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Urinary Excretion of 5-L-Oxoproline (Pyroglutamic Acid) Is Increased during Recovery from Severe Childhood Malnutrition^1,2, and Responds to Supplemental Glycine

Institute of Human Nutrition, University of Southampton, Bassett Crescent East Southampton SO16 7PX, United Kingdom ^* Tropical Metabolism Research Unit, University of the West Indies, Mona, Kingston 7, Jamaica

We hypothesized that a limitation in the endogenous formation of glycine might constrain catch-up growth during recovery from severe childhood malnutrition. The urinary excretion of 5-L-oxoproline is increased when the glycine available for glutathione synthesis is limited. Urinary excretion of 5-L-oxoproline was measured throughout recovery in 12 children (aged 16 ± 6 mo) with severe malnutrition. Urinary 5-L-oxoproline was similar at admission and after recovery, but was increased significantly during rapid catch-up growth. There was a significant relationship between the rate of weight gain and 5-L-oxoproline excretion in urine. In nine children (aged 15 ± 5 mo), the effect of oral supplementation with glycine, [1.7 mmol/(kg·d) for 48 h] during rapid catch-up growth on 5-L-oxoprolinuria and blood glutathione concentration was determined. In seven of the nine children weight gain was less than 17 g/(kg·d) and following oral glycine supplements 5-L-oxoproline excretion was reduced up to 64% and blood glutathione concentration increased up to 100%. In the two children who were gaining weight at a rate >17 g/(kg·d), glycine supplementation was associated with a further increase in 5-L-oxoproline excretion and a decrease in blood glutathione. If 5-L-oxoproline is an index of the relative availability of glycine, then the data indicate that glycine may be limiting during rapid catch-up growth. This would have important implications for repletion of muscle and gain in height.

KEY WORDS: • catch-up growth • glutathione • human protein requirements • amino acids • nitrogen

¹ Supported in part by the Nestlé Nutrition Research Grant Fund

² The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 USC section 1734 solely to indicate this fact.

³ To whom correspondence should be addressed.

Manuscript received 26 February 1996. Revision accepted 23 July 1996.

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