Urea production in normal breast-fed infants measured with primed/intermittent oral doses of [15N, 15N]urea

Urea nitrogen salvage mechanisms and their relevance to ruminants, non-ruminants and man

Maintaining a correct balance of N is essential for life. In mammals, the major sources of N in the diet are amino acids and peptides derived from ingested proteins. The immediate endproduct of mammalian protein catabolism is ammonia, which is toxic to cells if allowed to accumulate. Therefore, amino acids are broken down in the liver as part of the ornithine-urea cycle, which results in the formation of urea - a highly soluble, biochemically benign molecule. Mammals cannot break down urea, which is traditionally viewed as a simple waste product passed out in the urine. However, urea from the bloodstream can pass into the gastrointestinal tract, where bacteria expressing urease cleave urea into ammonia and carbon dioxide. The bacteria utilise the ammonia as an N source, producing amino acids and peptides necessary for growth. Interestingly, these microbial products can be reabsorbed back into the host mammalian circulation and used for synthetic processes. This entire process is known as 'urea nitrogen salvaging' (UNS). In this review we present evidence supporting a role for this process in mammals - including ruminants, non-ruminants and man. We also explore the possible mechanisms involved in UNS, including the role of specialised urea transporters.

Contributions of intestinal bacteria to nutrition and metabolism in the critically ill

Important advances in the study of bacteria associated with the human gastrointestinal tract have significant implications for clinicians striving to meet the metabolic and nutritional needs of critically ill patients. This article offers a broad overview of the importance of the host-microbe relationship, discusses what is currently known about the role of gut microbes in nutrition and metabolism in the healthy human host, reviews how gut microbes are affected by critical illness, and discusses interventions that have already been used to manipulate the gut microbiome in patients in the intensive care unit.

Urea-nitrogen production and salvage are modulated by protein intake in fed humans: results of an oral stable-isotope-tracer protocol and compartmental modeling

BACKGROUND

The influence of protein source on postprandial urea kinetics is poorly understood, despite its nutritional significance with respect to nitrogen homeostasis. Furthermore, traditional tracer infusion studies underestimate acute postprandial change in urea kinetics.

OBJECTIVE

We investigated postprandial, non-steady state urea kinetics and their modulation by qualitative and quantitative factors of protein intake by the combined use of robust clinical data on nitrogen postprandial distribution and mathematical modeling.

DESIGN

In healthy subjects standardized to a normal protein intake for 7 d, dietary and total nitrogen kinetics were measured for 8 h in plasma proteins, body, and urinary urea after the ingestion of a (15)N-labeled milk (n = 8), soy (n = 8), or wheat (n = 8) protein meal. In subjects who received the soy protein meal, these postprandial measurements were repeated after a further 7-d adaptation to a high protein intake. A 4-compartment model was developed to calculate from these data the postprandial kinetics of production, urinary excretion, and intestinal hydrolysis of urea nitrogen from both dietary and endogenous sources.

RESULTS

Urinary urea excretion was not influenced by the protein source in the meal but was influenced by the protein level in the diet. By contrast, urea production and hydrolysis were higher when ingesting plant versus animal protein, together with a higher efficiency of urea hydrolysis (50-60% versus 25% of the urea produced being hydrolyzed, respectively).

CONCLUSIONS

We conclude that urea hydrolysis is an acute nitrogen-sparing mechanism that can counterbalance a postprandial higher urea production, and the efficiency of this recycling is higher when the usual protein intake is lower.

