Table 3.
Glutamine supplementation in pediatric patients with gastrointestinal disease.
| Reference | Subjects | Design | Gln | Control | Outcomes | Results |
|---|---|---|---|---|---|---|
| Albers et al. 2005 [131] | 80 newborns and infants age ≤2 y requiring PN after major digestive tract surgery (GA ≥30 wk) | Randomized double-blind | Parenteral Gln; isonitrogenous isocaloric Gln (≤0.4 g/kg/d) supplemented PN started on d-2 after surgery and reached 90% of recommended AA intake of 1.5–2.5 g/kg/d (90% of Gln target dose of 0.4 g/kg/d) by d-4 until d-31, full EN, discharge or death; with tapering of PN started on or after d-6 (n = 41) | Standard PN started on d-2 after surgery and reached 90% of recommended AA intake of 1.5–2.5 g/kg/d by d-4 until d-31, full EN discharge or death, with tapering of PN started on or after d-6 (n = 39) | (1) Intestinal permeability (urinary lactulose/rhamnose ratio measured wk-1 through -4 after surgery, (2) nitrogen balance on d-4, -5, -6, urinary 3-MH excretion on d-5, mortality, LOS in ICU and in hospital, septic episodes, usage of antibiotics and ICU resources | (1) No effect on intestinal permeability, (2) no effect on nitrogen balance, urinary 3-MH excretion, mortality, LOS in ICU or in hospital, culture-proven sepsis, usage of antibiotics or ICU resources, and no adverse effects |
| Duggan et al. 2004 [130] | 20 neonates and infants aged <12 mo requiring PN after surgery for congenital or acquired gastrointestinal disease | Randomized double-blind | Enteral Gln; breastmilk or protein hydrolysate formula supplemented with enteral Gln (≤0.4 g/kg/d) until 7 consecutive d of full EN or hospital discharge (N = 9) | Breastmilk or protein hydrolysate formula supplemented with enteral iso-osmolar mix of nonessential AA (≤0.4 g/kg/d) until 7 consecutive d of full EN or hospital discharge (N = 11) | (1) Duration (d) on PN and d to achieve enteral feedings providing ≥80% of US-recommended dietary allowance for energy, (2) changes in macronutrient and energy absorption after supplementation, growth, and frequency of infections during trial | (1) No differences in d on PN or d to achieve ≥80% energy requirements by EN, (2) no improvement in energy absorption, no differences in frequency of infections, wt gain, length gain, or changes in anthropometric measures, safe |
| Zhu et al. 2002 [142] | 27 patients aged 9–67 y with SBS | Case series | Enteral/parenteral Gln; enteral and/or parenteral glycyl-Gln powder (0.6 g/kg/d) for ~1.5 ± 1.0 y or alanyl-Gln solution (0.3 g/kg/d) in combination with 3 wk rhGH and rehabilitative diet | None | Nutritional status and intestinal absorptive capacity after an average of 1.5 ± 1.0 y treatment | Increased wt, serum total protein, albumin, hemoglobin, reduced stool frequency and stool nitrogen, increased D-xylose absorption |
| Weiming et al. 2004 [141] | 37 patients aged 9–74 y with SBS (including 6 children aged 9–13 y) | Case series | Enteral Gln; oral Gln powder (0.6 g/kg/d) for 1-2 y in combination with rhGH (0.05 mg/kg/d) for 3 wk and rehabilitative diet | None | Efficacy in weaning off PN, intestinal absorptive capacity (D-xylose absorption, stool frequency, stool nitrogen) and plasma protein concentrations after 2-3 y of treatment | Improved intestinal absorptive capacity and increased plasma protein concentrations, 57% of patients weaned off PN |
| Ladd et al. 2005 [140] | 2 female pediatric patients aged 6 y (GA: 33 wk) and 6.5 y (GA: 26 wk) with SBS from neonatal gastrointestinal catastrophes | Retrospective review of medical records | Enteral Gln, SC rhGH (0.3 mg/kg/wk) and concurrent enteral Gln supplementation (30 mg/d) started at 6 y and 6.5 y, for 8 and 2.5 y, respectively | None | Retrospective review of supplemental nutritional requirement and serial growth parameters of height and wt over treatment period | Improvement in growth (approximating target percentiles for height and wt), improved intestinal tolerance/adaptation, weaned from PN |
| Akobeng et al. 2000* [148] | 18 children aged 6.8–15.7 y with active Crohn's disease | Randomized double-blind | Enteral Gln, exclusive polymeric EN with 42% of AA content as Gln for 4 wk (n = 9) | Isocaloric isonitrogenous exclusive standard polymeric EN with identical essential AA and 4% of AA content as Gln for 4 wk (n = 9) | Remission rates after 4 wk exclusive EN, changes in clinical and laboratory parameters of disease activity during 4 wk exclusive EN | No differences in remission rates, changes in platelet count, orosomucoid level or wt, less improvement in pediatric Crohn's disease activity index |
| Akobeng et al. 2000* [150] | 16 children aged 6.8–15.7 y with active Crohn's disease | Randomized double-blind | Enteral Gln, exclusive polymeric EN with 42% of AA content as Gln for 4 wk (n = 7) | Isocaloric isonitrogenous exclusive standard polymeric EN with identical essential AA and 4% of AA content as Gln for 4 wk (n = 9) | Intestinal permeability as assessed by lactulose/mannitol urinary excretion ratio after 4 wk exclusive EN | Decreased lactulose/mannitol intestinal permeability ratio (both groups) |
| Akobeng et al. 2002* [151] | 15 children aged 6.8–15.7 y with active Crohn's disease | Randomized double-blind | Enteral Gln, exclusive polymeric EN with 42% of AA content as Gln for 4 wk (n = 7) | Isocaloric isonitrogenous exclusive standard polymeric EN with identical essential AA and 4% of AA content as Gln for 4 wk (n = 8) | Serum IGF-1 concentrations and growth after 4 wk exclusive EN | No improvement in serum IGF1 (both groups), less improvement in wt, wt for height and MUAC |
| Akobeng et al. 2007* [152] | 15 children aged 6.8–15.7 y with active Crohn's disease | Randomized double-blind | Enteral Gln, polymeric EN with 42% of AA content as Gln for 4 wk (n = 7) | Isocaloric isonitrogenous exclusive standard polymeric EN with identical essential AA and 4% of AA content as Gln for 4 wk (n = 8) | Plasma antioxidant concentrations after 4 wk exclusive EN | Increased plasma selenium concentrations (both groups), decreased concentrations of vitamin C and E (both groups), no change in vitamin A, urates, glutathione, and malondialdehyde |
PN: parenteral nutrition; EN: enteral nutrition; wt: weight; GA: gestational age; AA: amino acid; 3-MH: 3-methyl-histidine; LOS: length of stay; ICU: intensive care unit; SBS: short bowel syndrome; rhGH: recombinant growth hormone; SC: subcutaneous; IGF-1: insulin-like growth factor-1; MUAC: mid upper arm circumference.
*Originating from the same cohort.