Table 4.
Enteral glutamine supplementation in children with diarrheal disease/malnutrition.
| Reference | Subjects | Design | Gln | Control | Outcomes | Results |
|---|---|---|---|---|---|---|
| Ribeiro Jr. et al. 1994 [160] | 118 male infants aged 1–12 mo with acute noncholera diarrhea and dehydration | Randomized double-blind | Oral Gln (90 mmol/L) added to standard glucose-based (90 mmol/L) WHO-ORS (n = 59) | Standard glucose-based (111 mmol/L) WHO-ORS (n = 59) | (1) Duration and severity (stool output, stool output rate) of diarrhea and (2) intake of ORS (recorded at 6 h intervals in a metabolic unit), urine output, vomitus, body wt, blood gases, and electrolytes monitored during hospitalization | (1) No differences in diarrheal stool output, stool output rate, or duration of diarrhea, (2) no differences in volume of ORS to achieve and maintain hydration, amount and number of vomitus, urine output, wt gain, safe, and well tolerated |
| Yalçin et al. 2004 [161] | 128 otherwise healthy children aged 6–24 mo with acute (<10 d) diarrhea | Randomized double-blind | Oral Gln (0.1 g/kg/d TID) capsules dissolved in water for 7 d (n = 63) | Oral placebo (cornstarch) capsules dissolved in water for 7 d (n = 65) | (1) Duration of diarrhea, (2) severity of diarrhea by mother self-report followed until end of diarrheal episode, immunologic parameters 7 d after treatment, wt gain and infectious disease monitored monthly until 3 months after treatment | (1) Shorter duration of diarrhea for entire cohort and for age ≥12 mo subgroup, (2) no differences in frequency of persistent diarrhea or vomiting, no differences in serum IL-8, salivary immunoglobulin A, wt gain or frequency of infections |
| Gutierrez et al. 2007 [162] | 147 dehydrated children aged 1–60 mo with acute noncholera diarrhea | Randomized double-blind | WHO-ORS in which glucose was replaced with Gln (20 g/L) until rehydration (n = 73) | Standard glucose-based WHO-ORS until rehydration (n = 74) | Efficacy in reducing (1) stool volume and (2) rehydratation time in acute diarrhea | (1) No differences in stool output during first 4 h, (2) no differences in time to successful rehydration, volume of ORS required for rehydration, urine output, or vomiting |
| Lima et al. 2005 [168] | 80 malnourished (WAZ < −2) hospitalized children aged 2–60 mo with or without diarrhea | Randomized double-blind | Gln-supplemented (16.2 g/d) enteral modified WHO formula for 10 d (n = 26) | (1) Modified WHO enteral formula standard (n = 27 not randomized) or (2) isomolar Gly-supplemented (8.3 g/d) enteral modified WHO formula for 10 d (n = 27) | (1) Intestinal permeability (urinary lactulose/mannitol ratio), (2) wt gain after 10 d supplementation | (1) Improvement in intestinal barrier function (decreased lactulose/mannitol ratio versus Gly or standard), (2) no effect on % urinary excretion of lactulose or mannitol or on duration of diarrhea, no differences in wt gain, no improvement in WAZ, safe, and well tolerated |
| Lima et al. 2007 [169] | 107 malnourished (WAZ, HAZ, or WHZ < −1) children aged 7.9–82.2 mo in northeastern Brazil | Randomized double-blind phase III | Oral alanyl-Gln (24 g/d) mixed with whole milk for 10 d (n = 51) | Oral isonitrogenous Gly (25 g/d) mixed with whole milk for 10 d (n = 56) | (1) Intestinal permeability (urinary lactulose/mannitol ratio) 10 d after supplementation, (2) growth (wt and height) measured until d120 of study, diarrheal disease morbidity | (1) No effect on lactulose/mannitol ratio, (2) improvement in barrier function (decrease in % lactulose recovery), reduction in absorptive epithelium (decrease in % mannitol recovery), improved (increased) cummulative change over 120 d in WHZ and WAZ but not HAZ (after adjustment for age and season), safe and well tolerated |
| Williams et al. 2007 [167] | 93 malnourished growth-faltering Gambian infants aged 4–11 mo | Randomized double-blind | Oral Gln 0.25 g/kg/d BID mixed with expressed breastmilk or distilled water for 5-6 mo (rainy season) (n = 46) | Oral isonitrogenous isocaloric mix of nonessential AA (Ala, Gly, Ser, Asn; 0.25 g/kg/d BID) and fructose mixed with expressed breastmilk or distilled water for 5-6 mo (rainy season) (n = 47) | (1) Growth and intestinal barrier function (intestinal permeability) measured monthly during 5 mo supplementation and 6 mo after, (2) plasma markers of immunostimulation (immunoglobulins and acute phase proteins) during supplementation and morbidity (as reported by mother) | (1) No improvement in wt gain or length gain, no improvement in lactulose/mannitol intestinal permeability ratio or % urinary lactulose or mannitol recovery, (2) no effect on plasma concentrations of immunoglobulins or acute phase proteins or on morbidity |
WHO: World Health Organization; ORS: oral rehydration solution; wt: weight; TID: 3 times a day; IL: interleukin; WAZ: weight for age z-score; HAZ: height for age z-score; WHZ: weight for height z-score; BID: twice a day; AA: amino acid.