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(Journal of Nutrition. 2000;130:2026-2031.)
© 2000 The American Society for Nutritional Sciences


Article

Protein-Bound D-Amino Acids, and to a Lesser Extent Lysinoalanine, Decrease True Ileal Protein Digestibility in Minipigs as Determined with 15N-Labeling1 ,2

Michael de Vrese3, Regine Frik, Nils Roos and Hans Hagemeister*

Federal Dairy Research Centre, Department of Physiology and Biochemistry of Nutrition, D-24103 Kiel, Germany and * Research Institute for the Biology of Farm Animals, Division of Nutritional Physiology, D-18059 Rostock, Germany

3To whom correspondence should be addressed.


    ABSTRACT
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Heat and alkali treatment of food may increase the concentrations of protein-bound D-amino acids and cross-links such as lysinoalanine (LAL). To examine how protein treatment affects digestibility, purified test meals [total protein 150 g/kg dry matter (DM), 0.44 MJ/(kg BW0.75 · d)] were prepared, containing (g/kg DM) casein, 75; ß-lactoglobulin, 50; or wheat protein, 40. Each was 15N-labeled. Test proteins were used either in their native form or after treatment for 6 or 24 h at 65°C, pH 10.5–11.5. Each meal was fed to nine adult miniature pigs (twofold complete cross-classification). Chyme was collected continuously over 33 h postprandially via T-fistulas in the terminal ileum, and digestibilities of test proteins and individual L- and D-amino acids were calculated on the basis of recovery of 15N and the respective amino acids in the chyme. Treatment of casein, ß-lactoglobulin or wheat protein for 24 h increased levels of D-amino acid residues. L-Asparagine and aspartate (L-Asx) were particularly susceptible; 14.7 ± 0.4, 11.7 ± 0.2 and 11.0 ± 0.9%, respectively, underwent racemization. LAL levels increased in parallel; 11.7 ± 0.3, 13.6 ± 0 and 14.8 ± 0.0%, respectively, of total lysine was converted to LAL. At the same time, prececal protein digestibility was decreased by 13.4 ± 2.3, 15.3 ± 1.4 and 17.8 ± 1.2% units, respectively (P < 0.05; mean ± SEM, n = 9). Digestibility of individual L-amino acids decreased by 10–15%, but L-amino acids prone to peptic cleavage, such as L-phenylalanine and L-tyrosine, were not affected. Digestibilities of D-amino acids and LAL were ~35%. It seems that mainly D-amino acids, and to a lesser extent LAL, were responsible for lower digestibility by interfering with peptic cleavage.


KEY WORDS: • miniature pigs • true protein digestibility • D-amino acids • lysinoalanine • 15N-labeling


    INTRODUCTION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Processing, particularly heat and/or alkali treatment, may increase concentrations of protein-bound D-amino acids in food and feed (Liardon and Ledermann 1986Citation , Man and Bada 1987Citation , Schwass and Finley 1984Citation ). Protein damage may also lead to the formation of lysinoalanine (LAL)4 and other cross-links (Friedman 1979Citation ).

The existing literature provides conflicting information concerning whether levels of free as well as peptide- and protein-bound D-amino acids or cross-linked products such as LAL are responsible for loss of digestibility. Short D-amino acid–containing peptide fragments are less digestible than the L-enantiomers (Lister et al. 1995Citation , Pappenheimer et al. 1997Citation ). Schwass et al. (1983)Citation observed a delayed absorption of enzymatically prepared hydrolysates of alkali-treated proteins compared with the respective nontreated proteins. This group and Bunjapamai et al. (1982)Citation suggested that this phenomenon is explained mainly by racemization before hydrolysis because in both studies, the suppressed formation of LAL and other cross-links did not attenuate loss of digestibility. However, in a study of similar design, Possompes et al. (1983)Citation found that inhibition of cross-linking during alkali-treatment of proteins prevented the loss of digestibility.

