Determinants of skeletal muscle protein turnover following severe burn trauma in children

Ioannis Malagaris, David Herndon, Efstathia Polychronopoulou, Victoria G. Rontoyanni, Clark R. Andersen, Oscar Suman, Craig Porter, Labros S. Sidossis

Research output: Contribution to journalArticle

Abstract

Background & aims: Burns remain the fifth cause of non-fatal pediatric injuries globally, with muscle cachexia being a hallmark of the stress response to burns. Burn-induced muscle wasting is associated with morbidity, yet the determinants of muscle protein catabolism in response to burn trauma remains unclear. Our objective was to determine the effect of patient and injury characteristics on muscle protein kinetics in burn patients. Methods: This retrospective, observational study was performed using protein kinetic data from pediatric patients who had severe burns (>30% of the total body surface area burned) and underwent cross-limb stable isotope infusions between 1999 and 2008 as part of prospective clinical trials. Mixed multiple regression models were used to assess associations between patient/injury characteristics and muscle protein fractional synthesis rate (FSR), net balance (NB), and rates of phenylalanine appearance (Ra; index of protein breakdown) and disappearance (Rd; index of protein synthesis) across the leg. Results: A total of 268 patients who underwent 499 studies were analyzed. Increasing time post injury was associated with greater FSR (p < 0.001) and NB (p = 0.01). Males were more catabolic than females (as indicated by lower NB, p = 0.04 and greater Ra, p = 0.008), a consequence of higher protein breakdown rather than lower synthesis. Increasing burn size was associated with higher protein synthesis rate (as indicated by higher FSR, p = 0.019) and higher protein breakdown rates (as indicated by greater Ra, p = 0.001). FSR was negatively associated with age (p < 0.001). Conclusions: Data from this large patient cohort show that injury severity, sex, and time post injury influence skeletal muscle wasting in burned children. These findings suggest that individual patient characteristics should be considered when devising therapies to improve the acute care and rehabilitation of burn survivors.

Original languageEnglish (US)
JournalClinical Nutrition
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Muscle Proteins
Skeletal Muscle
Burns
Wounds and Injuries
Proteins
Pediatrics
Muscles
Cachexia
Body Surface Area
Phenylalanine
Isotopes
Observational Studies
Survivors
Leg
Rehabilitation
Extremities
Retrospective Studies
Clinical Trials
Morbidity

Keywords

  • Amino acid kinetics
  • Burns
  • Muscle metabolism
  • Pediatric
  • Stable isotope

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Critical Care and Intensive Care Medicine

Cite this

Malagaris, I., Herndon, D., Polychronopoulou, E., Rontoyanni, V. G., Andersen, C. R., Suman, O., ... Sidossis, L. S. (Accepted/In press). Determinants of skeletal muscle protein turnover following severe burn trauma in children. Clinical Nutrition. https://doi.org/10.1016/j.clnu.2018.05.027

Determinants of skeletal muscle protein turnover following severe burn trauma in children. / Malagaris, Ioannis; Herndon, David; Polychronopoulou, Efstathia; Rontoyanni, Victoria G.; Andersen, Clark R.; Suman, Oscar; Porter, Craig; Sidossis, Labros S.

In: Clinical Nutrition, 01.01.2018.

Research output: Contribution to journalArticle

Malagaris, I, Herndon, D, Polychronopoulou, E, Rontoyanni, VG, Andersen, CR, Suman, O, Porter, C & Sidossis, LS 2018, 'Determinants of skeletal muscle protein turnover following severe burn trauma in children', Clinical Nutrition. https://doi.org/10.1016/j.clnu.2018.05.027
Malagaris, Ioannis ; Herndon, David ; Polychronopoulou, Efstathia ; Rontoyanni, Victoria G. ; Andersen, Clark R. ; Suman, Oscar ; Porter, Craig ; Sidossis, Labros S. / Determinants of skeletal muscle protein turnover following severe burn trauma in children. In: Clinical Nutrition. 2018.
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AU - Polychronopoulou, Efstathia

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AU - Suman, Oscar

AU - Porter, Craig

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AB - Background & aims: Burns remain the fifth cause of non-fatal pediatric injuries globally, with muscle cachexia being a hallmark of the stress response to burns. Burn-induced muscle wasting is associated with morbidity, yet the determinants of muscle protein catabolism in response to burn trauma remains unclear. Our objective was to determine the effect of patient and injury characteristics on muscle protein kinetics in burn patients. Methods: This retrospective, observational study was performed using protein kinetic data from pediatric patients who had severe burns (>30% of the total body surface area burned) and underwent cross-limb stable isotope infusions between 1999 and 2008 as part of prospective clinical trials. Mixed multiple regression models were used to assess associations between patient/injury characteristics and muscle protein fractional synthesis rate (FSR), net balance (NB), and rates of phenylalanine appearance (Ra; index of protein breakdown) and disappearance (Rd; index of protein synthesis) across the leg. Results: A total of 268 patients who underwent 499 studies were analyzed. Increasing time post injury was associated with greater FSR (p < 0.001) and NB (p = 0.01). Males were more catabolic than females (as indicated by lower NB, p = 0.04 and greater Ra, p = 0.008), a consequence of higher protein breakdown rather than lower synthesis. Increasing burn size was associated with higher protein synthesis rate (as indicated by higher FSR, p = 0.019) and higher protein breakdown rates (as indicated by greater Ra, p = 0.001). FSR was negatively associated with age (p < 0.001). Conclusions: Data from this large patient cohort show that injury severity, sex, and time post injury influence skeletal muscle wasting in burned children. These findings suggest that individual patient characteristics should be considered when devising therapies to improve the acute care and rehabilitation of burn survivors.

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