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The Effect of Graded Intake of Glycyl-l-Tyrosine on Phenylalanine and Tyrosine Metabolism in Parenterally Fed Neonates with an Estimation of Tyrosine Requirement

Although tyrosine is considered indispensable during the neonatal period, its poor solubility has limited its inclusion in parenteral amino acid solutions to less than 1% of total amino acids. Dipeptides of tyrosine are highly soluble, have been shown to be well used and safe in animal models and humans, and, therefore, may be used as an effective means of providing tyrosine in the parenterally fed neonate. The goal of the present study was to determine the tyrosine requirement of the parenterally fed neonate receiving graded intakes of glycyl-l-tyrosine as a source of tyrosine. Thirteen infants receiving adequate energy (340 ± 38 kJ·kg-1·d-1) and protein (2.4 ± 0.4 g·kg-1·d-1) were randomized to receive parenteral nutrition with one of five graded levels of glycyl-l-tyrosine. The mean requirement and safe level of intake were estimated using a 1-13C-phenylalanine tracer and linear regression cross-over analysis that identified a break point in the response of label appearance in breath CO2 (F13CO2) and phenylalanine oxidation to graded tyrosine intake. Based on the mean estimates of whole-body phenylalanine oxidation, the tyrosine mean requirement and safe level of intake were found to be 74 mg·kg-1·d-1 and 94 mg·kg-1·d-1, respectively. This represents 3.1 and 3.9% of total amino acids, respectively, considerably higher than levels found in present commercially available pediatric amino acid solutions. These data raise concern regarding the adequacy of aromatic amino acid intake in the parenterally fed neonate.