We therefore decided to measure in vivo whether and how partial racemization of amino acids within a protein affects true digestibility and thus the nutritional value of the proteins, using Göttingen miniature pigs as a model. The in vivo determination of prececal digestibility is the method of choice because all other approaches are fraught with shortcomings. Growth studies might be affected by other causes of reduced growth in addition to reduced proteolysis. In vitro studies cannot take into account aspects relevant to absorption and thus overall digestion, such as the rate of D-amino acid transport in the mucosa. Results from measurements of in vivo digestibility over the entire digestive tract may be distorted by microbial activity in the hind gut or endogenous protein secretion (De Groot and Slump 1969Citation , Possompes et al. 1983Citation ).

All of these limitations are avoided in this study. Pigs compare well with humans with respect to both the anatomy of the digestive tract and the overall digestive physiology (Erbersdobler 1990Citation , Moughan et al. 1994Citation ). Although protein digestibility through the entire tract is somewhat higher in pigs, there is no difference in the degree of digestion up to the terminal ileum (Moughan and Rowan 1989Citation ). With respect to technical aspects, pigs are particularly suited because they may be fitted with a fistula in the distal ileum, allowing prececal chyme sampling. Wheat and milk proteins were chosen as the test proteins because they are of high nutritional value and are widely used in human nutrition.


    MATERIALS AND METHODS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Materials.

Components of the purified experimental diets and providers are listed in Table 1Citation . 15N-ammonium sulfate (10 atom%) was obtained from Medgenix (Ratingen, Germany) and 99% o-methyl-iso-urea hydrogen sulfate from Fluka (Deisenhofen, Germany). All other chemicals were of analytical grade and were obtained from Merck (Darmstadt, Germany).


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Table 1. Composition of the basal and experimental diets for adult miniature pigs

 
Test proteins.

15N-labeled cow’s milk was produced by continuously infusing 15N-ammonium sulfate (50 g/d, 10 d) into the rumen of lactating cows via a permanent cannula. 15N-casein was isolated by acid precipitation of the defatted milk at 37°C, pH 4.6, acid-washed three times and lyophilized. Purity was determined by SDS gel electrophoresis. 15N-ß-lactoglobulin was isolated by microfiltration (Maubois et al. 1987Citation ) in the State Institute for Dairy Research, Jokionen, Finland; 15N-labeled wheat was provided by Dr. E. Fern, Nestlé, Vevey, Switzerland.

Aliquots of the labeled proteins were subjected to heat and alkali treatment. Suspensions (10%) of 15N-labeled casein, ß-lactoglobulin and wheat in 0.01 mol/L borate buffer were adjusted to pH 10.5–11.5 (depending on the protein) with 5 mol/L NaOH, and were incubated at 65°C for 6 or 24 h. Then, alkali-treated casein and ß-lactoglobulin were precipitated at their respective isoelectric points (4.6 and 5.2), washed and lyophilized. The high starch content of the wheat protein preparation interfered with precipitation. However, when the incubate was first lyophilized and resuspended in water (22°C), the wheat protein precipitated readily. Conditions of treatment are outlined in Table 2Citation .


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Table 2. Conditions for racemization of the test proteins

 
To differentiate between the effects of cross-linking (measured as LAL) and D-amino acids on prececal digestibility, we further guanidinated part of the casein under conditions that led to a reduction of LAL, whereas D-amino acid content did not change. This phenomenon was observed in an earlier study (de Vrese et al. 1994Citation ). In short, an aqueous suspension (200 g/L) of the 15N-labeled, 24-h heat- and alkali-treated casein was guanidinated with o-methyl-iso-urea (95 h at 4°C, pH 10.5), which means that lysine residues were modified at the {epsilon}-NH2-group. Then the material was acid-precipitated at the isoelectric point (pH 4.6) and washed three times with water at pH 4.6, according to Schmitz et al. (1991)Citation .

Animals.

Experimental animals were adult male Göttingen miniature pigs (n = 9; age 16–18 mo; initial body weight 32–35 kg; final weight 45–55 kg), bred in our animal facility from a strain supplied by the Institut für Tierzucht und Haustiergenetik, Universität Göttingen, Germany. Pigs were housed individually in metabolic cages at 19–21°C and 55–70% relative humidity. The pigs were fitted with a T-cannula in the distal ileum, 10 cm proximal to the ileocecal valve (Schmitz et al. 1991Citation ).

