Tyrosine requirement of healthy men receiving a fixed phenylalanine intake determined by using indicator amino acid oxidation

Post-prandial tracer studies of protein and amino acid utilisation: what can they tell us about human amino acid and protein requirements?

Nitrogen balance (NB), the principal methodology used to derive recommendations for human protein and amino acid requirements, has been widely criticised, and calls for increased protein and amino acid requirement recommendations have been made, often on the basis of post-prandial amino acid tracer kinetic studies of muscle protein synthesis, or of amino acid oxidation. This narrative review considers our knowledge of the homeostatic regulation of the FFM throughout the diurnal cycle of feeding and fasting and what can and has been learnt from post-prandial amino acid tracer studies, about amino acid and protein requirements. Within the FFM, muscle mass in well fed weight-stable adults with healthy lifestyles appears fixed at a phenotypic level within a wide range of habitual protein intakes. However homoeostatic regulation occurs in response to variation in habitual protein intake, with adaptive changes in amino acid oxidation which influence the magnitude of diurnal losses and gains of body protein. Post-prandial indicator amino acid oxidation (IAAO) studies have been introduced as an alternative to NB and to the logistically complex 24 h [13C-1] amino acid balance studies, for assessment of protein and amino acid requirements. However, a detailed examination of IAAO studies shows both a lack of concern for homeostatic regulation of amino acid oxidation and  major flaws in their design and analytical interpretation, which seriously constrain their ability to provide reliable values. New ideas and a much more critical approach to existing work is needed if real progress is to be made in the area.

Dietary Aromatic Amino Acid Requirements During Early and Late Gestation in Healthy Pregnant Women

BACKGROUND

Phenylalanine and tyrosine (referred to as total aromatic amino acids; TAAs) are essential for protein synthesis, and are precursors for important catecholamines. Current estimated average requirement (EAR) recommendations for TAA during pregnancy are 36 mg·kg-1·d-1, and has not been experimentally determined.

OBJECTIVES

The aim was to determine TAA requirements (dietary phenylalanine in the absence of tyrosine) during early and late gestation using the indicator amino acid oxidation (IAAO, with L-[1-13C]leucine) technique.

METHODS

Nineteen healthy pregnant women (age 22-38 y) were studied at a range of phenylalanine intakes (5 to 100 mg·kg-1·d-1) in early (13-19 wk) and/or late (33-39 wk) pregnancy for a total of 51 study days. Graded test intakes were provided as 8 hourly isonitrogenous and isocaloric meals. Breath samples were collected for 13C enrichment analysis on an isotope ratio mass spectrometer. A plasma sample was collected and analyzed for phenylalanine and tyrosine concentrations on an amino acid analyzer. The TAA requirement in early and late pregnancy was calculated using 2-phase linear regression crossover analysis that identified breakpoints in 13CO2 production (the requirement) in response to phenylalanine intakes.

RESULTS

TAA requirement during early pregnancy was 44 mg·kg-1·d-1 (95% CI: 28.3, 58.8) and during late pregnancy was 50 mg·kg-1·d-1 (95% CI: 36.1, 63.1). In early and late pregnancy, plasma phenylalanine and tyrosine concentrations rose linearly in response to graded phenylalanine intakes.

CONCLUSIONS

Our results suggest that the current EAR of 36 mg·kg-1·d-1 for TAAs is underestimated. When compared with results previously determined in nonpregnant adults, early pregnancy requirements were similar (43 compared with 44 mg·kg-1·d-1, respectively). During late pregnancy, a 14% higher TAA requirement was observed when compared with early pregnancy. The results from this study have potential implications for creating gestation stage-specific TAA recommendations.

Adult dogs of different breed sizes have similar threonine requirements as determined by the indicator amino acid oxidation technique

Threonine (Thr) requirements for immature (growing) Beagles have been determined, but little knowledge is available on Thr requirements for maintenance in mature dogs. Moreover, differences of Thr requirements among different breeds or sizes of adult dogs have not been investigated. The objective of the present study was to determine Thr requirements in adult dogs of three different breeds using the indicator amino acid oxidation (IAAO) technique. In total, 13 adult dogs were used, 4 Miniature Dachshunds (5.8 ± 0.4 kg body weight [BW]; 3 spayed and 1 neutered), 4 spayed Beagles (9.3 ± 0.6 kg BW), and 5 neutered Labrador Retrievers (30.5 ± 1.7 kg BW). Dogs were fed a Thr-deficient diet (Thr = 0.23%) and randomly allocated to receiving one of seven concentrations of Thr supplementation (final Thr concentration in experimental diets was 0.23%, 0.33%, 0.43%, 0.53%, 0.63%, 0.73%, and 0.83%; as fed basis) for 2 d. After 2 d of adaptation to the experimental diets, dogs underwent individual IAAO studies. During the IAAO studies, total daily feed was divided into 13 equal meals; at the sixth meal, dogs were fed a bolus of l-[1-13C]-Phenylalanine (Phe) (9.40 mg/kg BW), and thereafter, l-[1-13C]-Phe (2.4 mg/kg BW) was supplied with every meal. Before feeding the next experimental diet, dogs were fed a Thr-adequate basal diet for 4 d (Thr = 0.80% as fed basis) in known amounts that maintained individual dog BW. Total production of 13CO2 during isotopic steady state was determined by enrichment of 13CO2 in breath samples and total production of CO2 measured using indirect calorimetry. The mean requirements for Thr, defined as the breakpoint, and the 95% confidence interval (CI) were determined using a two-phase linear regression model. For Miniature Dachshunds, the two-phase model was not significant, and Thr requirements could not be determined. Mean Thr requirements for Beagles and Labradors were 72.2 and 64.1 mg/kg BW on an as-fed basis, respectively. The requirement for Thr between these two dog breeds was not different (P > 0.10). Thus, the data for Beagles and Labradors were pooled and a mean requirement for Thr was determined at 66.9 mg/kg BW, and the 95% CI was estimated at 84.3 mg/kg BW. In conclusion, estimated Thr requirements for Beagles and Labradors did not differ, and these recommendations are higher than those suggested by NRC (2006) and AAFCO (2014) for adult dogs at maintenance.

