Intermittent Bolus Feeding Has a Greater Stimulatory Effect on Protein Synthesis in Skeletal Muscle than Continuous Feeding in Neonatal Pigs

Abstract Background Orogastric tube feeding is indicated in neonates with an impaired ability to ingest food normally and can be administered with an intermittent bolus or continuous feeding schedule. Objectives The objectives were to 1) compare the long-term effect of continuous with intermittent feeding on growth using the newborn pig as a model, 2) determine whether feeding frequency alters lean tissue and fat mass gain, and 3) identify the signaling mechanisms by which protein deposition is controlled in skeletal muscle in response to feeding frequency. Design Neonatal pigs were fed the same amount of a balanced formula by orogastric tube either as an intermittent bolus meal every 4 h (INT) or as a continuous infusion (CON). Body composition was assessed at the start and end of the study by dual-energy X-ray absorptiometry, and hormone and substrate profiles, muscle mass, protein synthesis, and indexes of nutrient and insulin signaling were measured after 21 d. Results Body weight, lean mass, spine length, and skeletal muscle mass were greater in the INT group than in the CON group. Skeletal muscle fractional protein synthesis rates were greater in the INT group after a meal than in the CON group and were associated with higher circulating branched-chain amino acid and insulin concentrations. Skeletal muscle protein kinase B (PKB) and ribosomal protein S6 kinase phosphorylation and eukaryotic initiation factor (eIF) 4E–eIF4G complex formation were higher, whereas eIF2α phosphorylation was lower in the INT group than in the CON group, indicating enhanced activation of insulin and amino acid signaling to translation initiation. Conclusions These results suggest that when neonates are fed the same amounts of nutrients as intermittent meals rather than continuously there is greater lean growth. This response can be ascribed, in part, to the pulsatile pattern of amino acids, insulin, or both induced by INT, which enables the responsiveness of anabolic pathways to feeding to be sustained chronically in skeletal muscle.

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Continuous Feeding Does Not Blunt Skeletal Muscle Protein Synthesis and Lean Growth Compared to Intermittent Bolus Feeding in the Preterm Piglet (OR26-06-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz033.or26-06-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Marko Rudar ◽

Jane Naberhuis ◽

Hanh Nguyen ◽

Agus Suryawan ◽

Candace Style ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Weight ◽

Protein Synthesis ◽

Translation Initiation ◽

Muscle Protein ◽

Feeding Strategies ◽

Intermittent Bolus ◽

Lean Growth ◽

Continuous Feeding ◽

The Impact

Abstract Objectives Refining early feeding strategies for premature infants is essential for mitigating adverse outcomes of prematurity. In neonatal term piglets, continuous feeding blunts growth compared to intermittent bolus feeding. Our objective was to determine the impact of feeding modality on lean growth in preterm pigs. We hypothesized that intermittent bolus feeding can mitigate low lean growth rates in preterm neonates compared to continuous feeding. Methods Pigs obtained by C-section (105 d gestation; 952 ± 205 g body weight) were fitted with an umbilical artery catheter (later replaced with jugular vein catheter) and an orogastric tube for parenteral and enteral nutrition, respectively. Pigs were assigned to continuous (CONT; 7.5 mL/[kg·h]) or intermittent bolus (INT; 30 mL/kg every 4 h over 15 min) feeding for 21 d. Pigs initially received parenteral nutrition and were advanced to full oral feeds over 6 d (220 kcal/kg and 16 g/kg protein per day). Body composition (by DXA), plasma insulin, and skeletal muscle anabolic signaling and fractional protein synthesis rates (PS; L-[ring-2H5]phenylalanine) were determined in INT pigs in the postabsorptive (before a meal, INT-PA; n = 13) and postprandial (after a meal, INT-PP; n = 16) states and in CONT pigs (n = 14). Results Body weight gain, lean mass, and fat mass did not differ between INT and CONT pigs. Insulin was lower before feeding for INT pigs than CONT pigs (P < 0.05). Insulin increased with feeding for INT pigs and exceeded that of CONT pigs at 30 and 60 min (P < 0.01) before returning to baseline levels at 240 min. In the longissimus dorsi (LD), gastrocnemius, and soleus muscles, the abundance of the eIF4E·eIF4G complex, which is required for translation initiation, was greater in INT-PP and CONT pigs than INT-PA pigs (P < 0.01), but did not differ between INT-PP and CONT pigs. PS in the LD muscle was greater in INT-PP pigs than INT-PA pigs (P < 0.01), but did not differ between INT-PP and CONT pigs. Conclusions Continuous feeding does not blunt translation initiation and protein synthesis in skeletal muscle compared to intermittent bolus feeding in preterm piglets. The resulting absence of enhanced lean growth with intermittent bolus compared to continuous feeding contrasts with term piglets and may be a consequence of prematurity. Funding Sources USDA CRIS 6250-51000-055, NIH HD072891, and USDA NIFA 2013-67015-20438.

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Viscera and muscle protein synthesis in neonatal pigs is increased more by intermittent bolus than by continuous feeding

Pediatric Research ◽

10.1038/pr.2013.89 ◽

2013 ◽

Vol 74 (2) ◽

pp. 154-162 ◽

Cited By ~ 9

Author(s):

Samer W. El-Kadi ◽

María C. Gazzaneo ◽

Agus Suryawan ◽

Renán A. Orellana ◽

Roberto Murgas Torrazza ◽

...