All experimental procedures were approved by the Animal Care and Animal Ethics Committee of the Ministry of Environment of Schleswig-Holstein, Germany, and were carried out according to established guidelines for the care and use of laboratory animals.

Experimental protocol.

Two weeks before the onset of the experiments, the pigs were accustomed to a purified basal diet [390–410 g/d air-dried matter; protein (casein), 150 g/kg; metabolizable energy, 15.3 MJ/kg dry matter (DM); Table 1Citation ], given in two equal meals at 0600 and 1600 h, together with 1 L of water. Food was apportioned according to energy requirements [0.44 MJ/(kg body weight0.75 · d), i.e., body weight at the beginning of the respective protein periods described below]. Pigs had free access to water.

15N-labeled proteins were added to the basal diet at the expense of nonlabeled casein, such that the 15N concentration was identical in all diets and sufficiently high for measurement (15N-casein, 75 g/kg; 15N-ß-lactoglobulin, 50 g/kg; and 15N-wheat protein, 40 g/kg DM). Furthermore, 20 g/kg of the undigestible marker chromic oxide was added, to correct for losses of chyme not recorded by the T-cannula technique applied (Roos et al. 1994Citation , Schmitz et al. 1991Citation ). Overall there were nine test proteins (Table 2)Citation , i.e., four casein preparations (native form or heat- and alkali-treated for 6 or 24 h, and the 24-h treated and guanidinated casein), three ß-lactoglobulin preparations (native form or heat- and alkali-treated for 6 or 24 h) and two wheat protein preparations (native form or heat- and alkali-treated for 24 h), labeled with 15N each. All diets were tested in all nine miniature pigs.

There were three separate experimental periods for casein, ß-lactoglobulin and wheat protein. Within each protein period, diets with the various modifications of the protein were distributed to the nine pigs as a twofold complete cross classification. Therefore, the minor weight gain of the adult pigs between the separate trials within one period was not taken into account.

After the pigs were deprived of food for 14 h, the test diets were given as single morning meals (204 g), at least 2 wk apart. Ileal chyme was collected postprandially for 33 h. Chyme flow was blocked caudally to the fistula by inflating a balloon catheter (Rösch, Rommerlshausen, Germany). To avoid intestinal atonia, a complete occlusion of the intestine had to be avoided. Because of the ensuing minor loss of chyme to the ileocecal valve, the recovery of chromic oxide was <100%.

Chyme appearing at the fistula was immediately frozen in liquid nitrogen and stored at -20°C until lyophilization. The freeze-dried samples of the first 3 h and the successive 5-h periods were pooled, ground and passed through a sieve (0.5-mm pore size) before chemical analysis.

Analytical methods.

The test proteins and chyme lyophilizates were hydrolyzed for 24 h in 6 mol/L HCl at 105°C, and amino acids were determined on an amino acid analyzer (LC 5001, Biotronic, Maintal, Germany). The ratio of D- to L-amino acids was estimated by chiral phase capillary gas chromatography (Dani 8521, DANI, Monza, Italy) on chirasil-L- and D-Val stationary phases (Chrompack, Frankfurt, Germany), using N(O)-trifluoroacetyl- and pentafluoropropionyl-amino acid propyl esters (Frank 1990Citation ). The degree of racemization was determined only for some particularly racemization-prone amino acids, which were present in the treated protein at a relatively high concentration. Slowly racemizing amino acids were not determined because it would be difficult to distinguish between the low racemization due to alkali treatment and the unavoidable formation of D-amino acids during preparation for amino acid analysis.

Total nitrogen in the diet and in freeze-dried chyme samples was determined using the Kjeldahl method. Chromium was determined according to Stevenson and De Langen (1960)Citation . Measurement of the 15N-enrichment of the samples was performed on an isotope ratio mass spectrometer (delta e, Finnigan MAT, Bremen, Germany) as described previously by Roos et al. (1994)Citation .

Prececal digestibility of proteins and individual L- and D-amino acids is calculated as follows:


where Pd, Pc (µmol), Md and Mc (mg) denote the concentration/g DM of either the parameter of interest (P; 15N for protein digestibility, L- or D-amino acids) or the marker chromic oxide (M) in diet (d) or chyme (c), respectively.

