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In 2019, the French National Authority for Health (Haute Autorité de Santé, HAS) published guidelines on the diagnosis of undernutrition. The present article focuses on the impact of switching from the 2012 guidelines of the Nutrition Committee of the French Paediatric Society (CNSFP) to the HAS guidelines on the frequency of hospital undernutrition in children. We selected for the period 2010-2019 from the ePINUT database: (1) all children aged more than 2 years with (2) clinically confirmed nutritional status in (3) French sites. The frequency of undernutrition was 15.4% vs. 28.8% using the CNSFP and HAS criteria, respectively (p 0.01; n = 6304). When compared to non-malnourished children regardless of the criteria used, malnourished children: (1) stayed longer in hospital (CNSFP: 9.0 ± 11.8 vs. 6.5 ± 8.7 days, p 0.01; HAS: 7.8 ± 10.1 vs. 6.4 ± 8.4 days, p 0.01), (2) gained more weight during hospitalization (% of weight at admission) (CNSFP: +1.4 ± 4.1 vs. -0.3 ± 3.5%, p 0.01; HAS: +2.3 ± 4.7 vs. -0.1 ± 3.4%, p 0.01), and (3) received nutritional support more frequently during hospitalization (CNSFP: 20% vs. 5%, p 0.01; HAS: 13% vs. 4%, p 0.01). Switching to the HAS guidelines resulted in an almost twofold higher frequency of undernutrition in hospitalized children. Initiation of nutritional care remained low considering the nutritional status. The present study warrants interventional studies to determine which children may benefit more from nutritional therapy to improve their outcome.

International audience; Reducing the burden of non-communicable diseases (NCDs) is one of the top priorities of public health policies worldwide. One of the recognized means of achieving this objective is to improve the diet quality. The Nutri-Score (N-S) is a [five-color - A, B, C, D, E letters] front-of-pack labelling logo intended to help consumers quickly identify the healthier prepackaged foods within a food category. Available studies have shown that the N-S is an efficient tool to achieve this aim in terms of consumers' awareness, perception, understanding and purchasing and that its use may help to reduce the prevalence of NCDs. The N-S is currently implemented on a voluntary basis in seven European countries and a discussion is underway within the European Commission to achieve a harmonized mandatory label. However, no study on the putative impact of the N-S on children's dietary patterns and health is available. The N-S is not applicable to infants' and young children's formulas and to specific baby foods, the compositions of which are already laid down in European Union regulations. The N-S does not replace age-appropriate dietary guidelines. As children consume an increasing number of adult type and processed foods, the relevance of the N-S for children should be evaluated considering the children's high specific requirements, especially in younger children. This is especially necessary for fitting fat and iron requirements, whereas protein-rich foods should be better framed. Moreover, efforts should be made to inform on how to use the N-S and in education on healthy diets.

"Background and objective: Both food addiction (FA) and adult ADHD symptomatology have a significant impact on quality of life (QOL), which in turn may affect bariatric surgery outcomes in the context of severe obesity. The main objective of this study was to investigate the association between FA, ADHD symptomatology and QOL in the specific population of bariatric surgery candidates. Method: Three hundred and twenty-two adult bariatric surgery candidates were recruited during the systematic preoperative psychiatric assessment. The participants completed questionnaires assessing body mass index (BMI), QOL (QOL-Obesity, and Dietetics rating scale, QOLOD), FA (YFAS 2.0), and adult ADHD symptoms (ASRS). Results: Prevalence for FA and significant adult ADHD symptoms were 26.7% and 9% respectively. All QOL dimensions were negatively correlated with FA and adult ADHD symptoms. The age, the ASRS, and YFAS 2.0 scores independently predicted the QOL score. The participants with FA had significantly lower QOL scores on the five dimensions of the QOLOD. The participants with adult ADHD symptoms had significantly lower scores on the physical and psycho-social QOL dimensions only. Discussion: This study supports the hypothesis of FA and ADHD symptoms are associated with poorer QOL, in bariatric surgery candidates. Because they affect QOL and poorer surgery outcomes, investigation, and management of FA and ADHD symptoms may be interesting clinical interventions."