Tryptophan requirements in small, medium, and large breed adult dogs using the indicator amino acid oxidation technique1

Tryptophan (Trp) is an indispensable amino acid (AA) for dogs of all life stages; however, although Trp requirements for growing dogs are derived from 3 dose-response studies, there are no empirical data on Trp requirements for adult dogs at maintenance. The study objective was to determine Trp requirements of adult dogs of 3 different breeds using the indicator amino acid oxidation (IAAO) technique. Four spayed or neutered Miniature Dachshunds (5.28 ± 0.29 kg BW), 4 spayed Beagles (9.32 ± 0.41 kg BW), and 5 neutered Labrador Retrievers (30.51 ± 2.09 kg BW) were used. After a 14-d adaptation to a Trp-adequate basal diet (Trp = 0.482% dry matter), all dogs were fed a mildly Trp-deficient diet for 2 d (Trp = 0.092% dry matter) before being randomly allocated to receiving 1 of 7 concentrations of Trp supplementation (final Trp content in experimental diets was 0.092, 0.126, 0.148, 0.182, 0.216, 0.249, and 0.283% dry matter) and all dogs received all Trp treatments. After 2-d adaptation to the experimental diets, dogs underwent individual IAAO studies. Total feed was divided in 13 equal meals; at the sixth meal, dogs were fed a bolus of L-[1-13C]-Phenylalanine (Phe) (9.40 mg/kg BW), and thereafter, L-[1-13C]-Phe was supplied (2.4 mg/kg BW) with every meal. Total production of 13CO2 during isotopic steady state was determined by enrichment of 13CO2 in breath samples and total production of CO2 measured using indirect calorimetry. The maintenance requirement for Trp and the 95% confidence interval (CI) were determined using a 2-phase linear regression model. Mean Trp requirements were estimated at 0.154, 0.218, and 0.157% (dry-matter) for Dachshunds, Beagles, and Labradors, respectively. The upper 95% CI were 0.187, 0.269, and 0.204% (dry-matter) for Dachshunds, Beagles, and Labradors. In conclusion, estimated Trp requirements are higher for Beagles compared with Labradors or Dachshunds, and all estimated requirements are higher than those currently recommended by the NRC and AAFCO.

The Phenylalanine Requirement of Elderly Men and Women Measured by Direct 13C Carbon Oxidation Method Is Similar to That of Young Adults

BACKGROUND

The phenylalanine requirement of the elderly is not known. Current recommendations are based on studies in young adults and are derived from a combined estimate of the total aromatic amino acids, phenylalanine, and tyrosine.

OBJECTIVES

The purpose of this study was to determine the dietary phenylalanine requirement of adults aged >65 y, using the direct amino acid oxidation method, by measuring the oxidation of l-[1-13C]phenylalanine to 13CO2 in response to graded phenylalanine intakes in the presence of excess tyrosine.

METHODS

Twelve subjects (6 men, 6 women), aged 73.8 ± 6.7 y (mean ± SD) and with a BMI (in kg/m2) of 26.4 ± 4.8 and 25.2 ± 4.4 for men and women, respectively, were randomized to phenylalanine intakes ranging from 7.20 to 40.0 mg .kg-1 .d-1 for a total of 66 studies. Study diets were isocaloric and isonitrogenous, providing protein and energy at 1.0 g .kg-1 .d-1 and 1.5 × resting energy expenditure (REE), respectively. Protein was provided as an amino acid mixture patterned after egg protein, with an excess of tyrosine and alanine to balance the nitrogen as phenylalanine intakes were varied. Two days prior to the study day, subjects were adapted to a milkshake diet providing protein at 1.0 g.kg-1 .d-1 and energy at 1.7 × REE. The mean phenylalanine requirement was determined using biphase linear regression analysis, which identified a breakpoint in the F13CO2 in response to graded phenylalanine intakes.

RESULTS

The mean and upper 95% CIs (approximating the recommended dietary allowance) of phenylalanine requirements were estimated to be 9.03 and 15.9 mg.kg-1 .d-1, respectively.

CONCLUSION

These results are similar to previously derived estimates of 9.1 and 13.6 mg.kg-1 .d-1 in young adult men and suggest that higher protein needs of the elderly to stimulate similar muscle protein synthesis rates as young adults are not driven by an increased requirement for phenylalanine. This trial was registered at clinicaltrials.gov as NCT02971059.

