High-dose insulin administration is associated with hypoaminoacidemia during cardiac surgery

Hatzakorzian, Roupen; Carvalho, George; Bui, Helen; Sato, Tamaki; Wykes, Linda; Shum‐Tim, Dominique; Schricker, Thomas

doi:10.1016/j.metabol.2011.03.007

Cited by 10 publications

(9 citation statements)

References 25 publications

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“…After 90 min, plasma insulin concentrations no longer differed between experimental conditions (Figure 1). In agreement with previous work [42,43], the greater insulin response seemed to modulate the plasma amino acid kinetics (Figure 2). Carbohydrate co-ingestion attenuated the post-prandial rise in plasma amino acid concentrations, mainly the branched chain amino acids (Figure 2).…”

Section: Discussionsupporting

confidence: 93%

Carbohydrate co-ingestion with protein does not further augment post-prandial muscle protein accretion in older men

et al. 2013

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BackgroundA blunted muscle protein synthetic response to protein ingestion may contribute to the age related loss of muscle tissue. We hypothesized that the greater endogenous insulin release following co-ingestion of carbohydrate facilitates post-prandial muscle protein accretion after ingesting a meal-like bolus of protein in older males.MethodsTwenty-four healthy older men (75±1 y) were randomly assigned to ingest 20 g intrinsically L-[1-13C] phenylalanine-labeled casein protein with (PRO-CHO) or without (PRO) 40 g carbohydrate. Ingestion of specifically produced intrinsically L-[1-13C] phenylalanine labeled protein allowed us to assess post-prandial incorporation of dietary protein derived amino acids into muscle protein. Blood samples were collected at regular intervals, with muscle biopsies being obtained prior to and 2 and 6 h after protein ingestion.ResultsPlasma glucose and insulin concentrations showed a greater increase in PRO-CHO compared with PRO (P<0.001). Muscle protein-bound L-[1-13C] phenylalanine enrichments tended to increase to a greater extent in PRO-CHO compared with PRO during the first 2 h after protein ingestion (0.0072±0.0013 vs 0.0046±0.010 MPE, respectively; P=0.13). However, 6 h after protein ingestion, differences in muscle protein-bound L-[1-13C] phenylalanine enrichments were no longer observed between experiments (0.0213±0.0024 vs 0.0185±0.0010 MPE, respectively; P=0.30).ConclusionsThis study shows that carbohydrate ingestion may accelerate, but does not further augment post-prandial incorporation of dietary protein derived amino acids into muscle protein in healthy elderly men.

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Section: Discussionsupporting

confidence: 93%

Carbohydrate co-ingestion with protein does not further augment post-prandial muscle protein accretion in older men

et al. 2013

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“…In the early post-prandial period, plasma amino acid levels and [1-13 C]phenylalanine enrichments tended to be higher in the young versus the older group. This apparent delay in plasma amino acid concentrations and enrichments can be accounted for by either a delayed digestion and/or absorption rate (Boirie et al 1997;Volpi et al 1999;Koopman et al 2009b;Pennings et al 2011b), and/or a greater amino acid uptake secondary to the compensatory hyperinsulinemia (Hatzakorzian et al 2011) (Fig.1b), and/or an attenuated inhibition of the post-prandial reduction in protein breakdown (Wilkes et al 2009). …”

Section: Discussionmentioning

confidence: 99%

The muscle protein synthetic response to the combined ingestion of protein and carbohydrate is not impaired in healthy older men

Kiskini

Hamer

Wall

et al. 2013

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Aging is associated with a progressive decline in skeletal muscle mass. It has been hypothesized that an attenuated muscle protein synthetic response to the main anabolic stimuli may contribute to the age-related loss of muscle tissue. The aim of the present study was to compare the muscle protein synthetic response following ingestion of a meal-like amount of dietary protein plus carbohydrate between healthy young and older men.

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“…Fukagawa et al 11 Similar to the observed change in protein breakdown, whole body protein synthesis decreased in patients receiving insulin, most likely a consequence of reduced substrate supply, i.e., hypoaminoacidemia. As demonstrated in a previous study in cardiac surgery insulin administration led to a 30 -60% decrease in the circulating concentrations of most AAs (15). By contrast, patients with lung cancer and healthy young subjects showed increased protein synthesis and positive protein balance if hypoaminoacidemia was avoided by exogenous provision of amino acids (6,32) suggesting that the anabolic action of insulin requires adequate substrate supply (1,4).…”

Section: Discussionmentioning

confidence: 82%

“…We recently demonstrated that insulin administered as part of a hyperinsulinemic-normoglycemic clamp during open heart surgery caused significant hypoaminoacidemia (15). Branchedchain amino acids decreased by almost 70%, while AAs linked with the malate-aspartate cycle were reduced by 30%.…”

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confidence: 99%

Glucose and insulin administration while maintaining normoglycemia inhibits whole body protein breakdown and synthesis after cardiac surgery

Hatzakorzian

Shum‐Tim

Wykes

et al. 2014

Journal of Applied Physiology

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We investigated the effect of insulin administered as part of a hyperinsulinemic-normoglycemic clamp on protein metabolism after coronary artery bypass grafting (CABG) surgery. Eighteen patients were studied, with nine patients in the control group receiving standard metabolic care and nine patients receiving insulin (5 mU·kg(-1)·min(-1)). Whole body glucose production, protein breakdown, synthesis, and oxidation were determined using stable isotope tracer kinetics (l-[1-(13)C]leucine, [6,6-(2)H2]glucose) before and 6 h after the procedure. Plasma amino acids, cortisol, and lactate were also measured. Endogenous glucose production (preoperatively 10.0 ± 1.6, postoperatively 3.7 ± 2.5 μmol·kg(-1)·min(-1); P = 0.0001), protein breakdown (preoperatively 105.3 ± 9.8, postoperatively 85.2 ± 9.2 mmol·kg(-1)·h(-1); P = 0.0005) and synthesis (preoperatively 88.7 ± 8.7, postoperatively 72.4 ± 8.4 mmol·kg(-1)·h(-1); P = 0.0005) decreased in the presence of hyperinsulinemia, whereas both parameters remained unchanged in the control group. A positive correlation between endogenous glucose production and protein breakdown was observed in the insulin group (r(2) = 0.385). Whole body protein oxidation and balance decreased after surgery in patients receiving insulin without reaching statistical significance. In the insulin group the plasma concentrations of 13 of 20 essential and nonessential amino acids decreased to a significantly greater extent than in the control group. In summary, supraphysiological hyperinsulinemia, while maintaining normoglycemia, decreased whole body protein breakdown and synthesis in patients undergoing CABG surgery. However, net protein balance remained negative.

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High-dose insulin administration is associated with hypoaminoacidemia during cardiac surgery

Cited by 10 publications

References 25 publications

Carbohydrate co-ingestion with protein does not further augment post-prandial muscle protein accretion in older men

Carbohydrate co-ingestion with protein does not further augment post-prandial muscle protein accretion in older men

The muscle protein synthetic response to the combined ingestion of protein and carbohydrate is not impaired in healthy older men

Glucose and insulin administration while maintaining normoglycemia inhibits whole body protein breakdown and synthesis after cardiac surgery

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