Efficiency of enteral nitrogen support in surgical patients: small peptides v non-degraded proteins.

Abstract

In a prospective study, 12 intensive care patients, after abdominal surgery, received three alternate six-day courses of two enteral diets with identical nitrogen (0-3 g N/kg per day) and energy (60 kcal/kg per day) supply. The protein hydrolysate (PH) diet contained enzyme-hydrolysed casein and lactoserum (60% small peptides), while the non-degraded protein (NDP) diet contained a nitrogen source of similar amino acid composition, but in the form of non-degraded proteins. The patients were randomised to receive either PH-NDP-PH or NDP-PH-NDP. Parameters reflecting protein metabolism were assessed in the plasma, urine, and stomal effluent on days 1, 6, 12, and 18, three hours after stopping the nutrition (tO), and one hour after restarting it (ti).Comparisons of tl and tO values showed that 13 amino acids (including the eight essential amino acids) increased significantly with the protein hydrolysate diet, but only two increased with the non-degraded protein diet.Similarly, with protein hydrolysate, insulinaemia at tl was significantly higher than at tO and correlated with plasma leucine, phenylalanine, alanine, and lysine concentrations. In addition, significant improvements in plasma albumin, transferrin, and retinol binding protein concentrations were seen with protein hydrolysate, together with a significant decrease in the plasma phenylalanine/tyrosine ratio and urinary 3-methylhistidine excretion. We conclude that in patients in intensive care after abdominal surgery enteral support containing small peptides is more effective than an equivalent diet containing whole proteins in restoring plasma amino acid and protein levels.evidence that transport of short chain peptides is more efficient than that of free amino acids into enterocytes.9"'4 Furthermore, it has been shown'5 16 that the efficiency of proteolysate absorption is highly dependent on the relative amounts of dipeptides and tripeptides.The results of clinical studies comparing proteolysates with whole protein based diets have been far from convincing; in effect, either a limited number of parameters were studied'7 18 or the number of patients was small.920In the present work we compared the absorption of nitrogen supplied either in the form of a partial protein hydrolysate or the corresponding native proteins. The study was carried out in intensive care patients who had had abdominal surgery and were receiving continuous enteral nutrition.Patients and methods PATIENTSThe study was carried out in 12 intensive care patients (nine men, three women) who had undergone abdominal 'surgery in our institution.They had been referred to us from other centres after having had at least one laparotomy. The patients were aged 50 (19) years (mean (SD)) ( Table I).No renal failure, hepatic failure, or obesity was noted. The length of the small intestine after surgery was at least 1-5 m and all patients except case 2 had one or more stoma. Immediately after surgery the patients received total parenteral nutrition for 24-48 hours. They were then given continuo...

Fração solúvel de hidrolisado proteico de sardinha na alimentação do jundiá

“…The decrease in the excreted ammonia can indicate a higher metabolic efficiency of the diets. The protein hydrolysates are rich in small peptides, which can be absorbed more efficiently than intact proteins or free amino acids (ZIEGLER et al, 1990). Other authors described that the inclusion of hydrolysates in diets can improve the productive performance of fish, even when the hydrolysates replace key ingredients such as fish meal (REFSTIE et al, 2004;HEVROY et al, 2005;ZHENG et al, 2013;BUI et al, 2014;COSTA-BONFIM et al, 2016).…”

Acute pancreatitis

“…Semielemental formulas seem to pose the advantage of less pancreatic stimulation while not requiring the presence of pancreatic enzymes for absorption. 81,82 Studies, however, have not uniformly supported this hypothesis. 83 …”

Extração química e enzimática das proteínas do fubá de milho

“…Outra vantagem do método enzimático relaciona-se a uma maior digestibilidade protéica, uma vez que a hidrólise dá origem a oligopeptídeos que são absorvidos mais rápida e completamente que as proteínas intactas [8,17,28,34]. Ressalta-se ainda que, ao contrário da extração química, no método enzimático não houve necessidade de se fazer a neutralização do resíduo e do sobrenadante, uma vez que o pH final da extração situava-se em torno de 7,0.…”