International audience; N natural isotope abundance (NIA) is systematically higher in infants’ hair than in that of their mothers at birth. This study aimed to investigate this difference in plasma pools. We compared 15N NIA values for plasma amino acid (AA) pools (free + protein-bound) in the umbilical cord artery (UCA) and vein (UCV) and in the maternal vein (MV) at birth. This preliminary study included 7 mother–infant dyads. Whole plasma was treated (HCl) to hydrolyze protein. Following derivatization, AAs were separated using gas chromatography and compound-specific 15N NIA values were measured on-line using an isotope ratio monitoring mass spectrometer. 15N NIA plasma AA pools in the UCA and UCV were highly correlated to the MV, r2 > 0.89 and r2 > 0.88 (both P

Vitamin deficiencies have a serious impact on healthy aging in older people. Many age-related disorders have a direct or indirect impact on nutrition, both in terms of nutrient assimilation and food access, which may result in vitamin deficiencies and may lead to or worsen disabilities. Frailty is characterized by reduced functional abilities, with a key role of malnutrition in its pathogenesis. Aging is associated with various changes in body composition that lead to sarcopenia. Frailty, aging, and sarcopenia all favor malnutrition, and poor nutritional status is a major cause of geriatric morbidity and mortality. In the present narrative review, we focused on vitamins with a significant risk of deficiency in high-income countries: D, C, and B (B6/B9/B12). We also focused on vitamin E as the main lipophilic antioxidant, synergistic to vitamin C. We first discuss the role and needs of these vitamins, the prevalence of deficiencies, and their causes and consequences. We then look at how these vitamins are involved in the biological pathways associated with sarcopenia and frailty. Lastly, we discuss the critical early diagnosis and management of these deficiencies and summarize potential ways of screening malnutrition. A focused nutritional approach might improve the diagnosis of nutritional deficiencies and the initiation of appropriate clinical interventions for reducing the risk of frailty. Further comprehensive research programs on nutritional interventions are needed, with a view to lowering deficiencies in older people and thus decreasing the risk of frailty and sarcopenia.

International audience; Objective.- The year 2020 marks the 10th consecutive year of the ePINUT study which is used for promoting awareness of hospital malnutrition in paediatric wards. The present article describes the methods and the studied population.Materials and methods. - ePINUT is a cross-sectional study gathering data each year over 2 weeks in March. Any child up to 18 years old, hospitalized except in neonatal and intensive care units could be included in this study. Length of hospitalization, weight variations and height were measured. An online calculator was made available for nutritional indices (http://www.epinut.fr/), in accordance with the French Paediatric Society guidelines. A geographic grouping was done based on university inter-regions.Results. - A total of 13,332 entries in France were included from 2010 to 2019. On a geographic level, 6 of the 7 regions contributed yearly to 10 to 15% of these entries, while the western region accounted for 25% of the entries (P < 0.001). Ninety-two cities participated, with 36% participating 5 to 9 years, 39% participating 2 to 4 years, and 26% participating once. The median age was 4 years old, 10.2% of children had a Weight-for-Height z-score smaller than -2 at admittance. These children stayed longer in the hospital (8.3 +/- 11.3 vs. 6.4 +/- 9.3 days, P = 0.02) and had a greater percent weight change during hospitalization (2.8 +/- 4.7 vs. 0.4 +/- 3.8%, P < 0.0001).Conclusion. - Such a long-term promotion of awareness about hospital malnutrition is unique. The future aim is to empower young patients and their parents and to get them involved in reducing hospital malnutrition in children. (c) 2021 Societe francophone nutrition clinique et metabolisme (SFNCM).