Protein quality & amino acid requirements in relation to needs in India

The relevance of protein and its constituent amino acids (AAs) in the structure and function of the human body is well known. Accumulating evidence has conferred specific functional and regulatory roles for individual AAs, adding relevance to their requirements across different age groups. The methods for measuring AA requirements have progressed from the classical nitrogen balance to the current stable isotope-based AA balance methods. Requirements of most of the indispensable AA (IAA) have been estimated in healthy Indian population by the best available balance method and has shown to be higher than earlier 1985 WHO/FAO/UNU (World Health Organization/Food and Agriculture Organization/United Nations University) recommendations. In addition, potential changes in the requirement, through adaptation to chronic undernutrition or to infection, have also been evaluated. In 2007, the WHO/FAO/UNU released a recommendation that increased the daily IAA requirement, based on primary evidence from Indian balance studies. This meant that to ensure that the new IAA requirements were met, individual foods or mixed diets needed to be assessed for their protein quality, or their ability to deliver the required amount of IAA. The recent FAO report on protein quality evaluation recommends the use of a new chemical AA score, the digestible IAA score (DIAAS), to replace the earlier protein digestibility corrected AA score. The DIAAS requires the determination of individual AA digestibility at the ileal level. A minimally invasive dual stable isotope tracer-based approach has been developed in India and has been used to determine digestibility of various foods in Indian adults and children. The increase in IAA requirements and subsequent protein quality requirements have implications for national regulatory frameworks, growth and development, and in turn, for economic and agricultural policy.

High dietary intake of aromatic amino acids increases risk of hypertension

Recent studies investigated the relation between amino acids and blood pressure. Our aim was to examine the association between intake of aromatic amino acids (AAAs) and risk of hypertension. A total of 4288 individuals, aged 20-70 years, participants of the Tehran Lipid and Glucose Study, who were free of hypertension at baseline (2008-2011), were followed for 3 years (2011-2014). Average intakes of AAAs including phenylalanine, tyrosine, and tryptophan were collected using a valid and reliable food frequency questionnaire at baseline. Adjusted logistic regression models were used to report odds ratio (OR) of hypertension across quartiles of AAAs. At the end of follow-up, 429 (10%) hypertension cases were ascertained. The adjusted OR of hypertension for percentage of AAAs from total protein intakes was 1.63 (95% confidence interval, 1.06-2.50; P for trend: .03) when comparing the highest quartile to the lowest. Furthermore, in the adjusted analyses, a statistically significant positive relationship was observed between the highest versus the lowest quartile intake of phenylalanine (OR = 1.66; 95% confidence interval, 1.14-2.47; P for trend: .03). However, there was no significant association of tyrosine and tryptophan intakes with hypertension risk. Our data suggest that AAAs may increase the risk of incident hypertension.

A Simple Evaluation Method for the Quality of Dietary Protein in Rats Using an Indicator Amino Acid Oxidation Technique

We demonstrated that the indicator amino acid oxidation (IAAO) method could be employed for the evaluation of quality of dietary protein by comparing the protein intakes required to meet metabolic demand in rats fed different proteins. The objective of this study was to validate a simple evaluation method for determining the quality of dietary protein using the IAAO technique. Male Sprague-Dawley rats (5-6 wk old) were fed meals composed of graded protein, using either casein, wheat gluten (WG), soy protein isolate (SPI), or egg white protein (EW), every 3 h from 09:00 to 18:00. Administration of L-[1-(13)C]phenylalanine was performed hourly from 15:00 to 18:00. The (13)CO2 level in breath CO2 was measured at 18:30. The protein intake values required to meet the metabolic demand based on the breath (13)CO2 data for the dietary casein, WG, SPI, and EW intake were 18.0, 22.2, 17.5, and 10.1 g/kg BW/d, respectively. The breath (13)CO2 concentrations corresponding to the protein intake of 7.5 g/kg BW/d for casein, WG, SPI, and EW were 9.8, 10.9, 10.3, and 8.9 (‰)/100 g BW, respectively. A significant correlation was demonstrated between the protein intake required to meet the metabolic demands and the (13)CO2 concentration in the breath for a protein intake of 7.5 g/kg BW/d (r=0.967; p<0.05). These results demonstrated that the protein intake required to meet metabolic demand could be estimated and that the quality of the dietary protein could be evaluated using the (13)CO2 concentration in the breath with a protein intake of 7.5 g/kg BW/d.

Examination of lysine requirement of healthy young male adults on a Chinese habitual diet by the modified indicator amino acid oxidation method

There is currently no reference for intake of lysine for Chinese people; therefore, the present study was conducted to determine the lysine requirement of Chinese young male adults on a habitual Chinese mixed diet based on the modified indicator amino acid oxidation method. Seven young men with a mean age of 23.7 ± 2.2 years that were healthy based on questionnaire, physical examinations and screening tests were evaluated. Subjects were evaluated over five consecutive 7 day periods, during which time they were administered decreasing amounts of lysine via the diet (65, 55, 45, 35, 25 mg·kg(-1)·d(-1)). Subjects were allowed to adapt from day 1 to 6 and the isotopes were measured on day 7 in each period. The subjects' body weights, body compositions and plasma proteins were also examined during the study. Amino acid kinetics were measured based on the indicator amino acid oxidation technique using the (13)CO2 release rate and phenylalanine oxidation rate to estimate lysine requirements. Body weights, body compositions, and plasma proteins of subjects did not change significantly relative to those at baseline. The mean and the upper 95% CI of lysine requirements of Chinese habitual diets were determined to be 58.41 and 70.09 mg·kg(-1)·d(-1), respectively, based on the (13)CO2 release rate and 54.28 and 65.14 mg·kg(-1)·d(-1), respectively, based on the phenylalanine oxidation rate.