The transfer of 15N from urea to lysine in the human infant

To explore the nutritional significance of urea hydrolysis for human subjects, male infants being treated for severe undernutrition were given oral doses of 10 mg [15N15N]urea every 3 h for 36 h, on admission, during rapid growth and after repletion with either moderate or generous intakes of protein. Urea hydrolysis was calculated from the 15N enrichment of urinary urea, and where possible, lysine, alanine, glycine and histidine were isolated from urine by preparative ion-exchange chromatography for measurement of 15N enrichment. Sufficient N was obtained for 15N enrichment of lysine to be measured on fifteen occasions from six children. Urea hydrolysis accounted for half of all urea production with 130 (sd 85) mg N/kg hydrolysed per d, most of which appeared to be utilized in synthetic pathways. Of the samples analysed successfully, nine samples of lysine were enriched with 15N (mean atom percent excess 0·0102, range 0·0017–0·0208) with relative enrichment ratios with respect to lysine of 1·63 (range 0·18–3·15), 1·96 (range 0·7–3·73) and 0·9 (range 0·4–1·8) for glycine, alanine and histidine respectively. Enriched samples were identified at each treatment phase and 68 % of the variation in lysine enrichment was explained by the variation in urea enrichment with 54 % explained by the overall rate of delivery of 15N to the lower gastrointestinal tract. The results indicate a minimum of 4·7 mg lysine per kg body weight made available by de novo synthesis with the more likely value an order of magnitude higher. Thus, urea hydrolysis can improve the quality of the dietary protein supply by enabling an increased supply of lysine and other indispensable amino acids.To explore the nutritional significance of urea hydrolysis for human subjects, male infants being treated for severe undernutrition were given oral doses of 10 mg [15N15N]urea every 3 h for 36 h, on admission, during rapid growth and after repletion with either moderate or generous intakes of protein. Urea hydrolysis was calculated from the 15N enrichment of urinary urea, and where possible, lysine, alanine, glycine and histidine were isolated from urine by preparative ion-exchange chromatography for measurement of 15N enrichment. Sufficient N was obtained for 15N enrichment of lysine to be measured on fifteen occasions from six children. Urea hydrolysis accounted for half of all urea production with 130 (sd 85) mg N/kg hydrolysed per d, most of which appeared to be utilized in synthetic pathways. Of the samples analysed successfully, nine samples of lysine were enriched with 15N (mean atom percent excess 0·0102, range 0·0017–0·0208) with relative enrichment ratios with respect to lysine of 1·63 (range 0·18–3·15), 1·96 (range 0·7–3·73) and 0·9 (range 0·4–1·8) for glycine, alanine and histidine respectively. Enriched samples were identified at each treatment phase and 68 % of the variation in lysine enrichment was explained by the variation in urea enrichment with 54 % explained by the overall rate of delivery of 15N to the lower gastrointestinal tract. The results indicate a minimum of 4·7 mg lysine per kg body weight made available by de novo synthesis with the more likely value an order of magnitude higher. Thus, urea hydrolysis can improve the quality of the dietary protein supply by enabling an increased supply of lysine and other indispensable amino acids.To explore the nutritional significance of urea hydrolysis for human subjects, male infants being treated for severe undernutrition were given oral doses of 10 mg [15N15N]urea every 3 h for 36 h, on admission, during rapid growth and after repletion with either moderate or generous intakes of protein. Urea hydrolysis was calculated from the 15N enrichment of urinary urea, and where possible, lysine, alanine, glycine and histidine were isolated from urine by preparative ion-exchange chromatography for measurement of 15N enrichment. Sufficient N was obtained for 15N enrichment of lysine to be measured on fifteen occasions from six children. Urea hydrolysis accounted for half of all urea production with 130 (sd 85) mg N/kg hydrolysed per d, most of which appeared to be utilized in synthetic pathways. Of the samples analysed successfully, nine samples of lysine were enriched with 15N (mean atom percent excess 0·0102, range 0·0017–0·0208) with relative enrichment ratios with respect to lysine of 1·63 (range 0·18–3·15), 1·96 (range 0·7–3·73) and 0·9 (range 0·4–1·8) for glycine, alanine and histidine respectively. Enriched samples were identified at each treatment phase and 68 % of the variation in lysine enrichment was explained by the variation in urea enrichment with 54 % explained by the overall rate of delivery of 15N to the lower gastrointestinal tract. The results indicate a minimum of 4·7 mg lysine per kg body weight made available by de novo synthesis with the more likely value an order of magnitude higher. Thus, urea hydrolysis can improve the quality of the dietary protein supply by enabling an increased supply of lysine and other indispensable amino acids.To explore the nutritional significance of urea hydrolysis for human subjects, male infants being treated for severe undernutrition were given oral doses of 10 mg [15N15N]urea every 3 h for 36 h, on admission, during rapid growth and after repletion with either moderate or generous intakes of protein. Urea hydrolysis was calculated from the 15N enrichment of urinary urea, and where possible, lysine, alanine, glycine and histidine were isolated from urine by preparative ion-exchange chromatography for measurement of 15N enrichment. Sufficient N was obtained for 15N enrichment of lysine to be measured on fifteen occasions from six children. Urea hydrolysis accounted for half of all urea production with 130 (sd 85) mg N/kg hydrolysed per d, most of which appeared to be utilized in synthetic pathways. Of the samples analysed successfully, nine samples of lysine were enriched with 15N (mean atom percent excess 0·0102, range 0·0017–0·0208) with relative enrichment ratios with respect to lysine of 1·63 (range 0·18–3·15), 1·96 (range 0·7–3·73) and 0·9 (range 0·4–1·8) for glycine, alanine and histidine respectively. Enriched samples were identified at each treatment phase and 68 % of the variation in lysine enrichment was explained by the variation in urea enrichment with 54 % explained by the overall rate of delivery of 15N to the lower gastrointestinal tract. The results indicate a minimum of 4·7 mg lysine per kg body weight made available by de novo synthesis with the more likely value an order of magnitude higher. Thus, urea hydrolysis can improve the quality of the dietary protein supply by enabling an increased supply of lysine and other indispensable amino acids.

