{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:47:14Z","timestamp":1791478034751,"version":"4.3.4"},"reference-count":46,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2018,3,22]],"date-time":"2018-03-22T00:00:00Z","timestamp":1521676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Proteins are macro-molecules crucial for cell life, which are made up of amino acids (AAs). In healthy people, protein synthesis and degradation are well balanced. However, in the presence of hypercatabolic stimulation (i.e., inflammation), protein breakdown increases as the resulting AAs are consumed for metabolic proposes. Indeed, AAs are biochemical totipotent molecules which, when deaminated, can be transformed into energy, lipids, carbohydrates, and\/or biochemical intermediates of fundamental cycles, such as the Krebs\u2019 cycle. The biochemical consequence of hyper-catabolism is protein disarrangement, clinically evident with signs such as sarcopenia, hypalbuminemia, anaemia, infection, and altered fluid compartmentation, etc. Hypercatabolic protein disarrangement (HPD) is often underestimated by clinicians, despite correlating with increased mortality, hospitalization, and morbidity quite independent of the primary disease. Simple, cheap, repeatable measurements can be used to identify HPD. Therefore, identification and treatment of proteins\u2019 metabolic impairment with appropriate measurements and therapy is a clinical strategy that could improve the prognosis of patients with acute\/chronic hypercatabolic inflammatory disease. Here, we describe the metabolism of protein and AAs in hypercatabolic syndrome, illustrating the clinical impact of protein disarrangement. We also illustrate simple, cheap, repeatable, and worldwide available measurements to identify these conditions. Finally, we provide scientific evidence for HPD nutritional treatment.<\/jats:p>","DOI":"10.3390\/nu10040391","type":"journal-article","created":{"date-parts":[[2018,3,22]],"date-time":"2018-03-22T14:39:31Z","timestamp":1521729571000},"page":"391","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Protein-Amino Acid Metabolism Disarrangements: The Hidden Enemy of Chronic Age-Related Conditions"],"prefix":"10.3390","volume":"10","author":[{"given":"Evasio","family":"Pasini","sequence":"first","affiliation":[{"name":"Scientific Clinical Institutes Maugeri, IRCCS Lumezzane, Cardiac Rehabilitation Division, 25065 Lumezzane (Brescia), Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0326-0644","authenticated-orcid":false,"given":"Giovanni","family":"Corsetti","sequence":"additional","affiliation":[{"name":"Division of Human Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa, 11-25124 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Aquilani","sequence":"additional","affiliation":[{"name":"Department of Biology and Biotechnology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Romano","sequence":"additional","affiliation":[{"name":"Division of Human Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa, 11-25124 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7032-3487","authenticated-orcid":false,"given":"Anna","family":"Picca","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, 00198 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5472-2365","authenticated-orcid":false,"given":"Riccardo","family":"Calvani","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, 00198 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Dioguardi","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,3,22]]},"reference":[{"key":"ref_1","unstructured":"Lehninger, A.L. (1982). Principles of Biochemistry, Worth Publishers Inc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1016\/j.jprot.2012.01.041","article-title":"Amino acids: Chemistry, functionality and selected non-post-translational modifications","volume":"75","author":"Bischoffa","year":"2012","journal-title":"J. Proteom."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/S0021-9258(17)41289-0","article-title":"Some relationships between the amino acid contents of proteins and their nutritive values for the rat","volume":"163","author":"Mitchell","year":"1946","journal-title":"J. Biol. Chem."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"856S","DOI":"10.1093\/jn\/131.3.856S","article-title":"Signalling pathways involved in translational control of protein synthesis in skeletal muscle by leucine","volume":"131","author":"Anthony","year":"2001","journal-title":"J. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1079\/PNS19830055","article-title":"Amino acids-their role as an energy source","volume":"42","author":"Woolfson","year":"1983","journal-title":"Proc. Nutr. Soc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"6A","DOI":"10.1016\/j.amjcard.2003.11.002","article-title":"Wasting and the substrate to energy controller pathway: A role for insulin resistance and amino acids","volume":"93","author":"Dioguardi","year":"2004","journal-title":"Am. J. Cardiol."},{"key":"ref_7","first-page":"59","article-title":"Energy metabolism of the heart: From basic concepts to clinical applications","volume":"19","author":"Taegtmayer","year":"1994","journal-title":"Curr. Prob. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1016\/S0735-1097(03)00946-X","article-title":"Is nutritional intake adequate in chronic heart failure patients?","volume":"42","author":"Aquilani","year":"2003","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1161\/01.CIR.96.2.526","article-title":"Hormonal changes and catabolic\/anabolic imbalance in chronic heart failure and their importance for cardiac cachexia","volume":"96","author":"Anker","year":"1997","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11E","DOI":"10.1016\/j.amjcard.2008.02.074","article-title":"Hypercatbolic syndrome: Molecular basis and effects of nutritional supplementation with amino acids","volume":"101","author":"Pasini","year":"2008","journal-title":"Am. J. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.jacc.2004.10.003","article-title":"Increased skeletal muscle amino acid release with light exercise in deconditioned patients with heart failure","volume":"45","author":"Aquilani","year":"2005","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1093\/ajcn\/82.5.1065","article-title":"Aging is associated with diminished accretion of muscle proteins after the ingestion of a small bolus of essential amino acids","volume":"82","author":"Katsanos","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Martone, A.M., Marzetti, E., Calvani, R., Picca, A., Tosato, M., Santoro, L., Di Giorgio, A., Nesci, A., Sisto, A., Santoliquido, A., and Landi, F. (2017). Exercise and Protein Intake: A Synergistic Approach against Sarcopenia. Biomed. Res. Int., 2672435.","DOI":"10.1155\/2017\/2672435"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.jamda.2011.01.003","article-title":"Sarcopenia: An undiagnosed condition in older adults. Current consensus definition: Prevalence, etiology, and consequences. International working group on Sarcopenia","volume":"12","author":"Fielding","year":"2011","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1093\/gerona\/gls229","article-title":"Is the optimal level of protein intake for older adults greater than the recommended dietary allowance?","volume":"68","author":"Volpi","year":"2013","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.jamda.2010.04.014","article-title":"Society for Sarcopenia, Cachexia, and Wasting Disease. Nutritional recommendations for the management of Sarcopenia","volume":"11","author":"Morley","year":"2010","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.jamda.2013.05.021","article-title":"Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE Study Group","volume":"14","author":"Bauer","year":"2013","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1562S","DOI":"10.1093\/ajcn\/87.5.1562S","article-title":"Role of dietary protein in the Sarcopenia of aging","volume":"87","author":"Short","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1146\/annurev.nutr.25.050304.092545","article-title":"Role of Dietary Proteins and Amino Acids in the Pathogenesis of Insulin Resistance","volume":"27","author":"Tremblay","year":"2007","journal-title":"Annu. Rev. Nutr."},{"key":"ref_20","first-page":"466","article-title":"The mini nutritional assessment review of the literature: What does it tell us?","volume":"10","author":"Guigoz","year":"2006","journal-title":"J. Nutr. Health Aging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/eurjhf\/hfr154","article-title":"Albumin levels predict survival in patients with heart failure and preserved ejection fraction","volume":"14","author":"Liu","year":"2012","journal-title":"Eur. J. Heart Fail."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/S0140-6736(96)07015-8","article-title":"Wasting as independent risk factor for mortality in chronic heart failure","volume":"349","author":"Anker","year":"1997","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1093\/ajcn\/84.3.475","article-title":"The underappreciated role of muscle in health and diseases","volume":"84","author":"Wolfe","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s13539-012-0059-5","article-title":"The obesity paradox in chronic disease: Facts and numbers","volume":"3","author":"Lainscak","year":"2012","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Aquilani, R., Opasich, C., Viglio, S., Iadarola, P., and Pasini, E. (2008). Nutrition in acute decompensation of patients with acute heart failure syndrome. Acute Heart Failure, Springer.","DOI":"10.1007\/978-1-84628-782-4_81"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.phrs.2013.06.006","article-title":"The enemy within. How to identify chronic diseases induced-protein metabolism impairment and its possible pharmacological treatment","volume":"76","author":"Pasini","year":"2013","journal-title":"Pharmacol. Res."},{"key":"ref_27","unstructured":"Magnani, R. (1997). Sampling guide. Food and Nutrition Technical Assistance (FANTA) Project, Academy for Educational Development."},{"key":"ref_28","unstructured":"Cogil, B. (2003). Anthropometric indicators measurement guide. Food and Nutrition Technical Assistance (FANTA) Project, Academy for Educational Development."