International audience; Obesity increases protein metabolism with a potential effect on nitrogen isotope fractionation. The aim of this study was to test the influence of obesity on human milk extracted protein 15N natural isotope abundance (NIA) at one month post-partum and to compare human milk extracted protein 15N NIA and bulk infant hair 15N NIA. This cross-sectional observational study involved 16 obese mothers (body mass index (BMI) ≥ 30 kg m−2 before pregnancy) matched with 16 normal-weight mothers (18.5 kg m−2 ≤ BMI

Food choices affect the isotopic composition of the body with each food item leaving its distinct isotopic imprint. The common view is that the natural abundance of the stable isotopes of nitrogen (expressed as &delta, 15N) is higher in animals than in plants that constitute our contemporary diets. Higher &delta, 15N is thus increasingly viewed as a biomarker for meat and fish intake. Here we show that organic compared to conventional farming increases plant &delta, 15N to an extent that can appreciably impact the performance of &delta, 15N as a biomarker. The error that can arise when organic plants are consumed was modelled for the entire range of proportions of plant versus animal protein intake, and accounting for various intakes of organic and conventionally grown crops. This mass balance model allows the interpretation of differences in &delta, 15N in light of organic food consumption. Our approach shows that the relationship between &delta, 15N and meat and fish intake is highly contextual and susceptible to variation at the population, community or group level. We recommend that fertilization practices and organic plant consumption must not be overlooked when using &delta, 15N as a biomarker for meat and fish intake or to assess compliance to nutritional interventions.

International audience

BACKGROUND Malnutrition is often underdiagnosed in hospitalised children, although it is associated with postoperative complications, longer hospital lengths of stay and increased healthcare-related costs. OBJECTIVE We aimed to estimate the frequency of, and identify factors associated with, malnutrition in children undergoing anaesthesia. DESIGN Cross-sectional observational study. SETTING Paediatric anaesthesia department at the University Children's Hospital, Bordeaux, France. PARTICIPANTS A total of 985 patients aged less than 18 years. MAIN OUTCOME MEASURES Anthropometric measurements, American Society of Anesthesiologists physical status classification score and the Pediatric Nutritional Risk Score (PNRS) recorded at the pre-anaesthesia evaluation. RESULTS When assessed as a Waterlow index less than 80%, malnutrition was present in 7.6% children. This increased to 8.1% of children assessed by clinical signs and to 11% of children when defined by a BMI less than the third percentile. In a univariate analysis, children with a BMI less than the third percentile were more often born prematurely (22.4 vs 10.4%; P = 0.0008), were small for gestational age at birth (18.4 vs 4.5%; P

Background Impaired nutritional status is adversely associated with suboptimal outcomes in critically ill children. Undernutrition at pediatric intensive care unit (PICU) admission ranges from 15 to 65%. A lack of knowledge of the nutritional status of children in French PICUs prevents us from specifically targeting education. This study aims to describe the nutritional status of children in French PICUs and to assess nutritional practices and physicians’ knowledge of nutrition, in order to focus NutriSIP (the French-speaking PICU nutrition group) future education programs. A prospective observational multicenter point prevalence study was conducted in French PICUs, recruiting all children admitted over three different weeks. Anthropometric measurements were taken (weight, height/length, mid-upper arm, and head circumferences), in order to calculate nutritional indices. Nutritional status was defined according to WHO Body Mass Index z-score and dynamic assessment based on growth faltering detection. Concurrently, PICU physicians and PICU nurses from seven French-speaking countries completed a survey to ascertain knowledge about local nutritional care practices and overall nutrition knowledge. PICU physicians’ responses were compared to PICU nurses’ responses (previously published). Results Four hundred and thirty-two children were included in the observational study from 27 French PICUs. Undernutrition was diagnosed in 18.5% of them, young age and underlying chronic condition being the two independent risk factors. Faltering growth was diagnosed in 4.8% and overweight in 7.4%. Subjective nutritional assessment was not accurate. Thirty-eight French-speaking PICUs completed the survey. These showed nutritional practices frequently did not comply with international guidelines, especially regarding nutritional goals, and the reasons for withholding enteral nutrition. Comparison between physicians’ and nurses’ responses to the survey showed large discrepancies. Conclusion Undernutrition is frequent at admission in French PICUs. Nutritional status should be assessed using a holistic approach, because of the potential impact on outcome. French-speaking PICU healthcare professionals need further nutrition education, in order to improve nutritional practices to comply with international recommendations. This study will serve as a baseline to focus NutriSIP teaching programs in the future. Electronic supplementary material The online version of this article (10.1186/s13613-019-0493-z) contains supplementary material, which is available to authorized users.