Amino acid requirements in children and the elderly population

The factorial approach is used to measure the dietary indispensable amino acid (IAA) requirements in children, although recent measurements based on the indicator amino acid oxidation (IAAO) method have begun to generate more direct evidence. Difficulties with the factorial method are that it depends on accurate estimates of the maintenance protein requirement, as well as of protein deposition during growth. Also, a value for the efficiency of utilizing dietary protein for deposition has to be selected, based on published Nitrogen (N) balance studies. In the recent 2007 WHO/FAO/UNU report, the amino acid requirement pattern for infants was taken to be similar to the amino acid composition of breast milk. For pre-school and older children, the factorial method gave values for the scoring pattern of protein that were fairly close to the earlier 1985 WHO/FAO/UNU report for children, since growth progressively became a smaller component of the factorial calculation as age progressed. However, given that there are several assumptions in the derivation of factorial estimates, direct experimental measurements of the amino acid requirement are desirable. The IAAO method, as it is non-invasive, as made it possible to measure the IAA requirements in children. Over the last decade, some of the IAA requirements have been determined by using the IAAO method in healthy school age children; however, the data on IAA requirements in developing country populations are still being conducted. In the elderly, there are not enough data to make a separate recommendation for IAA requirements from that of adults.

An evaluation of protein intake for metabolic demands and the quality of dietary protein in rats using an indicator amino acid oxidation method

Currently, protein requirements are generally determined based on nitrogen balance studies, but there are a variety of limitations associated with this method. The indicator amino acid oxidation (IAAO) method, with a theoretical base that differs widely from the nitrogen balance method, was developed as an alternative method for humans. The objective of the present study was to evaluate protein intakes for metabolic demands and protein quality, using protein itself, in rats employing the IAAO technique with L-[1-(13)C]phenylalanine. Male Wistar/ST rats (5-6 wk old) received a graded casein (4.3, 8.6, 12.9, 17.2, 21.5, 25.8%), or a wheat gluten (7.2, 10.8, 14.4, 18.0, 21.6, 25.2%) diet, along with L-[1-(13)C]phenylalanine. An isotopic plateau in breath was achieved 210 min after the start of the (13)C ingestion. The protein intakes for metabolic demands were calculated by applying a mixed-effect change-point regression model to breath (13)CO(2) data, which identified a breakpoint at minimal breath (13)CO(2) in response to graded protein intake. The protein intakes for metabolic demands determined by the IAAO method were 13.1 g/kg BW/d for casein and 18.1 g/kg BW/d for wheat gluten, showing a tendency similar to that determined by the nitrogen balance method. These results demonstrated that the IAAO method could be employed to evaluate not only the protein intakes for metabolic demands, but the dietary protein quality in freely living rats, suggesting that this method might be viable in a clinical setting.

α-Linolenate reduces the dietary requirement for linoleate in the growing rat

BACKGROUND

We hypothesized that due to the absence of a dietary source of omega-3 fatty acids, the essential fatty acid (EFA) deficiency model leads to an overestimate of linoleic acid (LA) requirements.

METHODS

over 7wk, young rats consumed an EFA diet containing either 0en% linoleate (0LA) and 0en% α-linolenate (0LNA) or a diet containing 0.5en% LNA plus one of seven levels of added LA (0.12-4.0en%; n=6/group).

RESULTS

Rats consuming the 0LA-0LNA diet had the lowest final body weight, 34-68% lower LA and arachidonate in plasma and liver, 87% lower LA in epididymal fat, and an 8-20 fold higher eicosatrienoate in plasma, liver and muscle lipids. 0.5LNA completely prevented the lower growth and partly prevented the rise in eicosatrienoate seen in the 0LA-0LNA group.

CONCLUSION

Providing dietary LNA at 0.5 en% reduces the rat's physiological requirement for LA by an estimated factor of at least four (0.5en% instead of 2en%). Since LA requirements in humans are also based on the same flawed model of EFA deficiency, it is plausible that they too have been overestimated and should therefore be reinvestigated.

Tyrosine requirement during the rapid catch-up growth phase of recovery from severe childhood undernutrition

The requirement for aromatic amino acids during the rapid catch-up in weight phase of recovery from severe childhood undernutrition (SCU) is not clearly established. As a first step, the present study aimed to estimate the tyrosine requirement of children with SCU during the catch-up growth phase of nutritional rehabilitation using a diet enriched in energy and proteins. Tyrosine requirement was calculated from the rate of excretion of 13CO2 (F 13CO2) during [13C]phenylalanine infusion in thirteen children with SCU, five females and eight males, at about 19 d after admission when the subjects were considered to have entered their rapid catch-up growth phase and were consuming 627·3 kJ and about 3·5 g protein/kg per d. Measurements of F 13CO2 during [13C]phenylalanine infusion were made on two separate days with a 1 d interval. Three measurements at tyrosine intakes of 48, 71 and 95 mg/kg per d were performed on experimental day 1 and measurements at tyrosine intakes of 148, 195 and 241 mg/kg per d were performed on experimental day 2. An estimate of the mean requirement was derived by breakpoint analysis with a two-phase linear regression cross-over model. The breakpoint, which represents an estimate of the mean tyrosine requirement, is a value of 99 mg/kg per d when the children were growing at about 15 g/kg per d. The result indicates that the mean requirement for tyrosine during the catch-up growth phase of SCU is about 99 mg/kg per d under similar conditions to the present study.

