Impact of Dietary Protein on the Management of Pediatric Short Bowel Syndrome

Essential amino acids (AAs) play a key role in stimulating intestinal adaptation after massive small gut resection. The nutritional effect of dietary amino acids during intestinal regrowth has received considerable attention in recent years. This review explores the significance of dietary amino acids in the nutritional management of infants and children with intestinal failure and short bowel syndrome (SBS) as reported in the medical literature over the last three decades. A literature search was conducted using electronic databases. Breast milk emerged as the first-line enteral regimen recommended for infants with SBS. Hydrolyzed formulas (HFs) or amino acid formulas (AAFs) are recommended when breast milk is not available or if the infant cannot tolerate whole protein milk. The superiority of AAFs over HFs has never been demonstrated. Although glutamine (GLN) is the main fuel for enterocytes, GLN supplementation in infants with SBS showed no difference in the child's dependence upon parenteral nutrition (PN). Circulating citrulline is considered a major determinant of survival and nutritional prognosis of SBS patients. Early enteral nutrition and dietary supplementation of AAs following bowel resection in children are essential for the development of intestinal adaptation, thereby eliminating the need for PN.

Automated summary

Essential amino acids are crucial in promoting intestinal adaptation after significant small gut resection. The role of dietary amino acids in the nutritional management of infants and children with intestinal failure and short bowel syndrome (SBS) has been extensively studied over the past three decades. Breast milk is recommended as the first-line enteral regimen for infants with SBS, and hydrolyzed formulas or amino acid formulas are recommended when breast milk is not available or tolerated. The superiority of amino acid formulas over hydrolyzed formulas has not been proven. Glutamine supplementation in SBS infants does not affect their dependence on parenteral nutrition. Circulating citrulline is considered an important indicator of survival and nutritional prognosis in SBS patients. Early enteral nutrition and dietary amino acid supplementation are essential for intestinal adaptation and reducing the reliance on parenteral nutrition after bowel resection in children.