Plasma citrulline concentration as a biomarker for bowel loss and adaptation in hospitalized pediatric patients requiring parenteral nutrition

Jeremy S. Stultz, Emma Tillman, Richard A. Helms

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Citrulline is a nonessential amino acid produced solely in the enterocyte. Plasma citrulline concentration has been proposed as a noninvasive biomarker for bowel length, function, and dependency on parenteral nutrition (PN). The purpose of this study was to determine if citrulline concentrations differed between pediatric patients with and without small bowel loss requiring specialized nutrition support. Methods: This was a retrospective categorical analysis of citrulline concentrations from previously published studies. Patients were included if they were receiving PN, more than 30 days of age, and if they had at least 2 plasma citrulline concentrations. Patients with renal insufficiency and who received outpatient PN treatment were excluded. Patients were categorized as either having or not having small bowel loss. Results: Thirty-six patients were included for analysis (18 per category). The median citrulline concentration was significantly lower in the group with bowel loss, 8.4 μmol/L vs 10.5 μmol/L (P <.0005), and undetectable citrulline concentrations occurred more often in the bowel loss group, 40% vs 8% (P <.0005). In 13 patients who received enteral nutrition during the study periods, plasma citrulline concentrations increased only in patients without bowel loss. Conclusions: These data confirm previous studies and identify decreased citrulline concentrations in pediatric patients with bowel dysfunction in the absence of bowel loss. These data also represent the first serial citrulline concentrations over a 21-day period. The increase in citrulline concentrations only in fed patients without bowel loss suggests that citrulline concentrations could provide a biomarker for bowel function and adaptation.

Original languageEnglish (US)
Pages (from-to)681-687
Number of pages7
JournalNutrition in Clinical Practice
Volume26
Issue number6
DOIs
StatePublished - Dec 1 2011
Externally publishedYes

Fingerprint

Citrulline
Parenteral Nutrition
Biomarkers
Pediatrics
Enterocytes
Enteral Nutrition
Renal Insufficiency
Outpatients

Keywords

  • amino acids
  • citrulline
  • enterocytes
  • parenteral nutrition
  • pediatrics
  • short bowel syndrome

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Plasma citrulline concentration as a biomarker for bowel loss and adaptation in hospitalized pediatric patients requiring parenteral nutrition. / Stultz, Jeremy S.; Tillman, Emma; Helms, Richard A.

In: Nutrition in Clinical Practice, Vol. 26, No. 6, 01.12.2011, p. 681-687.

Research output: Contribution to journalArticle

@article{196e18d0d64b4103b909f820fb124b55,
title = "Plasma citrulline concentration as a biomarker for bowel loss and adaptation in hospitalized pediatric patients requiring parenteral nutrition",
abstract = "Background: Citrulline is a nonessential amino acid produced solely in the enterocyte. Plasma citrulline concentration has been proposed as a noninvasive biomarker for bowel length, function, and dependency on parenteral nutrition (PN). The purpose of this study was to determine if citrulline concentrations differed between pediatric patients with and without small bowel loss requiring specialized nutrition support. Methods: This was a retrospective categorical analysis of citrulline concentrations from previously published studies. Patients were included if they were receiving PN, more than 30 days of age, and if they had at least 2 plasma citrulline concentrations. Patients with renal insufficiency and who received outpatient PN treatment were excluded. Patients were categorized as either having or not having small bowel loss. Results: Thirty-six patients were included for analysis (18 per category). The median citrulline concentration was significantly lower in the group with bowel loss, 8.4 μmol/L vs 10.5 μmol/L (P <.0005), and undetectable citrulline concentrations occurred more often in the bowel loss group, 40{\%} vs 8{\%} (P <.0005). In 13 patients who received enteral nutrition during the study periods, plasma citrulline concentrations increased only in patients without bowel loss. Conclusions: These data confirm previous studies and identify decreased citrulline concentrations in pediatric patients with bowel dysfunction in the absence of bowel loss. These data also represent the first serial citrulline concentrations over a 21-day period. The increase in citrulline concentrations only in fed patients without bowel loss suggests that citrulline concentrations could provide a biomarker for bowel function and adaptation.",
keywords = "amino acids, citrulline, enterocytes, parenteral nutrition, pediatrics, short bowel syndrome",
author = "Stultz, {Jeremy S.} and Emma Tillman and Helms, {Richard A.}",
year = "2011",
month = "12",
day = "1",
doi = "10.1177/0884533611425682",
language = "English (US)",
volume = "26",
pages = "681--687",
journal = "Nutrition in Clinical Practice",
issn = "0884-5336",
publisher = "SAGE Publications Ltd",
number = "6",