Relatively high amounts of protein-bound D-amino acids, but not of lysinoalanine, were already measured in untreated proteins, mainly as a result of acidic hydrolysis during preparation for amino acid determination. D-Amino acid concentrations in treated proteins were corrected for these basal D-amino acid levels.

LAL was chosen as an indicator of alkali-induced cross-linking because LAL levels were higher in the alkali-treated proteins than levels of other cross-links such as lanthionine, ornithinoalanine and ß-aminoalanine (Friedman 1979Citation ) and because LAL is particularly relevant because of its nephrotoxicity and its inhibitory effect on digestion.

Statistics.

If not indicated otherwise, data shown are means ± pooled SEM, n = 9 pigs. Statistical evaluation was performed using the Statgraphics statistical package version 6.1, 1993 (Statistical Graphics, Rockwell, MD). The three test proteins were evaluated separately. Individual treatments of the same protein were compared by one-way ANOVA, followed by the Scheffé test (Scheffé 1953Citation ), except for comparison of D-amino acid digestibility of 6- vs. 24-h treated proteins, which was done using one-sided, paired t tests. Differences were considered significant at P < 0.05.


    RESULTS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Characterization of the test proteins.

Levels of D-amino acids and LAL of all test proteins increased with both duration of treatment and temperature (Table 3Citation ).


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Table 3. Proportion of selected L-amino acids that underwent racemization and the proportion of lysine converted to lysinoalanine (LAL) after proacessing in the test proteins1

 
Overall, the degree of racemization and cross-linking was comparable among proteins, but racemization differed among individual amino acids. Of the racemization-prone amino acids, aspartic acid plus asparagine (Asx), serine, and glutamic acid plus glutamine (Glx) were determined. Up to 15% of these amino acids were transformed to D-amino acids, and a similar proportion of lysine was converted to LAL; however, a lesser proportion of phenylalanine, alanine and tyrosine was racemized, at most up to 5%.

Effect of heat and alkali treatment on true prececal protein digestibility.

Heat and alkali treatment decreased prececal digestibility by up to 18% compared with control native proteins. This was true for all proteins tested and for all degrees of treatment (Table 4Citation ).


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Table 4. Influence of heat and alkali treatment of proteins on true 15N-digestibility up to the distal small intestine in adult miniature pigs123

 
Effect of lysinoalanine concentration on protein digestibility.

When the casein preparations containing varying amounts of protein-associated D-amino acids and LAL were tested, prececal 15N-recovery and consequently true prececal digestibility changed in parallel with the increase in D-amino acid (D-Asx) content, but were independent of LAL levels (Fig. 1Citation ).



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Figure 1. Influence on digestibility of casein with various concentrations of D-amino acids and lysinoalanine (LAL) in nine miniature pigs. The contribution of cross-linking to overall impairment of protein digestibility was determined by comparing three casein preparations, i.e., 6-h heat- and alkali-treated, 24-h treated (not guanidinated) and 24-h treated casein, which was further guanidinated with o-methyl-iso-urea. Guanidinated and not guanidinated 24-h treated caseins contained the same amount of protein-associated D-amino acids [14.4 ± 0.1 and 14.7 ± 0.4% D-aspartic acid + asparagine (Asx)], but the former contained approximately half as much LAL as its counterpart (6.0 ± 0.2 and 11.7 ± 0.3%). Values are means ± SEM. 15N-recovery from the terminal ileum instead of digestibility (=100 - recovery) is shown (mean ± SEM, n = 9 pigs). Different superscripts within a variable (D-Asx, LAL and 15N-recovery) indicate significant differences (P < 0.05).

 
Effect of racemization on prececal L- and D-amino acid digestibility.

Apparent prececal amino acid digestibility was determined for some of the particularly racemization-prone amino acids present in the labeled casein and wheat protein. Heat and alkali treatment significantly (P < 0.05) increased recovery in the ileal chyme of the L-enantiomers of some of the amino acids studied (L-Asx, L-serine and L-Glx), indicating a decrease in apparent digestibility by up to 17% (equivalent to 25% of the native protein digestibility), independent of the length of treatment (Table 5Citation ). However, recovery of other amino acids, such as L-phenylalanine and L-tyrosine, was not affected.


