ESPEN 2022 Abstract Submission
Topic: Protein and amino acid metabolism
Abstract Submission Identifier: ESPEN22-ABS-1599
COMPREHENSIVE METABOLIC AMINO ACID FLUX ANALYSIS IN CRITICALLY ILL MALE AND FEMALE PATIENTS
N. E. Deutz*, 1, P. Singer 2, R. A. Wierzchowska-McNew 1, M. V. Viana 3, I. A. Ben-David 4, O. Pantet 3, J. J. Thaden 1, G. A. Ten Have 1, M. P. Engelen 1, M. M. Berger 3
1Center for Translational Research in Aging and Longevity, Texas A&M University, College Station, United States, 2General Intensive Care and Institute for Nutrition Research, Tel Aviv University, Tel Aviv, Israel, 3Adult Intensive Care, Lausanne University Hospital, Lausanne, Switzerland, 4General Intensive Care and Institute for Nutrition Research, Tel Aviv University, College Station, Israel
Rationale: Some studies suggest a better long term survival for females than for males when they become critically ill, possibly related to the lower ICU admission and higher ICU survival rates of females. As amino acid (AA) metabolism is severely disturbed in critically ill patients (1), we used comprehensive AA phenotyping with measurements of plasma concentrations and whole body production (WBP) to examine whether metabolic (kinetic) differences exist between female and male ICU patients.
Methods: In 51 critically ill ICU patients (female/male (F/M)=15/36); SOFA~6.6) and 49 healthy controls (F/M=22/27), we measured fat-free mass (FFM) by BIA and collected arterial(ized) blood for baseline AA concentrations between 4 and 10 days of admission. We subsequently administered an 8 ml IV solution containing 18 stable tracers of AA as a pulse and calculated the AA WBP rates (mmol/hour). We measured concentrations/enrichments by LC-MS/MS. We expressed WBP as the mean [95% CI] predicted by ANCOVA, considering as covariates critical illness (disease), sex, disease*sex, age, ffm and protein breakdown (assessed by phenylalanine WBP).
Results: Females had lower WBP rates than males for many essential and non-essential amino acids, independent of disease. However, glutamine WBP was higher in females in the critically ill group (56.2 [49.4, 64.0]) than in the healthy (30.3 [27.0, 34.1]). The significant disease*sex interaction (p=0.0004) indicate the large difference between the response of females and males (44.8 [40.6, 49.5] to 55.6 [51.1, 60.5]). In addition, the same disease*sex interaction was present with a larger increase of the WBP of the BCAA leucine (p=0.0007) and valine (p=0.0023) in females. The observations in glutamine, leucine and valine WBP remained after correction for protein breakdown.
Conclusion: When critically ill, females seem able to increase glutamine and BCAA production more than males, independent of the increase in protein breakdown. We hypothesize that this specific metabolic adaptation could play a role in the better survival previously observed in females when critically ill.
References: Deutz NEP, Singer P, Wierzchowska-McNew RA, Viana MV, Ben-David IA, Pantet O, Thaden JJ, Ten Have GAM, Engelen M, Berger MM. Comprehensive metabolic amino acid flux analysis in critically ill patients. Clinical nutrition (Edinburgh, Scotland). 2021;40(5):2876-97. Epub 2021/05/05. https://doi.org/10.1016/j.clnu.2021.03.015. PubMed PMID: 33946038.
Disclosure of Interest: None Declared
Keywords: glutamine, isoleucine, leucine, stable isotope, tracers, valine