Cyst(e)ine requirements in enterally fed very low birth weight preterm infants

OBJECTIVE

Optimal nutrition is of utmost importance for the preterm infant's later health and developmental outcome. Amino acid requirements for preterm infants differ from those for term and older infants, because growth rates differ. Some nonessential amino acids, however, cannot be sufficiently synthesized endogenously. Cyst(e)ine is supposed to be such a conditionally essential amino acid in preterm infants. The objective of this study was to determine, at 32 and 35 weeks' postmenstrual age, cyst(e)ine requirements in fully enterally fed very low birth weight preterm infants with gestational ages of <29 weeks.

METHODS

Infants were randomly assigned to 1 of the 5 graded cystine test diets that contained generous amounts of methionine. Cyst(e)ine requirement was determined with the indicator amino acid oxidation technique ([1-(13)C]phenylalanine) after 24-hour adaptation.

RESULTS

Fractional [1-(13)C]phenylalanine oxidation was established in 47 very low birth weight preterm infants (mean gestational age: 28 weeks +/- 1 week SD; birth weight: 1.07 kg +/- 0.21 kg SD). Increase in dietary cyst(e)ine intake did not result in a decrease in fractional [1-(13)C]phenylalanine oxidation.

CONCLUSIONS

These data do not support the hypothesis that endogenous cyst(e)ine synthesis is limited in very low birth weight preterm infants with gestational ages of <29 weeks, both at 32 and 35 weeks postmenstrual age. It is safe to conclude that cyst(e)ine requirement is <18 mg/kg per day in enterally fed very low birth weight preterm infants who are older than 32 weeks' postmenstrual age and whose methionine intake is adequate. Therefore, cyst(e)ine is probably not a conditionally essential amino acid in these infants.

In vivo regulation of phenylalanine hydroxylation to tyrosine, studied using enrichment in apoB-100

Phenylalanine hydroxylation is necessary for the conversion of phenylalanine to tyrosine and disposal of excess phenylalanine. Studies of in vivo regulation of phenylalanine hydroxylation suffer from the lack of a method to determine intrahepatocyte enrichment of phenylalanine and tyrosine. apoB-100, a hepatic export protein, is synthesized from intrahepatocyte amino acids. We designed an in vivo multi-isotope study, [(15)N]phenylalanine and [2H2]tyrosine to determine rates of phenylalanine hydroxylation from plasma enrichments in free amino acids and apoB-100. For independent verification of apoB-100 as a reflection of enrichment in the intrahepatocyte pool, [1-(13)C]lysine was used as an indicator amino acid (IAA) to measure in vivo changes in protein synthesis in response to tyrosine supplementation. Adult men (n = 6) were fed an amino acid-based diet with low phenylalanine (9 mg.kg(-1).day(-1), 4.54 mumol.kg(-1).,h(-1)) and seven graded intakes of tyrosine from 2.5 (deficient) to 12.5 (excess) mg.kg(-1).day(-1). Gas chromatography-quadrupole mass spectrometry did not detect any tracer in apoB-100 tyrosine. A new and more sensitive method to measure label enrichment in proteins using isotope ratio mass spectrometry demonstrated that phenylalanine hydroxylation measured in apoB-100 decreased linearly in response to increasing tyrosine intake and reached a break point at 6.8 mg.kg(-1).day(-1). IAA oxidation decreased with increased tyrosine intake and reached a break point at 6.0 mg.kg(-1).day(-1). We conclude: apoB-100 is an accurate and useful measure of changes in phenylalanine hydroxylation; the synthesis of tyrosine via phenylalanine hydroxylation is regulated to meet the needs for protein synthesis; and that plasma phenylalanine does not reflect changes in protein synthesis.

Individual amino acid requirements in humans: an update

PURPOSE OF REVIEW

To discuss recent amino acid requirement studies in adult humans and school-age children, primarily determined using the indicator amino acid oxidation technique.

RECENT FINDINGS

Using the minimally invasive indicator amino acid oxidation model, requirements for most indispensable amino acids have been defined in adult humans. The estimates are comparable to the values obtained using the more elaborate 24-h indicator amino acid oxidation and balance model. The less-invasive indicator amino acid oxidation model has also been successfully applied to define requirements in healthy school-age children and children with disease. A recent adaptation of the indicator amino acid oxidation method to determine protein requirements in adult humans resulted in mean and safe values of 0.93 and 1.2 g protein/kg/day, respectively. These estimates are 40-50% higher than current recommendations and suggest an urgent need to reassess recommendations for protein intake in humans.

SUMMARY

In summary, indicator amino acid oxidation is a robust technique, and has resulted in the definition of amino acid and protein requirements in adult humans and children. A wider application of the technique in other vulnerable populations across life stages and in other diseases is now possible.

Reevaluation of the protein requirement in young men with the indicator amino acid oxidation technique

BACKGROUND

The current estimated protein requirements are based on the nitrogen balance method, which has many limitations. An alternate approach is needed to permit a reevaluation of protein requirements.

OBJECTIVE

The objective was to determine protein requirements in men by using the indicator amino acid oxidation technique.

DESIGN

Eight healthy men randomly received graded protein intakes (0.10, 0.30, 0.60, 0.90, 1.2, 1.5 and 1.8 g kg(-1) d(-1)) as a crystalline amino acid mixture along with L-[1-(13)C]phenylalanine. The mean protein requirement was determined by applying a biphase linear regression crossover analysis on F(13)CO(2) data, which identified a breakpoint at the minimal rate of appearance of (13)CO(2) to graded protein intakes.