Relationship between birth weight and urea kinetics in children

OBJECTIVE

To explore the effect of birth weight on urea kinetics in young healthy children.

DESIGN

Observational study.

SETTING

Tertiary center for treatment of malnutrition.

SUBJECTS

A total of 17 male children, 6-24 months old, who had recovered from malnutrition.

INTERVENTIONS

Urea kinetics were measured using stable isotope methodology with [(15)N(15)N]-urea over 36 h.

RESULTS

Birth weight was negatively related to urea hydrolysis after controlling for the intake of protein (adjusted R (2 ) = 0.91, P = 0.001) and separately for energy intake (adjusted R (2) = 0.95, P = 0.001), age (adjusted R (2) = 0.90, P = 0.001) and rate of weight gain (adjusted R (2) = 0.91, P = 0.001). There was a tendency for higher urea production in the children with lower birth weight after controlling for nitrogen intake (adjusted R (2) = 0.93, P = 0.099), and separately for age (adjusted R (2) = 0.94, P = 0.06) and rate of weight gain (adjusted (R (2) = 0.92, P = 0.096). Urea excretion was not significantly related to birth weight.

CONCLUSIONS

The salvaging of urea nitrogen following urea hydrolysis contributed significantly more to the nitrogen economy in children with lower birth weight compared to those with higher birth weight. This may be as a result of reductive adaptation in the children with lower birth weight as a consequence of inappropriate prenatal nutrition and growth.

Minimal sampling protocol for accurate estimation of urea production: a study with oral [13C]urea in fed and fasted piglets

BACKGROUND & AIMS

An oral [13C]urea protocol may provide a simple method for measurement of urea production. The validity of single pool calculations in relation to a reduced sampling protocol was assessed.

METHODS

In eight fed and five fasted piglets, plasma urea enrichments from a 10 h sampling protocol were measured following an intragastric [13C]urea bolus. Blood [13C]bicarbonate was measured to trace gut [13C]urea oxidation. Two-compartment and regression (single pool) computations were performed. Pool sizes were compared to urea distribution over total body water (TBW). Shorter protocol duration was tested in regression simulations.

RESULTS

Differences in urea kinetics between fed and fasted piglets did not reach statistical significance. Mean (+/-SE) urea pool from TBW times plasma urea concentration was 2.2+/-0.16 mmol kg(-1). Two-compartment modelling yielded similar results for pool size (despite the oxidation of a small amount of urea tracer). Urea appearance rate was 306+/-18 micromol kg(-1)h(-1). Regression calculations overestimated urea appearance rate vs. compartmental model (P<0.05). When samples <2 h were discarded, results were comparable to compartmental calculations even if protocol length was 6 h (325+/-24 micromol kg(-1)h(-1), NS).

CONCLUSIONS

Regression calculations using plasma enrichments sampled between 2 and 6 h after oral [13C]urea administration provide accurate rates of urea production, and are not affected by tracer oxidation.

Higher weight at birth is related to decreased maternal amino acid oxidation during pregnancy

BACKGROUND

Small size at birth is associated with cardiovascular disease in adult life. Decreased fetal growth may result from a limitation in the nutrient supply to the fetus. Net tissue deposition in the mother and fetus increases the demand for nitrogen, but because maternal consumption of protein does not increase, there must be a change in the partitioning of amino acids, away from oxidation and toward deposition.

OBJECTIVE

Our objective was to characterize amino acid oxidation in pregnancy and to investigate whether the relative partitioning of amino acids was related to fetal growth.

DESIGN

We determined amino acid oxidation as urea production in 25 women during mid (17-19 wk) and late (26-29 wk) gestation. Urea production was measured from urinary [(15)N-(15)N]urea excretion over 48 h after a single oral dose of [(15)N-(15)N]urea. We measured the infant's size at birth.