Protein-energy malnutrition (PEM) is poorly reported in cri du chat syndrome (CDCS) (OMIM #123450), a genetic disease that causes developmental delay and global growth retardation. The objective was to determine the nutritional status at different ages in children with CDCS and factors associated with PEM. A questionnaire focused on growth and nutritional care was sent to 190 families. Among 36 analyzable questionnaires, growth and nutritional indices compatible with PEM occurred in 47% of patients: 19% before 6 months of age, 24% between 6-12 months and 34% after 12 months. Eight patients received enteral feeding. Speech therapy for swallowing education was performed more often in malnourished children (63% vs. 22%, P < 0.02). PEM is frequent and occurs early in this disease, requiring closed nutritional monitoring.

Introduction: the exact mechanisms underlying the established association between ADHD and obesity remain unclear. Food addiction and binge eating may contribute to this link. We examined for the first time the association between childhood/adult ADHD and food addiction/binge eating in patients with obesity, as well as the association between ADHD and sleep apnea syndrome.Methods: we included 105 obese patients from the Nutrition Department of the University Hospital of Tours (France) between January and December 2014. We assessed categorical diagnoses of childhood/adulthood ADHD (semi-structured interview DIVA 2.0), food addiction (Yale Food Addiction Scale 2.0), binge eating (Binge Eating Scale), obstructive sleep apnea (clinical assessment), and BMI (clinical assessment).Results: patients with adult ADHD were at significantly higher risk of food addiction than patients without adult ADHD (28.6% vs. 9.1%; p = .016). Adult and childhood ADHD were significantly associated with self-reported food addiction, food addiction scores and binge eating scores, with a larger effect size for adult (ORs: 4.00 [1.29–12.40], 1.37 [1.14–1.65] and 1.08 [1.03–1.14], respectively) than childhood (ORs: 3.32 [1.08–10.23], 1.29 [1.08–1.55] and 1.06 [1.01–1.11], respectively) ADHD. ADHD diagnosis was not significantly correlated to obstructive sleep apnea. Mean age of onset of ADHD preceded mean age of onset of obesity.Conclusion: ADHD diagnosis is associated with food addiction and binge eating, with a larger effect size for adult than childhood ADHD. Our results provide a strong rationale for further longitudinal research on the link between ADHD, food addiction, binge eating and obesity, paving the way for evidence-based therapeutic interventions for these patients.