RESULTS

The mean and population-safe (recommended dietary allowance; RDA) protein requirements were found to be 0.93 and 1.2 g kg(-1) d(-1), respectively. These requirements are comparable with those estimated by the application of a biphase linear regression model to the data from nitrogen balance studies (0.91 and 1.0 g kg(-1) d(-1), respectively). These requirements are 41% and 50% higher than the current recommendations for the estimated average requirement (EAR) of 0.66 g kg(-1) d(-1) and the RDA of 0.80 g kg(-1) d(-1), as determined by applying a linear regression model where it intersects the zero balance line.

CONCLUSION

The indicator amino acid oxidation technique defined a protein requirement that is comparable with that estimated by the application of a biphase linear regression model to nitrogen balance data in the literature. Our data and the reanalysis of the preexisting nitrogen balance data suggest that the current recommended protein requirements are too low and require reassessment.

Lysine requirement of healthy school-age children determined by the indicator amino acid oxidation method

BACKGROUND

The current Dietary Reference Intake (DRI) recommendations for lysine requirements in children are based on a factorial estimate.

OBJECTIVE

The objective of the current study was to determine the lysine requirement in healthy school-age children by measuring the oxidation of l-[1-(13)C]phenylalanine to (13)CO(2) (F(13)CO(2)) in response to graded intakes of lysine.

DESIGN

Five healthy school-age children randomly received each of 7 lysine intakes (5, 15, 25, 35 50, 65, and 80 mg x kg(-1) x d(-1)) along with an amino acid mixture to give a final calculated protein intake of 1.5 g x kg(-1) x d(-1) and an energy intake of 1.7 x resting energy expenditure (REE). The mean lysine requirement was determined by applying 2-phase linear regression crossover analysis on F(13)CO(2) data, which identified a breakpoint (requirement) at minimal F(13)CO(2) in response to graded lysine intakes.

RESULTS

The mean and population-safe (upper 95% CI) lysine requirements were determined to be 35 and 58 mg x kg(-1) x d(-1), respectively.

CONCLUSIONS

The mean and population-safe lysine requirements for children are similar to those for adults (36 and 52 mg x kg(-1) x d(-1), respectively), which suggests that the findings from the current study reflect predominantly the maintenance lysine requirements in children and not all requirements for growth. Therefore, to ensure age-appropriate growth in school-age children, we propose the addition of the requirement of lysine for growth (approximately 6 mg x kg(-1) x d(-1)) to the mean estimate. The new mean and population-safe lysine requirements are 41 and 58 mg x kg(-1) x d(-1), respectively; these values are significantly higher than the current DRIs of 37 and 46 mg x kg(-1) x d(-1), respectively.

Aromatic amino acid requirements in healthy human subjects

Dietary aromatic amino acids are needed to meet the requirements for phenylalanine and tyrosine for protein synthesis. The amounts needed for neurotransmitter synthesis and other biological processes are small and quantitatively negligible. The earlier nitrogen balance-based estimates were judged to be inadequate. Very recently, there have been 3 estimates published based on the indicator amino acid oxidation technique, which average 42 mg.kg(-1).d(-1). This average value was obtained by feeding subjects a tyrosine-free diet and hence is an estimate of the mean maximum phenylalanine requirement. The mean minimum phenylalanine requirement estimate in the presence of an excess of tyrosine is 9.1 mg.kg(-1).d(-1). Hence, tyrosine can spare 78% of the dietary phenylalanine need. Finally the optimal proportions of dietary phenylalanine and tyrosine have been shown to be 60:40, respectively.

The daily phenylalanine requirement of healthy Indian adults

BACKGROUND

The daily requirement for phenylalanine is not known with certainty. Earlier 24-h tracer studies have suggested that the requirement is between 30 and 40 mg . kg(-1) . d(-1).

OBJECTIVE

The objective was to assess the phenylalanine requirement in healthy well-nourished Indians with the use of 8 test phenylalanine intakes (19, 23, 27, 31, 35, 38, 43, and 47 mg . kg(-1) . d(-1)) and the 24-h indicator amino acid oxidation (24-h IAAO) and 24-h indicator amino acid balance (24-h IAAB) methods.

DESIGN

Thirty-two healthy, well-nourished Indian men were studied during each of 2 randomly assigned 6-d diet periods in which phenylalanine intakes of 19, 23, 27, 31, 35, 38, 43, and 47 mg . kg(-1) . d(-1) were supplied; the diet was devoid of tyrosine. A 24-h [13C]leucine tracer infusion was used to measure 24-h IAAO and 24-h IAAB on day 7. The breakpoint in the relation between these values and the phenylalanine intake was determined.

RESULTS

Two-phase linear regression of daily leucine oxidation and balance against phenylalanine intake estimated a breakpoint in the response curve at phenylalanine intakes of 37 and 38 mg . kg(-1) . d(-1) (95% CI for both: 31, >47 mg . kg(-1) . d(-1)), respectively.

CONCLUSION

On the basis of the 24-h IAAO and 24-h IAAB methods, a mean phenylalanine requirement of 38 mg . kg(-1) . d(-1) is proposed for healthy well-nourished Indian adults in the absence of tyrosine intake. This finding is similar to that in Western adults.

Aromatic amino acid requirements in healthy men measured by indicator amino acid oxidation

BACKGROUND

In the current literature, no agreement exists on estimates for aromatic amino acid (phenylalanine plus tyrosine) requirements as measured by stable-isotope techniques.

OBJECTIVE

The goal of the present study was to determine the phenylalanine requirement in healthy men who were fed a diet without tyrosine by using the indicator amino acid oxidation method.

