Effect Of Glutamine-enriched Enteral Nutrition Research Articles

Efficacy of glutamine-enriched enteral feeding formulae in critically ill patients: a systematic review and meta-analysis of randomized controlled trials.

Critically ill patients usually suffer from catabolic stress that could lead to malnutrition and nutritional support therefore is essential to maintain lean body mass, improve metabolic and immune response and decrease rate of mortality and comorbidity in these patients. This meta-analysis was aimed to evaluate effect of glutamineenriched enteral nutrition in critically ill patients. In order to obtain randomized clinical trial studies (RCTs), international databases including MEDLINE and Google scholar and also electronic resources in Iran, including IRAN MEDEX, IRAN DOC, SID, Magiran were systematically searched without language and publication restriction before December 2014. The final included number of studies for meta-analysis was 10. The methodological quality of eligible studies was assessed by four investigators using the Jadad 5-point scale, a scale containing three items describing randomization, blinding and fate of participants. We analyzed data from the included studies using STATA version 12.0, and calculated a pooled odds ratio for dichotomous data and mean differences for continuous data with 95% confidence intervals (CIs). There was no significant difference in mortality in elevated pooled odds ratios (p-value=0.070). A funnel plot was drawn for evaluation of publication bias, but none was found. The fixed effect model shows significant reduction in gut permeability in who received enteral feeding enriched with glutamine (-0.84, 95% CI=-1.25 to -0.44), moreover the funnel plot did not show publication bias. Based on the available data, our meta-analysis showed that enteral glutamine (Gln) supplementation increased mortality rate, though non-significantly, but decreased gut permeability significantly.

Intestinal microbiota in allergic and nonallergic 1‐year‐old very low birth weight infants after neonatal glutamine supplementation

Previously, glutamine-enriched enteral nutrition in very low birth weight infants (VLBW) decreased the incidence of atopic dermatitis at age 1 year. The aim of this study was to determine whether this effect is related to changes in intestinal bacterial species that are associated with allergy, such as bifidobacteria, clostridium histolyticum, clostridium lituseburense (Chis/lit group) and Escherichia coli at age 1 year. Eighty-nine infants were eligible for this follow-up study, conducted at a Tertiary care hospital. Bifidobacteria, Chis/lit group and E. coli were measured by fluorescent in situ hybridization in faecal samples collected at age 1 year. Information on allergic and infectious diseases was previously determined by questionnaire. Seventy-two of 89 (81%) infants were participated. Prevalence of all studied species was not different between glutamine-supplemented and control groups. Allergic infants were less frequently colonized with bifidobacteria than nonallergic infants (p =0.04). Between neonatal period and 1 year, prevalence of bifidobacteria was increased (p < 0.001), of Chis/lit group was unchanged (p=0.84), and of E. coli was decreased (p < 0.001). The beneficial effect of glutamine-enriched enteral nutrition on the incidence of atopic dermatitis in the first year of life in VLBW infants is not related to changes in bifidobacteria, Chis/lit group or E. coli. Allergic VLBW infants are less frequently colonized with bifidobacteria compared to nonallergic VLBW infants.

Cytokine profiles in 1‐yr‐old very low‐birth‐weight infants after enteral glutamine supplementation in the neonatal period

In a previous study, we found that glutamine-enriched enteral nutrition in 102 very low-birth-weight (VLBW) infants decreased both the incidence of serious neonatal infections and atopic dermatitis during the first year of life. The aims of this follow-up study were to determine whether these beneficial effects are attended by changes in Th(1) and Th(2) cytokine profiles at age 1 yr. Furthermore, we studied changes in cytokine profiles during the first year of life in these VLBW infants. In total, 89 infants were eligible for the follow-up study (12 died, 1 exclusion due to a chromosomal abnormality). Th(1) (IFN-gamma, TNF- alpha and IL-2) and Th(2) cytokine (IL-10, IL-5, and IL-4) profiles following in vitro whole blood stimulation were measured at 1 yr. Cytokine profiles were measured in 59/89 (66%) infants. Glutamine-enriched enteral nutrition in neonatal period did not influence cytokine profiles at 1 yr. Cytokine profiles were not different in infants with and without allergic or infectious diseases. The beneficial effect of glutamine-enriched enteral nutrition on the incidence of serious neonatal infections and atopic dermatitis during the first year of life is not related to changes in the Th(1) and Th(2) cytokine profiles. Both Th(1) and Th(2) cytokine profiles increased during the first year of life in this cohort of VLBW infants.

