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Fasting and Postprandial Plasma Citrulline and the Correlation to Intestinal Function Evaluated by 72‐Hour Metabolic Balance Studies in Short Bowel Jejunostomy Patients With Intestinal Failure
Author(s) -
Fjermestad Hilde,
Hvistendahl Mark,
Jeppesen Palle Bekker
Publication year - 2018
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607116687497
Subject(s) - postprandial , citrulline , short bowel syndrome , medicine , gastroenterology , endocrinology , parenteral nutrition , arginine , chemistry , biochemistry , insulin , amino acid
Background : Fasting plasma citrulline (p‐citrulline) is a marker of functional enterocyte mass. However, the optimal timing of measurement in relation to meals has yet to be clarified. Furthermore, p‐citrulline has been proposed to be a surrogate marker for small bowel length and intestinal absorption parameters in short bowel syndrome patients with intestinal failure (SBS‐IF). Materials and Methods : Eight patients with SBS‐IF and 8 healthy controls (HCs) were given a standardized mixed test meal, and p‐citrulline was measured 15 minutes before and 60, 120, and 180 minutes after completion of the meal. The patients with SBS‐IF had their intestinal absorption of wet weight, energy, macronutrients, and electrolytes measured in relation to 72‐hour metabolic balance studies. We investigated the possible correlations between p‐citrulline and short bowel length, absorptive parameters, and the dependence on parenteral support (PS). Results : In the patients with SBS‐IF, we found a 12% ( P = .041) reduction in postprandial citrulline levels after 180 minutes. In the HCs, there was a 13% postprandial reduction at 60 minutes ( P = .018). No significant correlations between fasting p‐citrulline and bowel length, bowel absorptive function, or the dependence on PS were found. Even when excluding 2 patients in whom the intestinal absorption was adjacent to the intestinal insufficiency borderlines, these correlations were not significant. Conclusion : Based on findings in this small study, the optimal timing of p‐citrulline measurement is on fasting samples. However, p‐citrulline seems insufficiently discriminative to serve as a valid biomarker of bowel length, bowel absorptive function, or dependence on PS in patients with SBS‐IF.