 postprandial hours, the inflow of amino acids from the PS meal was lower than that from the P meal, whereas blood insulin was at its highest. As a consequence, the endogenous intracellular amino acid pool was reduced and dietary amino acids, resulting from slower gastric emptying, may more readily have been diverted from oxidation (44). In contrast, during the later hours, because the insulin effect is dose dependent (45), the insulin-mediated inhibition of proteolysis was reduced, whereas during this period, the PS meal (compared with the P meal) provided a larger quantity of dietary amino acids that were relatively less spared than were endogenous amino acids. These combined effects may explain why the sparing effect on dietary nitrogen appeared to be concentrated during the first 2 h, whereas the effect on endogenous nitrogen showed a more widely spread pattern. This is in line with studies proposing that gut amino acid output is a major factor accounting for variations in amino acid utilization (46, 47), and others reporting that the kinetics of amino acid or carbohydrate supply may modulate postprandial nitrogen retention (13, 48). The diversion of dietary amino acids from oxidation may arise from increased retention in the splanchnic area and also from improved transfer to the systemic circulation. The preferential diversion of dietary amino acids from oxidation, during the first 2 h after a meal, may also result from the muscle uptake of dietary amino acids not extracted by the splanchnic area. In particular, dietary branched-chain amino acids, poorly extracted in the splanchnic area, are extensively taken up by muscle, particularly if insulin concentrations are high (49, 50).
In conclusion, these different effects of the addition of carbohydrates to a protein test meal halved the oxidative peak of dietary nitrogen during the early absorptive phase (02 h), whereas there was little absolute difference later. The effect of sucrose on endogenous and exogenous amino acid deamination was of similar amplitude over the 8-h postprandial period. However, the sparing of dietary and endogenous amino acids did not occur at the same time or in the same way, thus showing that the same mechanisms do not govern utilization of endogenous and dietary nitrogen.
| ACKNOWLEDGMENTS |
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