Glutamine-Enriched Enteral Nutrition in Very Low-Birth-Weight Infants: Effect on the Incidence of Allergic and Infectious Diseases in the First Year of Life

van den Berg A, van Zwol A, Moll HA, Fetter WP, van Elburg RM. Arch Pediatr Adolesc Med. 2007;161(11):1095–1101 PURPOSE OF THE STUDY. To determine the effect of glutamine-enriched enteral nutrition in very low birth weight infants on the incidence of allergic and infectious diseases during the first year of life. The authors hypothesized that glutamine may enhance maturation of the immune response by shifting the fetal T-helper 2 (Th2) response toward Th1 cytokine responses in early infancy, leading to decreased allergic disease later in life. STUDY POPULATION. Infants with a gestational age of &amp;lt;32 weeks and/or birth weight of &amp;lt;1500 g who were admitted to a level III NICU were randomly assigned to receive enteral glutamine or control (l-alanine) supplementation. METHODS. Enteral glutamine supplementation (l-glutamine, 0.3 g/kg per day) was administered to the intervention group from 3 through 30 days of life. Validated questionnaires were later sent to the parents of all eligible children, when they were a corrected age of 1 year, to assess the incidence of allergic and infectious diseases during the child's first year of life. Bronchial hyperreactivity was defined by report of at least 3 of the following physician-diagnosed symptoms: dyspnea, wheezing, humming/sawing breath sounds, or nightly dry cough without rhinitis. RESULTS. Of 90 eligible infants, 77 participated (response rate: 86%). The risk for atopic dermatitis (AD) was lower in the glutamine-supplemented group (odds ratio: 0.13 [95% confidence interval: 0.02–0.97]). However, other outcomes did not differ between the intervention and control groups, such as incidence of bronchial hyperreactivity, upper respiratory tract infections, lower respiratory tract infections, and gastrointestinal infections. CONCLUSIONS. Glutamine-enriched enteral nutrition in very low birth weight infants decreased the incidence of AD during the first year of life but had no effect on the incidence of bronchial hyperreactivity and infectious diseases during the first year of life. REVIEWER COMMENTS. The sample size was relatively small and was not powered sufficiently, specifically to assess the incidence of bronchial hyperreactivity. Moreover, the corrected age of 1 year is too early for assessing the incidence of development of atopy and infections. Therefore, it is unclear as to whether AD was prevented or simply delayed in onset among this cohort.

Glutamine-Enriched Enteral Nutrition in Very Low-Birth-Weight Infants

To determine the effect of glutamine-enriched enteral nutrition in very low-birth-weight infants on the incidence of allergic and infectious diseases during the first year of life. Follow-up study. Tertiary care hospital. All surviving infants who participated in a trial of glutamine-enriched enteral nutrition in very low-birth-weight infants. Enteral glutamine supplementation (l-glutamine, 0.3 g/kg per day) from 3 through 30 days of life. The incidence of allergic and infectious diseases during the first year of life, as assessed by means of validated questionnaires. Seventy-seven of 90 infants (86%) participated in the follow-up study. Baseline patient, maternal, and environmental characteristics did not differ between the glutamine-supplemented (n = 37) and control (n = 40) groups, except for the incidence of serious neonatal infections and child care attendance. After adjustment for confounding factors, the risk for atopic dermatitis was lower in the glutamine-supplemented group (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.02-0.97). However, the incidence of bronchial hyperreactivity (OR, 0.34; 95% CI, 0.10-1.21) and infections of the upper respiratory (OR, 0.99; 95% CI, 0.35-2.79), lower respiratory (OR, 0.39; 95% CI, 0.13-1.24), and gastrointestinal (OR 1.25, 95% CI 0.23-6.86) tracts was not different between the treatment groups. Glutamine-enriched enteral nutrition in very low-birth-weight infants decreased the incidence of atopic dermatitis during the first year of life but had no effect on the incidence of bronchial hyperreactivity and infectious diseases during the first year of life.

The effect of glutamine-enriched enteral nutrition on intestinal microflora in very low birth weight infants: A randomized controlled trial

In a previous study, we have found that glutamine supplementation decreased the infection rate in very low birth weight (VLBW) infants. In this study, we investigated whether this beneficial effect originated from increased number of bifidobacteria and lactobacilli in the intestinal microflora of these infants. In a randomized controlled trial, VLBW infants (gestational age <32 weeks and/or birth weight <1500g) received enteral glutamine supplementation (0.3g/kg/day) or isonitrogenous placebo supplementation between d3 and d30 of life. Faecal microflora was determined by fluorescent in situ hybridization <48h, at d7, d14 and d30 of life. In 43/52 (glutamine group) and 43/50 (control group) infants, > or = 2 samples were analyzed. Baseline characteristics were not different between groups. The prevalence of bifidobacteria, lactobacilli, Escheria coIi, streptococci and clostridia was not different between groups (p>0.05). In both groups, colonization with bifidobacteria was delayed, whereas potentially pathogenic bacteria such as E. coli, appeared rapidly after birth. Antibiotic treatment decreased the prevalence of all faecal bacteria (p<0.05). Decreased infectious morbidity in VLBW infants that received glutamine supplementation was not associated with alterations in the prevalence of bifidobacteria, lactobacilli, E. coIi, streptococci and clostridia. In general, colonization with health-promoting bacteria was delayed, whereas potentially pathogenic bacteria appeared rapidly after birth. Antibiotic treatment delayed the bacterial colonization.

