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Tryptophan Requirement of the Enterally Fed Term Infant in the First Month of Life

Huang, Lisha*; Hogewind-Schoonenboom, Jacomine E.*; Zhu, Li; Kraaijenga, Juliette V.S.*; van Haren, Nicky P.C.§; Voortman, Gardi J.; Schierbeek, Henk*; Twisk, Jos W.R.||; Huang, Ying; Chen, Chao; van Goudoever, Johannes B.*

Journal of Pediatric Gastroenterology & Nutrition: September 2014 - Volume 59 - Issue 3 - p 374–379
doi: 10.1097/MPG.0000000000000434
Original Articles: Hepatology and Nutrition

Objectives: Tryptophan not only is an amino acid essential to protein synthesis but also serves as a precursor in 2 important metabolic pathways: the serotonin and the kynurenine pathways. Tryptophan is related to sleeping patterns. The objective of the present study was to determine the tryptophan requirement of term infants using the indicator amino acid oxidation (IAAO) method with L-[1-13C]phenylalanine as the indicator.

Methods: Enterally fed infants were randomly assigned to tryptophan intakes ranging from 0.5 to 73 mg · kg−1 · day−1 as part of an elemental diet. After 1-day adaptation to the test diet, [13C]bicarbonate and L-[1-13C]phenylalanine tracers were given enterally. Breath samples were collected at baseline and during isotopic plateaus. The mean tryptophan requirement was determined by using the biphasic linear regression crossover analysis on the fraction of 13CO2 recovery from L-[1-13C]phenylalanine oxidation (F13CO2). Data are presented as mean ± standard deviation.

Results: A total of 30 term neonates (gestational age 39 ± 1 weeks) were studied at 9 ± 4 days. F13CO2 decreased until a tryptophan intake of 15 mg · kg−1 · day−1; additional increases in tryptophan intake did not affect F13CO2. Mean requirement was determined to be 15 mg · kg−1 · day−1.

Conclusions: The mean tryptophan requirement for elemental formula-fed term infants is 15 mg · kg−1 · day−1. This requirement is lower than the present recommended intake of 29 mg · kg−1 · day−1, which is based on the average intake of a breastfed infant.

*Department of Pediatrics, Academic Medical Centre, Emma Children's Hospital-AMC

Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands

Department of Pediatrics, Division of Neonatology, Children's Hospital of Fudan University, Shanghai, P.R. China

§UMC St. Radboud, Nijmegen

||Department of Methodology and Applied Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands

Department of Pediatrics, Division of Gastroenterology, Children's Hospital of Fudan University, Shanghai, P.R. China.

Address correspondence and reprint requests to Johannes B. van Goudoever, MD, PhD, Department of Paediatrics, Emma Children's Hospital, AMC, 9 Meibergdreef, PO Box 22660, 1100 DD Amsterdam, The Netherlands (e-mail:

Received 18 November, 2013

Accepted 4 May, 2014

The study formulas were manufactured by SHS, UK, and transportation to Shanghai was facilitated by Dumex, China. Financial support was received from Danone. The study sponsors had no influence on the study design, the analysis of the data, or the writing of the present manuscript. registration no. NTR1610.

L.H., J.E.H.-S., L.Z., and J.B.V. received research grants from Danone. The other authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,