OBJECTIVES AND STUDY: This study aimed at measuring the effect in normal to restricted protein diets with specific 15N natural isotopic abundance (NIA) given during gestation and/or lactation on the 15N NIA of fur, liver and muscle in dams and their offspring from birth to adulthood. The secondary aim was to study the effect of growth on the same parameters. METHODS: Female Balb/c mice were fed normal protein diet containing 22% protein or isocaloric low protein diet containing 10% protein throughout gestation. Dam's diets were either maintained or switched to the other diet until weaning at 30 days. All animals were fed standard chow thereafter. Offspring were sacrificed at 1, 11, 30, 60, 480 days and a group of dams at d1. Growth was modeled as an exponential function on the group followed up until 480 days. Fur, liver and muscle were sampled at sacrifice and analyzed for bulk 15N NIA. Fixed effects and interactions between fixed effects and random elements were tested by three-way ANOVA.[br/] RESULTS: Higher 15N NIA in the diet resulted in higher organ 15N NIA. Switching from one diet to another changed 15N NIA in each organ. Although dam and offspring shared the same isotopic environment during gestation, 15N NIA at day 1 was higher in dams. Growth rate did not differ between groups after 10 days and decreased between 1 and 5 months. 15N NIA differed between organs and was affected by growth and gestation/lactation.[br/] CONCLUSION: Dietary 15N NIA is a major determinant of the 15N NIA of organs. 15N NIA depended on organ and age (i.e. growth) suggesting an effect of metabolism and/or dilution space. Post-natal normal-protein diet of lactating dams could reverse the effect of a protein-restricted diet during gestation on the offspring growth. Measuring 15N NIA in various matrices may open a field of application particularly useful in studying the pre- and post-natal origins of health and disease

summary Background and aims: Nephropathy is a serious long-term complication in type 2 diabetic patients. Few data are available about nitrogen metabolism in diabetic nephropathy. Bulk 15 N natural isotopic abundance (NIA) in hair has been shown modified in different pathologies with altered protein metabolism. We have compared bulk 15 N NIA in hair proteins in type 2 diabetic patients to look for differences between groups with or without nephropathy. Methods: Case patients were type 2 diabetic patients with high urinary albumin concentrations (� 20 mg/L or 30 mg/24 h on two of three urine collections) and/or an estimated glomerular filtration rate (eGFR) below 60 mL min � 1 1.73 m � 2 , according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Control subjects were type 2 diabetic patients of the same geographical origin with long-term diabetes, normo-albuminuria and eGFR above 60 mL min � 1 1.73 m � 2 . The bulk 15 NN IA values for hair were measured by isotope ratio measurement mass spectrometry coupled with an elemental analyzer. Results: Thirty-three patients in the nephropathy group and 31 in the control group were included. The mean age of the participants was 69 ± 8 years, and the mean duration of diabetes was 22 ± 8 years. Bulk hair 15 N NIA were 8.9 ± 0.7‰ in the nephropathy group and 9.0 ± 0.5‰ in the control group (p ¼ 0.41). Positive correlations were found between bulk hair 15 N NIA with eGFR (p < 0.01) and with urinary urea concentration (p < 0.01), and a negative correlation with the urinary albumin-to-creatinine ratio (p < 0.001). Conclusions: Bulk hair

Epigenetics is defined as the modulation of gene expression without changes to the underlying DNA sequence. Epigenetic alterations, as a consequence of in utero malnutrition, may play a role in susceptibility to develop adulthood diseases and inheritance. However, the mechanistic link between epigenetic modifications and abnormalities in nutrition remains elusive. This review provides an update on the association of suboptimal nutritional environment and the high propensity to produce adult-onset chronic illnesses with a particular focus on modifications in genome functions that occur without alterations to the DNA sequence. We will mention the drivers of the phenotype and pattern of epigenetic markers set down during the reprogramming along with novel preventative and therapeutic strategies. New knowledge of epigenetic alterations is opening a gate toward personalized medicine.