The Effect of Glutamine‐Enriched Enteral Nutrition on Intestinal Permeability in Very‐Low‐Birth‐Weight Infants: A Randomized Controlled Trial

Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion. Glutamine depletion has negative effects on intestinal integrity. The lower infection rate in VLBW infants receiving glutamine-enriched enteral nutrition may originate from improved intestinal integrity, as reflected by decreased intestinal permeability. The aim of our study was to investigate whether glutamine-enriched enteral nutrition in VLBW infants enhances the normal decrease in intestinal permeability, as measured by the sugar absorption test (SAT). In a double-blind, randomized, placebo-controlled trial, VLBW infants (gestational age <32 weeks or birth weight <1,500 g) received enteral glutamine supplementation (0.3 g/kg/d) or an isonitrogenous placebo supplementation (alanine) between days 3 and 30 of life. Intestinal permeability, determined from the urinary lactulose/mannitol (L/M) ratio after an oral dose of lactulose and mannitol, was assessed at 4 time points: before the start of the study, and at days 7, 14, and 30 of life. At least 2 SATs were performed in 45/52 (86%) and 45/50 (90%) infants in the glutamine-supplemented and control groups, respectively. Baseline patient and nutrition characteristics were not different between the groups. There was no effect of glutamine-enriched enteral nutrition on the decrease of the L/M ratio between the start and end of the study (p = .78). In both treatment groups, median urinary lactulose concentrations decreased (p < .001), whereas median urinary mannitol concentrations increased (p = .003). Glutamine-enriched enteral nutrition does not enhance the postnatal decrease in intestinal permeability in VLBW infants. Any beneficial effect of glutamine may involve other aspects of intestinal integrity; for example, modulation of the intestinal inflammatory response.

Glutamine-enriched enteral nutrition in very-low-birth-weight infants and effects on feeding tolerance and infectious morbidity: a randomized controlled trial

Glutamine depletion has negative effects on the functional integrity of the gut and leads to immunosuppression. Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion because nutrition is limited in the first weeks of life. The objective was to determine the effect of glutamine-enriched enteral nutrition on feeding tolerance, infectious morbidity, and short-term outcome in VLBW infants. In a double-blind randomized controlled trial, VLBW infants (gestational age <32 wk or birth weight <1500 g) were allocated to receive enteral glutamine supplementation (0.3 g . kg(-1) . d(-1)) or isonitrogenous control supplementation (alanine) between days 3 and 30 of life. The supplementations were added to breast milk or to preterm formula. The primary endpoint for the study was time to full enteral feeding. Secondary endpoints were other variables of feeding tolerance, infectious morbidity, and short-term outcome. Baseline patient and nutritional characteristics were not significantly different in the glutamine-supplemented (n = 52) and the control (n = 50) groups. The median time to full enteral feeding was 13 d (range: 7-31 d) in the glutamine-supplemented group and 13 d (range: 6-35 d) in the control group (hazard ratio: 1.19; 95% CI: 0.79, 1.79; P = 0.40). In the glutamine-supplemented group, 26 of 52 infants (50%) had >/=1 serious infection compared with 38 of 50 (76%) in the control group (odds ratio: 0.32; 95% CI: 0.14, 0.74; P = 0.008). Other variables of feeding tolerance and short-term outcome were not significantly different between groups. Glutamine-enriched enteral nutrition did not improve feeding tolerance or short-term outcome in VLBW infants. However, infectious morbidity was significantly lowered in infants who received glutamine-enriched enteral nutrition.

Plasma taurine concentrations increase after enteral glutamine supplementation in trauma patients and stressed rats

Taurine is a unique amino acid with antioxidant and osmolytic properties. Glutamine serves as the preferred fuel for the gut, liver, and immune cells and as a precursor for antioxidants. Trauma patients have low glutamine concentrations. We investigated the effect of glutamine-enriched enteral nutrition on plasma taurine concentrations in patients with severe trauma (injury severity score >20). Additionally, plasma taurine concentrations and organ fluxes were studied in a stressed rat model. Twenty-nine patients with multiple trauma received glutamine-enriched nutrition and 31 patients received isocaloric, isonitrogenous control solution for 5 d. Plasma taurine and glutamine concentrations were measured. Male Wistar rats (250-300 g) received a glutamine-enriched diet (12%, by wt) or a control solution for 2 wk. Plasma taurine concentrations were measured. Taurine fluxes and fractional extraction rates in the liver, kidneys, and gut were assessed with a radioactive microsphere technique. Both patient groups had low taurine concentrations on day 1. From day 3 onward, the glutamine-fed patients had significantly higher taurine concentrations. Rats fed a glutamine-enriched diet had significantly higher plasma taurine concentrations than did the controls. A high taurine uptake was found in the liver, kidneys, and gut of the glutamine-fed rats. Fractional extraction rates were not significantly different between the rat groups. Glutamine enrichment increases plasma taurine in trauma patients and in stressed rats. Because of increased availability, organ fluxes showed a higher taurine uptake in the liver, kidneys, and gut. The reduction in morbidity with glutamine enrichment could be explained in part by increased taurine availability.