}

TY - JOUR

T1 - Plasma citrulline concentration as a biomarker for bowel loss and adaptation in hospitalized pediatric patients requiring parenteral nutrition

AU - Stultz, Jeremy S.

AU - Tillman, Emma

AU - Helms, Richard A.

PY - 2011/12/1

Y1 - 2011/12/1

N2 - Background: Citrulline is a nonessential amino acid produced solely in the enterocyte. Plasma citrulline concentration has been proposed as a noninvasive biomarker for bowel length, function, and dependency on parenteral nutrition (PN). The purpose of this study was to determine if citrulline concentrations differed between pediatric patients with and without small bowel loss requiring specialized nutrition support. Methods: This was a retrospective categorical analysis of citrulline concentrations from previously published studies. Patients were included if they were receiving PN, more than 30 days of age, and if they had at least 2 plasma citrulline concentrations. Patients with renal insufficiency and who received outpatient PN treatment were excluded. Patients were categorized as either having or not having small bowel loss. Results: Thirty-six patients were included for analysis (18 per category). The median citrulline concentration was significantly lower in the group with bowel loss, 8.4 μmol/L vs 10.5 μmol/L (P <.0005), and undetectable citrulline concentrations occurred more often in the bowel loss group, 40% vs 8% (P <.0005). In 13 patients who received enteral nutrition during the study periods, plasma citrulline concentrations increased only in patients without bowel loss. Conclusions: These data confirm previous studies and identify decreased citrulline concentrations in pediatric patients with bowel dysfunction in the absence of bowel loss. These data also represent the first serial citrulline concentrations over a 21-day period. The increase in citrulline concentrations only in fed patients without bowel loss suggests that citrulline concentrations could provide a biomarker for bowel function and adaptation.

AB - Background: Citrulline is a nonessential amino acid produced solely in the enterocyte. Plasma citrulline concentration has been proposed as a noninvasive biomarker for bowel length, function, and dependency on parenteral nutrition (PN). The purpose of this study was to determine if citrulline concentrations differed between pediatric patients with and without small bowel loss requiring specialized nutrition support. Methods: This was a retrospective categorical analysis of citrulline concentrations from previously published studies. Patients were included if they were receiving PN, more than 30 days of age, and if they had at least 2 plasma citrulline concentrations. Patients with renal insufficiency and who received outpatient PN treatment were excluded. Patients were categorized as either having or not having small bowel loss. Results: Thirty-six patients were included for analysis (18 per category). The median citrulline concentration was significantly lower in the group with bowel loss, 8.4 μmol/L vs 10.5 μmol/L (P <.0005), and undetectable citrulline concentrations occurred more often in the bowel loss group, 40% vs 8% (P <.0005). In 13 patients who received enteral nutrition during the study periods, plasma citrulline concentrations increased only in patients without bowel loss. Conclusions: These data confirm previous studies and identify decreased citrulline concentrations in pediatric patients with bowel dysfunction in the absence of bowel loss. These data also represent the first serial citrulline concentrations over a 21-day period. The increase in citrulline concentrations only in fed patients without bowel loss suggests that citrulline concentrations could provide a biomarker for bowel function and adaptation.

KW - amino acids

KW - citrulline

KW - enterocytes

KW - parenteral nutrition

KW - pediatrics

KW - short bowel syndrome

UR - http://www.scopus.com/inward/record.url?scp=84855170705&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84855170705&partnerID=8YFLogxK

U2 - 10.1177/0884533611425682

DO - 10.1177/0884533611425682

M3 - Article

C2 - 22205556

AN - SCOPUS:84855170705

VL - 26

SP - 681

EP - 687

JO - Nutrition in Clinical Practice

JF - Nutrition in Clinical Practice

SN - 0884-5336

IS - 6

ER -