RESULTS

For the group as a whole, urea excretion decreased and amino acid oxidation remained similar between mid and late pregnancy, but there was wide variation between the women. Heavier infants were born to the mothers in whom amino acid oxidation decreased the most during pregnancy (slope of regression line: -80 g x g N(-1) x d(-1); 95% CI: -129, -31; P = 0.003). After adjustment for length of gestation and the infant's sex, the change in maternal amino acid oxidation explained 34% of the variation in birth weight.

CONCLUSIONS

Amino acid oxidation varied widely between the women during pregnancy. Understanding the ability of a pregnant woman to adapt metabolically may have implications for establishing dietary recommendations in pregnancy.

Protein metabolism in the extremely low-birth weight infant

Although extensive data are available on the impact of nutrient and protein administration on growth, plasma amino acids, and nitrogen balance in the newborn and growing infants, relatively few studies have carefully examined the dynamic aspects of protein metabolism in vivo and particularly in the micropremie or ELBW infant. These studies show that the very preterm infants, either because of immaturity or because of the intercurrent illness, have high rates of protein turnover and protein breakdown. This high rate of proteolysis is not as responsive to nutrient administration. Intervention strategies aimed at promoting nitrogen accretion, such as insulin, human growth hormone, or glutamine, have not thus far resulted in enhanced protein accretion and growth. This may be, in part, due to limitations in delivery of adequate calorie and nitrogen.

Dietary protein, growth and urea kinetics in severely malnourished children and during recovery

The case mortality for severe malnutrition in childhood remains high, but established best approaches to treatment are not used in practice. The energy and protein content of the diet at different stages of treatment appears important, but remains controversial. The effect on growth, urea kinetics and the urinary excretion of 5-L-oxoproline was compared between a standard infant formula (HP group) provided in different quantities at each stage of treatment and a recommended dietary regimen, which differentiates the requirements of protein and energy during the acute phase of resuscitation (maintenance intake of energy and protein, relatively low protein to energy ratio, LP group) from those during the restoration of a weight deficit (energy and nutrient dense). The energy required to maintain weight was less in the HP than the LP group, but the HP group was not able to achieve as high an energy intake during repletion of wasting because of the high volume which would have had to be consumed. Compared to the LP group, in the HP group during catch-up growth there was significantly greater deposition of lean tissue and higher rates of urea production, hydrolysis and salvage of urea-nitrogen. These, together with higher rates of 5-L-oxoprolinuria, suggest a greater constraint of the formation of adequate amounts of nonessential amino acids, especially glycine, in the face of enhanced demands. Although more effective rehabilitation might be achieved using a standard formula, there is the need to determine the extent to which it might impose metabolic stress compared with the modified formulation.

Urea kinetics in healthy women during normal pregnancy

Urea kinetics were measured in normal women aged 22-34 years at weeks 16, 24 and 32 on either their habitual protein intake (HABIT) or a controlled intake of 60 g protein/d (CONTROL), using primed-intermittent oral doses of [15N15N]urea and measurement of plateau enrichment in urinary urea over 18 h (ID) or a single oral dose of [15N15N]urea and measurement of enrichment of urea in urine over the following 48 h (SD). The intake of protein during HABIT-ID (80 g/d) was greater than that on HABIT-SD (71 g/d); urea production as a percentage of intake was significantly greater at week 16 for HABIT-ID than HABIT-SD, whereas urea hydrolysis at week 16 was greater for HABIT-SD than HABIT-ID and urea excretion at week 32 was greater for HABIT-ID than HABIT-SD. The combined results for HABIT-ID and HABIT-SD showed a significant reduction in urea production at week 32 compared with week 24. Urea excretion decreased significantly from week 16 to week 24 with no further decrease to week 32 and urea hydrolysis was significantly greater at week 24 than either week 16 or week 32. Compared with HABIT, on CONTROL there was a decrease in urea production at week 16, and urea excretion was significantly reduced at week 16. For all time periods urea production was closely related to the sum of intake plus hydrolysis. Hydrolysis was greatest at week 24 and closely related to urea production. There was a significant inverse linear relationship overall for hydrolysis as a proportion of production and excretion as a proportion of intake. The results show that on HABIT N is more effectively conserved in mid-pregnancy through an increase in urea hydrolysis and salvage, and during late pregnancy through a reduction in urea formation. Lowering protein intake at any stage of pregnancy increased the hydrolysis and salvage of urea. The staging of these changes was later than that in pregnancy in Jamaica.