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Frisancho, R. (1990). Anthropometric Standards for the Assessment of Growth and Nutritional Status, The University of Michigan Press.","DOI":"10.3998\/mpub.12198"},{"key":"ref_30","unstructured":"Watson, R.R. (1984). Nutritional stresses: Levels of complement proteins and their functions. Nutrition, Disease Resistance and Immune Function, Marcel Dekker."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/elps.200800565","article-title":"A rapid method for simultaneous determination of creatine, 1-and 3 methyhistidine in human urine","volume":"30","author":"Ferrari","year":"2009","journal-title":"Electrophoresis"},{"key":"ref_32","first-page":"226","article-title":"A practical method to diagnose muscle degradation in normo-nourished patient with chronic heart failure","volume":"2","author":"Aquilani","year":"2009","journal-title":"Int. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1067\/mhj.2001.115792","article-title":"Relative lymphocyte count: A prognostic indicator of mortality in elderly patients with congestive heart failure","volume":"142","author":"Acanfora","year":"2001","journal-title":"Am. Heart J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.jchf.2015.10.009","article-title":"Pathogenic Gut Flora in Patients with Chronic Heart Failure","volume":"4","author":"Pasini","year":"2016","journal-title":"JACC Heart Fail."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1007\/s40520-016-0605-7","article-title":"Plasma kinetics of essential amino acids following their ingestion as free formula or as dietary protein components","volume":"29","author":"Rondanelli","year":"2017","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1093\/ajcn\/78.2.250","article-title":"Essential amino acids are primarily responsible for the amino acid stimulation of muscle protein anabolism in healthy elderly adults","volume":"78","author":"Volpi","year":"2003","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"22E","DOI":"10.1016\/j.amjcard.2008.02.077","article-title":"Amino Acids and mitochondrial biogenesis","volume":"101","author":"Nisoli","year":"2008","journal-title":"Am. J. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.cmet.2010.08.016","article-title":"Branched-chain amino acid supplementation promotes survival and supports cardiac and skeletal muscle mitochondrial biogenesis in middle-aged mice","volume":"12","author":"Ragni","year":"2010","journal-title":"Cell Metab."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1113\/jphysiol.2007.134593","article-title":"Nutrient signalling in the regulation of human muscle protein synthesis","volume":"582","author":"Fujita","year":"2007","journal-title":"J. Physiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"104E","DOI":"10.1016\/j.amjcard.2008.03.008","article-title":"Oral amino acid supplementation improve exercise capacities in elderly patients with heart failure","volume":"101","author":"Aquilani","year":"2008","journal-title":"Am. J. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"78E","DOI":"10.1016\/j.amjcard.2008.03.005","article-title":"Impairment in walking capacity and myocardial function in the elderly: It is a role for non-pharmacologic therapy with nutritional amino acid supplementation?","volume":"101","author":"Scognamiglio","year":"2008","journal-title":"Am. J. Cardiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/j.ejheart.2008.09.002","article-title":"Adequate energy-protein intake is not enough to improve nutritional and metabolic status in muscle-depleted patients with chronic heart failure","volume":"10","author":"Aquilani","year":"2008","journal-title":"Eur. J. Heart Fail."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"69E","DOI":"10.1016\/j.amjcard.2008.03.004","article-title":"Nutritional supplements with oral amino acid misture increases whole body lean mass and insulin sensitivity in elderly subjects with Sarcopenia","volume":"101","author":"Solerte","year":"2008","journal-title":"Am. J. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"26E","DOI":"10.1016\/j.amjcard.2008.02.078","article-title":"Morphometric changes induced by amino acid supplementation in skeletal and cardiac muscles of old mice","volume":"101","author":"Corsetti","year":"2008","journal-title":"Am. J. Cardiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1093\/oxfordjournals.eurheartj.a060447","article-title":"Nutritional assessment and muscle energy metabolism in severe chronic congestive heart failure: Effects of long-term dietary supplementation","volume":"15","author":"Broqvist","year":"1994","journal-title":"Eur. Heart J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1743-7075-6-12","article-title":"Dietary Guidelines should reflect new understandings about adult protein needs","volume":"6","author":"Layman","year":"2009","journal-title":"Nutr. Metab."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/4\/391\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T14:58:08Z","timestamp":1760194688000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/4\/391"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,22]]},"references-count":46,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2018,4]]}},"alternative-id":["nu10040391"],"URL":"https:\/\/doi.org\/10.3390\/nu10040391","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,22]]}}}