DESIGN

Five healthy men were assigned to receive in random order diets devoid of tyrosine and with 8 graded intakes of phenylalanine (5, 10, 15, 25, 35, 45, 60, and 70 mg x kg(-1) x d(-1)). The phenylalanine requirement was measured by the rate of 13CO2 release (F13CO2) from L-[1-(13)C]lysine oxidation.

RESULTS

The graded intakes of phenylalanine had no effect on lysine flux, as required for this method. The phenylalanine (ie, total aromatic amino acid) requirement, in the absence of tyrosine, was estimated to be 48 mg x kg(-1) x d(-1) by applying a two-phase linear regression crossover model to the F13CO2 data.

CONCLUSIONS

In the absence of tyrosine, the mean phenylalanine requirement is higher than the current FAO/WHO/UNU (1985) and Dietary Reference Intake (2002) recommendations.

Phase of menstrual cycle affects lysine requirement in healthy women

The aim of this study was to investigate whether the phases of the menstrual cycle affect lysine requirement in healthy adult females, as determined by the indicator amino acid oxidation (IAAO) method. Five healthy females with regular menstrual cycles were studied at seven graded levels of lysine intake, in random order, with an oral [13C]phenylalanine tracer protocol in both the follicular and luteal phases. A total of 14 studies were conducted for each subject. Breath and plasma samples were collected according to the standard IAAO protocol. Serum 17beta-estradiol and progesterone concentrations were measured on each IAAO study day. The rate of release of 13CO2 from [13C]phenylalanine oxidation (F13CO2) was measured, and a two-phase linear regression crossover model was applied to determine lysine requirement. F13CO2 was higher during the luteal phase (P < 0.001) and was positively associated with serum concentrations of 17beta-estradiol and progesterone. The F13CO2 data were adjusted for subjects and sex hormones and used to define breakpoints for lysine requirements. The lysine requirement of healthy females in the luteal phase was 37.7 mg.kg(-1).day(-1) and higher (P = 0.025) than that of females in the follicular phase (35.0 mg.kg(-1).day(-1)). At all lysine intake levels, plasma amino acids were lower and phenylalanine oxidation was higher in the luteal relative to the follicular phase. Therefore, we reason that the higher lysine requirement observed in the luteal phase is probably due to higher amino acid catabolism.

Different approaches to define individual amino acid requirements

A full review of the strengths and limitations of the various methods used to define amino acid requirements is provided. The focus is on the recent development of carbon oxidation techniques such as indicator amino acid oxidation and 24-h amino acid balance to determine dietary indispensable (essential) amino acid needs in adults. All approaches depend on the change in a metabolic parameter in response to graded intake of the test amino acid. In humans, the within-subject variance is less than the between-subject variance, which has led to an appreciation of the need to study each subject across a range of intakes, above and below the mean requirement level. The data can then be analyzed using two-phase linear regression crossover and a precise population mean requirement can be determined. Several approaches have been used to define the variance of the mean requirement. Finally, a minimally invasive indicator amino acid oxidation model has been developed which allows the determination of dietary essential amino acid requirements in children and other vulnerable populations.

Problems with essential fatty acids: time for a new paradigm?

The term 'essential fatty acid' is ambiguous and inappropriately inclusive or exclusive of many polyunsaturated fatty acids. When applied most rigidly to linoleate and alpha-linolenate, this term excludes the now well accepted but conditional dietary need for two long chain polyunsaturates (arachidonate and docosahexaenoate) during infancy. In addition, because of the concomitant absence of dietary alpha-linolenate, essential fatty acid deficiency is a seriously flawed model that has probably led to significantly overestimating linoleate requirements. Linoleate and alpha-linolenate are more rapidly beta-oxidized and less easily replaced in tissue lipids than the common 'non-essential' fatty acids (palmitate, stearate, oleate). Carbon from linoleate and alpha-linolenate is recycled into palmitate and cholesterol in amounts frequently exceeding that used to make long chain polyunsaturates. These observations represent several problems with the concept of 'essential fatty acid', a term that connotes a more protected and important fatty acid than those which can be made endogenously. The metabolism of essential and non-essential fatty acids is clearly much more interconnected than previously understood. Replacing the term 'essential fatty acid' by existing but less biased terminology, i.e. polyunsaturates, omega3 or omega6 polyunsaturates, or naming the individual fatty acid(s) in question, would improve clarity and would potentially promote broader exploration of the functional and health attributes of polyunsaturated fatty acids.

The effects of the formula of amino acids enriched BCAA on nutritional support in traumatic patients

AIM: To investigate the formula of amino acid enriched BCAA on nutritional support in traumatic patients after operation.

METHODS: 40 adult patients after moderate or large abdominal operations were enrolled in a prospective, randomly and single-blind-controlled study, and received total parenteral nutrition (TPN) with either formula of amino acid (AA group, 20 cases) or formula of amino acid enriched BCAA (BCAA group, 20 cases). From the second day after operation, total parenteral nutrition was infused to the patients in both groups with equal calorie and equal nitrogen by central or peripheral vein during more than 12 hours per day for 6 days. Meanwhile, nitrogen balance was assayed by collecting 24 hours urine for 6 days. The markers of protein metabolism were investigated such as amino acid patterns, levels of total protein, albumin, prealbumin, transferrin and fibronectin in serum.