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Table 5. Apparent digestibility of selected L-amino acids in untreated and heat- and alkali-treated casein up to the distal small intestine in adult miniature pigs1234

 
The apparent digestibilities of D-Asx, D-Glx and D-phenylalanine were not significantly different from each other or from that of LAL and were between 28.7 and 38.8%, independent of the time of treatment and thus the degree of racemization of the test proteins. D-Alanine and D-tyrosine levels were too low to be determined with sufficient precision, whereas D-serine was already present at a relatively high concentration in the intestine of pigs not given partially racemized proteins, and was therefore not evaluated.


    DISCUSSION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
The effects of heat and alkali treatment on the true prececal digestibility of several dietary proteins (casein, ß-lactoglobulin and wheat protein) were determined. Overall, we found that heat and alkali treatment of proteins impaired digestibility far more than was assumed from previous in vitro proteolysis studies in which mixtures of proteolytic enzymes were used (Chung et al. 1986Citation ). This suggests that, in addition to a delayed enzymatic breakdown, absorption of released free D-amino acids and peptides containing D-amino acids and LAL may be delayed. This mechanism cannot be investigated in in vitro proteolysis studies. Furthermore, this study gives evidence that even relatively small amounts of D-amino acids and LAL within a protein impair digestibility in vivo. This impairment was already significant at a level of 8.5% D-Asx found in treated ß-lactoglobulin (24 h at 65°C, pH 10.5).

The question whether either D-amino acids and D-amino acid–containing peptides (Bunjapamai et al. 1982Citation ) or cross-links (Possompes et al. 1983Citation ) alone are responsible for this lower protein digestibility, or whether their effects are additive (Jenkins et al. 1984Citation ), had not been answered until now. Both racemization and cross-links were shown to inhibit proteolysis and decrease protein and peptide digestibility in in situ experiments using isolated loops of rat intestine (Lister et al. 1995Citation , Schwass et al. 1983Citation ).

The results of the experiments with the guanidinated caseins, in which the loss of digestibility was independent of LAL levels, offer strong evidence that D-amino acids are mainly responsible for the impaired digestibility, whereas LAL plays at most a minor role. This conclusion is in contrast to previously observed inhibitory effects of LAL on proteolysis (Friedman et al. 1985Citation , Savoie 1984Citation ). In contrast to earlier work in this field (Bunjapamai et al. 1982Citation , Jenkins et al. 1984Citation , Schwass et al. 1983Citation ), the different LAL concentrations obtained in this experiment were achieved by treatment of the protein preparation after racemization, which guaranteed that proteins were practically identical with respect to amino acid pattern.

The slower absorption of free (Jervis and Smyth 1959Citation ) and peptide-bound (Lister et al. 1995Citation , Pappenheimer et al. 1997Citation ) D- compared with L-amino acids might contribute to this decrease in protein digestibility. Clues concerning further mechanisms were provided by the measurement of the digestibility of individual amino acids. D-Amino acids and LAL showed the same low prececal digestibility of < 40%. This value was lower than might have been expected on the basis of earlier in vitro studies and was largely independent of the amino acid itself.

The apparent digestibility of the L-amino acids in native proteins was twice as high as that of the D-enantiomers. Heat and alkali treatment decreased prececal digestibility of the L-amino acids, L-serine, L-Asx and L-Glx, but not of others, including L-phenylalanine and L-tyrosine (Table 5)Citation . This loss of digestibility obviously does not correlate with the degree of racemization because the effect was already maximal after 6 h, although racemization increased further with a longer time of treatment (Table 3)Citation .

This phenomenon may be explained by the following line of arguments. During the digestive process, the endopeptidases pepsin and chymotrypsin attack mainly the peptide chain at bonds involving phenylalanine or tyrosine. Therefore, proteolysis of dietary proteins due to pepsin (in the stomach) and chymotrypsin (in the upper section of the small intestine) creates mainly peptides with the terminal amino acids phenylalanine or tyrosine. During further degradation of the peptides by carboxy- and aminopeptidases, these amino acids are the first to be cleaved and absorbed. Peptidic degradation proceeds up to the point at which there is a D-amino acid at the end of the peptide chain, inhibiting further activity of the exopeptidases and the release of absorbable peptides and free amino acids (Paquet et al. 1985Citation ). This means that digestibility of all amino acids remaining in these peptides is impaired. Amino acids that are substrates for exopeptidases would be largely unaffected.