Keyword(s):

Protein Synthesis ◽

Muscle Protein ◽

Muscle Protein Synthesis ◽

Neonatal Pigs ◽

Intermittent Bolus ◽

Continuous Feeding

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Intermittent Bolus Compared with Continuous Feeding Enhances Insulin and Amino Acid Signaling to Translation Initiation in Skeletal Muscle of Pigs Born at Term (P08-071-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz044.p08-071-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Agus Suryawan ◽

Samer El-Kadi ◽

Hanh Nguyen ◽

Marta Fiorotto ◽

Teresa Davis

Keyword(s):

Skeletal Muscle ◽

Protein Synthesis ◽

Amino Acid ◽

Translation Initiation ◽

Muscle Protein ◽

Muscle Protein Synthesis ◽

Intermittent Bolus ◽

Lean Growth ◽

Continuous Feeding ◽

Amino Acid Signaling

Abstract Objectives Our recent study in a piglet model of the human neonate born at full term showed that intermittent bolus feeding promotes greater rates of protein synthesis in skeletal muscle than continuous feeding, leading to an increase in lean growth. This enhanced rate of muscle protein synthesis with intermittent bolus feeding is associated with an increased activation of mTORC1-dependent translation initiation. However, the mechanism underlying this response is unknown. In this study, we aimed to identify the insulin and/or amino acid signaling components involved in the enhanced stimulation of lean growth by intermittent bolus compared to continuous feeding in term-born pigs. Methods Term piglets (2–3 d old) were fed for 21 d an equal amount (240 ml/kg body weight [BW]/d) of sow milk replacer containing 12.8 g protein and 175 kcal/kg BW/d. Feedings were administered by gastrostomy tube either as intermittent bolus meals every 4 h (INT) or by continuous infusion (CON). After 21 d, gastrocnemius muscle was collected from CON, INT-0 (before a meal) and INT-60 (60 min after a meal) groups. Upstream and downstream insulin and amino acid signaling components of relevance to mTORC1 activation and protein translation were measured. Results Phosphorylation of AKT and TCS2 was greater in INT-60 than in INT-0 and CON groups (P < 0.05). There was no significant difference between CON and INT groups in the phosphorylation of ERK 1/2 and AMPK. The association of Sestrin2, a leucine sensor, with GATOR2 was similar in CON and INT-0 but was lower in INT-60 (P < 0.05). The abundances of RagA-mTOR, RagC-mTOR, and Rheb-mTOR complexes were higher in INT-60 than in CON and INT-0 (P < 0.05). The phosphorylation of S6K1 and 4EBP1 was higher in INT-60 than CON and INT-0 groups (P < 0.05). Phosphorylation of eIF2alpha and eEF2 were not affected by treatments. Conclusions Our results demonstrate that, following a full-term birth, the enhanced rate of skeletal muscle protein synthesis and lean growth with intermittent bolus compared to continuous feeding is at least in part due to the enhanced activation of both insulin and amino acid signaling pathways leading to greater stimulation of translation initiation. Funding Sources NIH HD085573, USDA CRIS 6250-51000-055, NIH HD072891, USDA NIFA 2013-67015-20438.

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Pulsatile delivery of a leucine supplement during long-term continuous enteral feeding enhances lean growth in term neonatal pigs

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00479.2015 ◽

2016 ◽

Vol 310 (8) ◽

pp. E699-E713 ◽

Cited By ~ 8

Author(s):

Claire Boutry ◽

Samer W. El-Kadi ◽

Agus Suryawan ◽

Julia Steinhoff-Wagner ◽

Barbara Stoll ◽

...

Keyword(s):

Skeletal Muscle ◽

Protein Synthesis ◽

Enteral Feeding ◽

Oral Feeding ◽

Orogastric Tube ◽

Neonatal Pigs ◽

Lean Growth ◽

Continuous Feeding ◽

Pulsatile Delivery

Neonatal pigs are used as a model to study and optimize the clinical treatment of infants who are unable to maintain oral feeding. Using this model, we have shown previously that pulsatile administration of leucine during continuous feeding over 24 h via orogastric tube enhanced protein synthesis in skeletal muscle compared with continuous feeding alone. To determine the long-term effects of leucine pulses, neonatal piglets ( n = 11–12/group) were continuously fed formula via orogastric tube for 21 days, with an additional parenteral infusion of either leucine (CON + LEU; 800 μmol·kg−1·h−1) or alanine (CON + ALA) for 1 h every 4 h. The results show that body and muscle weights and lean gain were ∼25% greater, and fat gain was 48% lower in CON + LEU than CON + ALA; weights of other tissues were unaffected by treatment. Fractional protein synthesis rates in longissimus dorsi, gastrocnemius, and soleus muscles were ∼30% higher in CON + LEU compared with CON + ALA and were associated with decreased Deptor abundance and increased mTORC1, mTORC2, 4E-BP1, and S6K1 phosphorylation, SNAT2 abundance, and association of eIF4E with eIF4G and RagC with mTOR. There were no treatment effects on PKB, eIF2α, eEF2, or PRAS40 phosphorylation, Rheb, SLC38A9, v-ATPase, LAMTOR1, LAMTOR2, RagA, RagC, and LAT1 abundance, the proportion of polysomes to nonpolysomes, or the proportion of mRNAs encoding rpS4 or rpS8 associated with polysomes. Our results demonstrate that pulsatile delivery of a leucine supplement during 21 days of continuous enteral feeding enhances lean growth by stimulating the mTORC1-dependent translation initiation pathway, leading to protein synthesis in skeletal muscle of neonates.

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