Objective: Nutrition during fetal life and early childhood is thought to play a crucial role in the risk for developing metabolic syndrome and cardiovascular diseases in the future adult and branched chain amino acids (BCAA) intake may play a role in the development of obesity. The aim of this study was to compare the breast milk amino acid profiles of obese and normal weight (control) breast-feeding mothers. Methods: Fifty obese and 50 control breast-feeding mothers were enrolled. Age and parity were similar in both groups. Breast milk samples were collected at the end of the first month of lactation. Free amino acid (FAA) concentrations in breast milk were determined by ultra-performance liquid chromatography tandem mass spectrometry. Comparisons between groups were performed using a two-tailed paired t test. Results: We analyzed 45 breast milk samples from each group. Body mass index was 34.3 +/- 3.9 kg/m(2) in the obese group and 21.6 +/- 1.4 kg/m(2) in the control group (P < 10(-4)). BCAA concentrations were higher in breast milk of obese mothers (95.5 +/- 38.2 mu M versus 79.8 +/- 30.9 mu M; P = 0.037), as was tyrosine concentration (13.8 +/- 7.1 mu M versus 10.6 +/- 5.2 mu M; P = 0.016). Conclusion: The mature breast milk of obese mothers contained 20% more BCAA and 30% more tyrosine than breast milk of control mothers. Whether altered breast milk FAA profile affects metabolic risk in the breast-fed child remains to be explored. (C) 2016 Elsevier Inc. All rights reserved.

Resume Les donnees epidemiologiques concernant la nutrition enterale a domicile (NED) correspondent a des estimations peu precises. L’evolution tres recente du cadre legislatif a rendu possible les etudes d’incidence et de prevalence de la NED. Patients et methodes Il s’agit d’une etude retrospective observationnelle, realisee grâce aux Caisses primaires d’Assurance maladie, qui ont fourni pour les annees 2011 et/ou 2012, (1) le nombre annuel de patients ayant debute une NED, (2) le nombre annuel de patients ayant beneficie d’un forfait de NED avec ou sans pompe. L’incidence et la prevalence ont ete obtenues en rapportant ces nombres a la population cible (population « protegee » par l’Assurance maladie). Resultats Quinze regions (39,8 millions d’habitants) ont fourni leurs donnees ; l’incidence moyenne de la NED etait de 24,9/100 000 habitants/an et la prevalence moyenne de 57,3/100 000 habitants/an. Les disparites regionales sont importantes pour les taux d’incidence (13,0 a 47,6) comme ceux de prevalence (29,1 a 96,2). Les incidences et prevalences sont plus elevees que les moyennes apres 40 ans et surtout apres 60 ans. Conclusion Il s’agit de la premiere etude qui determine de maniere fiable l’incidence et la prevalence de la NED en France. Ainsi la projection de ces chiffres pour une population francaise estimee en 2012 a 65,5 millions (INSEE) amene a une estimation d’environ 37 500 patients pris en charge par an en NED. L’analyse des disparites regionales doit necessiter des etudes ulterieures.

Resume L’estimation du metabolisme proteique par perfusion d’acides amines marques par des isotopes stables, non radioactifs, est une methode employee en recherche clinique et difficile a mettre en œuvre au lit du patient pour adapter l’apport proteique. Il manque un marqueur simple, fiable et non invasif utilisable en clinique. Nous nous sommes tournes vers la mesure de l’enrichissement naturel en azote 15 du cheveu comme index de la synthese de keratine, la proteine du cheveu. Le cheveu est coupe a sa base, prepare puis soumis a une combustion totale avant que les gaz produits soient analyses par spectrometrie de masse de rapports isotopiques (SMRI). Plus le metabolisme proteique est intense plus l’enrichissement naturel dans le cheveu est eleve a cause d’un « effet isotopique ». Nous avons recemment montre que l’enrichissement du cheveu du nouveau-ne etait plus eleve que celui de sa mere traduisant l’intensite du metabolisme proteique fœtal. Nous travaillons actuellement sur les mecanismes qui modulent l’enrichissement en isotopes stables au sein de proteines d’interet. Les applications sont multiples en clinique humaine (epidemiologie nutritionnelle des populations, nutrition de l’homme malade).