Therefore, although many amino acids show only a low susceptibility toward racemization, their digestibility may nevertheless be markedly impaired. This implies that treatments such as those used here may have nutritional disadvantages. Even if essential amino acids were not racemized to D-enantiomers and would, after breakdown of the protein, be available for absorption, adjacent D-amino acids might nevertheless interfere with their absorption.

These findings are of considerable importance in animal nutrition, in which an impairment of protein digestibility far less than the 18% observed here translates into major economic costs. Feeding roller-dried milk powder to calves may impair their growth. Some NaOH and/or heat-treated feedstuffs may contain considerable amounts of D-amino acids, for example, as a consequence of alkaline detoxification of aflatoxines. Another example are protein concentrates that are left over when alcohol is produced from barley and wheat residues of starch production.

These results also have relevance for human nutrition. They show a diminished nutritive value for racemized, heat- and alkali-treated dietary proteins not only due to a reduction in L-amino acid content but also because of a diminished digestibility.

These findings would also be relevant to scientists who evaluate feed because the evaluation score of protein quality may become misleading. The "protein digestibility-corrected amino acid score," favored by the FAO/WHO (1990)Citation , calculates protein quality from the amino acid pattern, corrected for standard true protein digestibility and/or bioavailability of limited amino acids in rats. Because proteolysis of undigested dietary protein by the intestinal microflora is generally not accounted for, the protein digestibility is overestimated compared with the true prececal digestibility.

Nevertheless, at least in industrial countries, the impaired digestibility observed in this study should not be rated too highly with respect to its relevance for humans. First, more and more mild processing techniques have been used in recent years and second, there is generally a sufficient to superfluous protein supply.


    ACKNOWLEDGMENTS
 
We thank the staff of the Department of Physiology and Biochemistry of Nutrition of the Federal Dairy Research Center, Kiel, for expert technical assistance and care of the animals, T. Tupasela, Agricultural Research Center, Jokioinen, Finland, for preparation of labeled ß-lactoglobulin, and E. Fern, Nestlé, Vevey, Switzerland, for provision of labeled wheat.


    FOOTNOTES
 
1 Presented in part at the 7th International Symposium on Digestive Physiology in Pigs, May 1997, St. Malo, France [Frik, R., Hagemeister, H., Roos N. & de Vrese, M (1997) Effects of protein-bound D-amino acids on true protein digestibility determined by 15N- and homoarginine-labeling. In: Proceedings of the VIIth International Symposium on Digestive Physiology in Pigs, (Laplace, J.-P. Février, C. & Barbeau, A., eds.), pp. 395–399. EAAP-Publication no. 88, INRA, Saint Malo, France]; and at Bioavailability '97, May 1997, Wageningen, The Netherlands [de Vrese, M., Frik, R. & Hagemeister, H. (1997) Effect of D-amino acids and LAL on true protein digestibility. Bioavailability 97, Book of Abstracts 224, p. 125]; and In: Hagemeister, H., Frik, R., de Vrese, M. and Tupasela, T. (1999) Einfluß von proteingebundenen D-Aminosäuren auf die praecaecale Verdaulichkeit beim Schwein: Wissenschaftliche Mitteilungen der Bundesforschungsanstalt für Landwirtschaft (FAL), Tagungsband Aktuelle Aspekte bei der Erzeugung von Schweinefleisch, S193: 229–238. Back

2 Supported by Deutsche Forschungsgemeinschaft (Grant HA 456 2–1). Back

4 Abbreviations used: Asx, aspartic acid + asparagine; DM, dry matter; Glx, glutamic acid + glutamine; LAL, lysinoalanine. Back

Manuscript received September 28, 1999. Initial review completed October 29, 1999. Revision accepted April 3, 2000.


    REFERENCES
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 

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