The metabolic effects of multi-trace elements on parenteral nutrition for pediatric patients: A Randomized Control Trial and Metabolomic Research

Abstract Objectives: The recommended dose of multi-trace element injection Ⅰ (MTEI-(Ⅰ)), and the effects of MTEI-(Ⅰ) on nutrient metabolism were investigated by supplementing different doses of multi-trace element parenteral nutrition (PN) to severe pediatric subjects. Methods: Enrolled subjects were randomly divided into two groups: Group A (low-dose group) received MTEI-(I) at 1 mL/kg/d, and Group B (high-dose group) received MTEI-(I) at 2 mL/kg/d, with a maximum dose of 15 mL/d. Patient blood samples before PN, and five day after treatment were collected for trace element detection and metabolomics analyses. Results: After 5 days treatment, white blood counts (WBC), nitrogen (N), chromium (Cr), total bilirubin (TB), direct bilirubin (DB) and albumin (ALB) levels in both groups were variably decreased; of which, WBC (p=0.011) and Cr (p=0.007) levels of subjects in Group B were significantly decreased; Overall, after 5 days of treatment, manganese (Mn) and copper (Cu) levels were decreased, zinc (Zn) and selenium (Se) levels were increased. The increase of Zn (A: 0.170±0.479 VS B：0.193±0.900)and decrease of Cu (A: -0.240±0.382 VS B: -0.373±0.465) of subjects in group B were particularly greater than those in group A. After 5 days treatment, valine, leucine, isoleucine degradation (α-ketoisovaleric acid) products, taurine and hypotaurine metabolism (hypotaurine), arginine and proline metabolism (phosphocreatine), ketone body metabolism (acetoacetic acid and acetone), and other metabolic outputs were decreased (p＜0.05). For Group B, β-oxidation of very long chain fatty acids (hexacosanoic acid), arginine and proline metabolism (phosphocreatine), pentose phosphate metabolism (D-ribose), ketone body metabolism (acetone), citric acid cycle (succinic acid), purine metabolism (adenine), caffeine metabolism (dimethylxanthine) and pyruvate metabolism (acetyl phosphate) were variably decreased (p＜0.05) when compared with Group A at T5. Conclusions: Our work suggested that the high-dose administration of MTEI-(I) is safe for severe pediatric patients. It may alleviate inflammation and antioxidation, relieved hyper caused by stress, improved tissues-based hypoxia, and improved renal function. (Trial registration: ChiCTR-IPR-17013037. Registered 19 October 2017, http://www.chictr.org.cn/showproj.aspx?proj=22327)