RESULTS: The positive nitrogen balance in BCAA group occurred two days earlier than that in AA group. The serum levels of total protein and albumin in BCAA group were increased more obviously than that in AA group. The concentration of valine was notably increased and the concentration of arginine was markedly decreased in BCAA group after the formula of amino acids enriched BCAA transfusion.

CONCLUSION: The formula of amino acid enriched BCAA may normalize the levels of serum amino acids, reduce the proteolysis, increase the synthesis of protein, improve the nutritional status of traumatic patients after operation.

Phenylalanine requirement in children with classical PKU determined by indicator amino acid oxidation

Dietary restriction of phenylalanine is the main treatment for phenylketonuria (PKU), and current estimates of requirements are based on plasma phenylalanine concentration and growth. The present study aimed to determine more precisely the phenylalanine requirements in patients with the disease by use of indicator amino acid oxidation, with L-[1-13C]lysine as the indicator. Breath 13CO2 production (F 13 CO2) was used as the end point. Finger-prick blood samples were also collected for measurement of phenylalanine to relate phenylalanine intake to blood phenylalanine levels. The mean phenylalanine requirement, estimated using a two-phase linear regression crossover analysis, was 14 mg. kg(-1). day(-1), and the safe population intake (upper 95% confidence interval of the mean) was found to be 19.5 mg. kg(-1). day(-1). A balance between phenylalanine intake and the difference between fed and fasted blood phenylalanine concentration was observed at an intake of 20 mg. kg(-1). day(-1). The similarity between these two values (19.5 and 20 mg. kg(-1). day(-1)) suggests that the maximal phenylalanine intake for children with PKU should be no higher than 20 mg. kg(-1). day(-1).

Lysine requirements of healthy adult Indian subjects receiving long-term feeding, measured with a 24-h indicator amino acid oxidation and balance technique

BACKGROUND

The mean lysine requirement of healthy Indian subjects was estimated from short-term experimental diet periods to be 29 mg x kg(-1) x d(-1), which is higher than the 1985 FAO/WHO/UNU upper requirement of 12 mg x kg(-1) x d(-1).

OBJECTIVE

Our objective was to confirm our proposed requirement of 29 mg x kg(-1) x d(-1) by extending the diet period to 21 d and by using 4 test lysine intakes (12, 20, 28, and 36 mg x kg(-1) x d(-1)) and a 24-h indicator amino acid oxidation and balance approach.

DESIGN

During two 21-d diet periods, 18 healthy Indian men were randomly assigned to receive 12 and 28 or 20 and 36 mg lysine x kg(-1) x d(-1) as part of an L-amino acid diet. At 1800 on days 6 and 20, [(13)C]leucine was infused over 24 h to assess leucine oxidation and daily leucine balance at each test intake.

RESULTS

Leucine oxidation, balance, and flux did not differ significantly between days 7 and 21. Twenty-four-hour leucine oxidation was lower at lysine intakes of 28 and 36 mg than at 12 and 20 mg. Leucine balances at lysine intakes of 12 and 20 mg were negative and significantly less than equilibrium (P < 0.01) and lower (P < 0.02) than balances at 28 and 36 mg lysine. Two-phase regression analysis indicated a breakpoint at 31 mg lysine x kg(-1) x d(-1) in the relation between lysine intake and 24-h leucine oxidation and balance.

CONCLUSIONS

Full adaptation to a low lysine intake occurs within 7 d. The previously proposed tentative mean lysine requirement for Western subjects of 30 mg x kg(-1) x d(-1) is confirmed for healthy Indian adults.

Oral and intravenous tracer protocols of the indicator amino acid oxidation method provide the same estimate of the lysine requirement in healthy men

To investigate whether splanchnic uptake of the indicator amino acid ([1-(13)C] phenylalanine) during the fed state alters the estimate of lysine requirement, five healthy men were studied at graded levels of lysine intake, with either an oral or intravenous (IV) tracer protocol, in a randomized, crossover design. Splanchnic extraction of the oral tracer was expressed as the difference between the ratio of the enrichments in urinary phenylalanine between tracer protocols. The rate of release of (13)CO(2) from (13)C-phenylalanine oxidation (F(13)CO(2)) was measured and a two-phase linear regression crossover model was applied to determine the lysine requirement. Mean splanchnic extraction of the oral tracer was approximately 19%. Although actual F(13)CO(2) was higher during oral tracer infusion (P < 0.001), the breakpoint was not different from that determined with IV infusion (P = 0.98), with both yielding a mean lysine requirement of 36.6 mg/(kg. d). The upper 95% confidence intervals were 52.5 and 53.3 mg/(kg. d) for the oral and IV isotope infusions, respectively. These results demonstrate that routes of isotope administration using the indicator amino acid oxidation technique do not affect the estimated amino acid requirement. Therefore, the indicator amino acid oxidation method using the oral route, which is less invasive and allows for studies in vulnerable groups such as infants and children, should be the preferred method for studying amino acid requirements.

Isotopic studies of protein and amino acid requirements

The quantification of protein and amino acid requirements in health and disease is still an incompletely resolved issue, despite its importance to our knowledge of nutrition, to the clinical management of most health disorders and to food policy. However, the dynamic and adaptive features of protein metabolism render this determination difficult. The first nitrogen balance studies performed have demonstrated their limitations in providing accurate protein and amino acid requirements. Isotopic methods developed over the past 15 years have considerably enhanced the quantification of amino acid and protein requirements and our knowledge of the physiological phenomena underlying these needs. These methods are consistently being improved and producing new estimates for protein and amino acid requirements, together with a clearer understanding of this complex issue.