Proteins and amino acids in enteral nutrition.

PURPOSE OF REVIEW: This review reports recent findings on the effect of enterally fed protein and amino acids on metabolism, function, and clinical outcome, particularly during the neonatal period. RECENT FINDINGS: Splanchnic tissues metabolize significant proportions of some enteral amino acids and this likely contributes to the higher requirement for these amino acids when they are provided enterally versus parenterally. Splanchnic tissues are particularly key in the provision of nutrition to preterm infants, who possess an exceedingly high protein anabolic drive, but limited tolerance to aggressive enteral feeding. The protein anabolic response to specific proteins is influenced by the rate of digestion and the pattern of feeding, as well as the amino acid composition of the proteins. The post-prandial rise in amino acids and insulin stimulates neonatal tissue protein synthesis by modulation of the nutrient and insulin signaling pathways that lead to translation initiation. A flurry of investigations into the metabolic response and clinical impact of individual amino acids suggests that leucine, glutamine, and arginine, in particular, have specific roles in regulating protein synthesis and immune function. SUMMARY: Recent findings suggest that enteral nutrition support that provides an optimum combination of proteins and amino acids can have a beneficial impact on the clinical outcome of patients.