Summary Background & aims Several single-center studies have reported malnutrition among hospitalized children in France. The aim of this survey was to estimate the frequency of malnutrition and the clinical factors associated with it in a large number of centers including medical and surgical wards in university and non-university hospitals. Methods This multi-center one-day cross-sectional survey took place in the third week of March 2011. All participating centers followed the same diagnostic procedure. Intensive care units and emergency rooms were excluded. All children admitted on the same day were weighed and measured. Any child with a body mass index below the third centile for age and sex underwent clinical examination. Associations between clinical factors recorded in the diagnostic procedure and malnutrition (Z-WFH Results Fourteen pediatric departments (32 pediatric wards) throughout France participated in the study. Data were collected in 1063 cases and analyzed in 923. Median age was 6.0 years (1 day to 16 years). Malnutrition was observed in 12% and was associated with height faltering in 2.5% of the whole population. Among the 625 children with a documented diagnosis, 52% were hospitalized for chronic disease. Only muscle loss and disability remained significantly associated with Z-WFH 97th centile (overweight including obesity) was seen in 14% of hospitalized children. Conclusion One in 10 hospitalized children was affected by malnutrition. The present survey is first to investigate a wide variety of pediatric wards throughout France. The initiative must be repeated in order to increase awareness of malnutrition in pediatric hospitals.

National audience; No abstract

International audience; La mesure de l’enrichissement naturel en 15N dans les protéines humaines permet d’estimer la synthèse protéique. Le numéro d’avril des CND 2013 montre que cette mesure est utilisée dans des domaines aussi différents que l’anthropologie [1] et la pédiatrie [2]. En anthropologie, la différence d’enrichissement naturel en 15N entre la racine dentaire (protéines enformation au moment du décès) et la table osseuse (protéines formées durant la période de vie) est utilisée pour estimer le moment du sevrage. L’hypothèse est que l’enrichissement naturel diminue lorsque le lait maternel est remplacé par la nourriture de sevrage avec donc un enrichissement osseux plus important que celui de la racine dentaire. En pédiatrie,l’enrichissement est mesuré au niveau des protéines du cheveu (prélèvement non invasif) et comparé à l’enrichissement du lait maternel chez des enfants exclusivement allaités. La capacité à enrichir le cheveu par rapport au lait est interprétée comme un index de l’intensité de la synthèse protéique propre au jeune âge. approches se complètent donc et ouvrent de nouvelles perspectives dont voici le rationnel.

International audience; Background & aims: Glutamine is a potent gluconeogenic precursor and stimulates insulin secretion. Glutamine's effect on glucose metabolism in Duchenne muscular dystrophy (DMD) has never been studied. To determine plasma glucose and insulin concentrations measured during and after glutamine administration in DMD boys. We hypothesized that glutamine can modulate whole body glutamine glucose metabolism in DMD, a genetically determined disease. Methods: As secondary endpoints of a randomized crossover trial in 30 prepubertal DMD boys, we measured fasting blood glucose, insulin and the Homeostasis Model Assessment (HOMA) index after daily oral glutamine (0.5 g kg(-1) d(-1)) for 4 months versus placebo. In a separate time series trial in 6 prepubertal DMD boys, we measured the same endpoints as well as plasma glutamine and whole body glucose turnover (Ra,glc) (primed continuous i.v. infusion of D-[6,6-D-2]glucose), while participants received acute oral glutamine (0.5 g kg(-1) d(-1)) continuously for 5 h. Results: In the randomized trial, baseline measurements of HOMA correlated with age (r = 0,51, p = 0.007) and percent fat estimated by bioelectrical impedance analysis (BIA) (r = 0.39, p = 0.047). After 4 months glutamine supplementation, we observed no treatment or order effect on HOMA or insulin. During acute glutamine for 5 h (time series trial), plasma glutamine doubled and was associated with lincreased plasma insulin concentration (10.42 +/- 2.54 vs 7.32 +/- 1.86, p = 0.05) with no effect on plasma glucose, HOMA or Ra,glc. Conclusions: Acute glutamine transiently stimulates insulin secretion in DMD boys, which could be mediated by plasma glutamine concentrations. Fasting insulin concentration and HOMA might provide quantifiable indices of disease progression. (C) 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

International audience