2009, Number 4
<< Back Next >>
Rev Endocrinol Nutr 2009; 17 (4)
Glutamine in clinical nutrition
Canul-Medina G, Coop-Gamas O, Guevara-Guarfias U, Montaño-Candia MT, Machado-Villarroel L, Montaño-Candia M, Zúñiga-Rivera A
Language: Spanish
References: 87
Page: 161-169
PDF size: 173.11 Kb.
ABSTRACT
The supplementation of glutamine (Gln) has been effective to reduce the morbi-mortality of the catabolic patient and to protect against phenomena of oxidative stress. Gln is an essential amino acid involved in the synthesis of urea in liver, ammonia in the kidney, as well as glycogenesis and serves as a source of energy for some cells. Under stressful conditions its concentration falls and it needs to be supplemented in order to avoid systemic complications. It is a precursor of glutathione and of the neurotransmitter glutamate and is also considered a powerful antioxidant. Its supplementation is recommended in patients with serious illnesses, particularly those in Intensive Care suffering from hemato-oncological conditions and extensive burns, among others. The purpose of this revision is to summarize the most important applications of glutamine in clinical nutrition
REFERENCES
Abcouver S, Bode P, Souba W. Glutamine as a metabolic intermediate. Nutrition and Metabolism in the Surgical Patient. Second edition. Boston: Littlie, Brown and Co, 1996: 353-384.
Souba W. The gut as a nitrogen processing organ in the metabolic response to critical illness. Nutr Sup Serv 1988: 15-22.
Jonas C, Ziegrer T. Potential role of glutamine administration in inflammatory bowel disease. Nestle Nutr Workshop Ser Clin Perform Programme 1999: 217.
Marliss EB, Aoki TT, Pozefsky T, Most AS et al. Muscle and splanchnic glutmine and glutamate metabolism in postabsorptive and styarved man. J Clin Invest 1971; 50: 814-871.
Darmaun D, Messing B, Just B et al. Glutamine metabolism after small intestinal resection in humans. Metabolism 1991; 40: 42-44.
Haisch M, Fukagawa NK, Matthews DE. Oxidation of glutamine by the splanchnic bed in humans. Am J Physiol Endocrinol Metab 2000; 278: E593-602.
Dechelotte P, Hasselmann M, Cynober L, Allaouchiche B, Coëffier M, Hecketsweiler B et al. L-alanyl-L-glutamine dipeptide–supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: The French controlled, randomized, double-blind, multicenter study. Crit Care Med 2006; 24: 598-604.
Déchelotte P, Darmaun D, Rongier M et al. Absorption and metabolic effects of enterally administered glutamine in humans. Am J Physiol 1991; 260: 677-682.
Iapichino G, Radrizzani D, Destrebecq A et al. Metabolic support of the critically ill: Update. Minerva Anestesiol 2008; 74: 709-713.
Chung-Bok M, Vincent N, Jhala U, Watford M. Rat hepatic glutaminase: Identification of the full coding sequence and characterization of a functional promoter. Biochem J 1997; 324: 193-200.
Krebs H. Metabolism of amino acids: The synthesis of glutamine from glutamic acid and ammonia and the enzymic hydrolysis of glutamine in animal tissues. Biochem J 1935; 29: 1951–1969.
Curthoys NP, Watford M. Regulation of gutaminase activity and glutamine metabolism. Annu Rev Nutr 1995; 15: 133-159.
Bonet A, Grau T. Glutamine, an almost essential amino acid in the critically ill patient. Med Intensiva 2007; 31: 402-406.
Caballero B, Allen L, Prentice A. Encyclopedia of Human Nutrition. 2nd ed. 2005.
Wu G. Intestinal mucosal amino acid catabolism. J Nutr 1998; 128: 1249-1252.
Souba W. Nutritional support. N Engl J Med 1997; 336: 41-48.
Intestinal glutamine metabolism and nutrition. Nutr Biochem 1993; 4: 2-9.
Ziegler T, Puckett A, Griffiths D, Galloway J. Interactions between nutrients and growth factors in cellular growth and tissue repair. In: Growth Factors and Wound Healing: Basic Science and Potential Clinical Applications. 1997: 104-150.
Lovat R, Preiser JC. Antioxidant therapy in intensive care. Curr Opin Crit Care 2003; 9: 266-270.
Gutteridge J, Mitchell J. Redox imbalance in the critically ill. BMJ 1999; 55: 49-75.
Frei B. Reactive oxygen species and antioxidant vitamins: mechanisms of action. Am J Med 1994; 97: 5-23.
Therond P, Bonnefont-Rousselot D, Davit-Spraul A, Conti M, Legrand A. Biomarkers of oxidative stress: an analytical approach. Curr Opin Clin Nutr Metab Care 2000; 3: 373-384.
Metnitz PGH, Bartens C, Fischer M, Fridrich P, Steltzer H, Druml W. Antioxidant status in patients with acute respiratory distress syndrome. Intensive Care Med 1999; 25: 180-185.
Alonso de Vega JM, Diaz J, Serrano E, Carbonell LF. Oxidative stress in critically ill patients with systemic inflammatory response syndrome. Crit Care Med 2002; 30: 1782-1786.
Motoyama T, Okamoto K, Kukita I, Hamaguchi M, Kinoshita Y, Ogawa H. Possible role of increased oxidant stress in multiple organ failure after systemic inflammatory response syndrome. Crit Care Med 2003; 31: 1048-1052.
Abilés J, Moreno R, Moratalla G et al. Effects of supply with glutamine on antioxidant system and lipid peroxidation in patients with parenteral nutrition. Nutr Hosp 2008; 23: 332-339.
Amores M, Medina M. Glutamine, as a Precursor of Glutathione, and oxidative stress. Mol Genet Metab 1999; 67: 100-105.
Fürst P, Stehle P. The potential use of parenteral dipeptides in clinical nutrition. Nutr Clin Pract 1993; 8: 106-114.
Hammarqvist F, Luo J, Andersson K, Cotgreave IA, Wernerman. Skeletal muscle glutation is depleted in critically ill patients. Crit Care Med 1997; 25: 78-84.
Deitch E. The role of intestinal barrier failure and bacterial translocation in the development of systemic infection and multiple organ failure. Arch Surg 1990; 125: 403-404.
Windmueller H, Spaeth A. Respiratory fuels and nitrogen metabolism in vivo in small intestine of fed rats. Quantitative importance of glutamine, glutamate, and aspartate. J Biol Chem 1980; 255: 107-112.
Alpers DH. Enteral feeding and gut atrophy. Curr Opin Clin Nutr Metab Care 2002; 5: 679-683.
Reeds P, Burrin D. Glutamine and the bowel. J Nutr 2001; 131(supl 9): 2505-2508.
Deniel N, Marion-Letellier R et al. Glutamine regulates the human epithelial intestinal HCT-8 cell proteome under apoptotic conditions. Mol Cell Proteomics 2007; 6: 1671-1679.
Evans M, Jones D, Ziegler T. Glutamine prevents cytokine-induced apoptosis in human colonic epithelial cells. J Nutr 2003; 133: 3065-3071.
Roth E, Oehler R, Manhar N, Exner R, Wessner B, Strasser E, Spittler A. Regulative potential of glutamine-relation to glutathione metabolism. Nutrition 2002; 18: 217-221.
Alarcón T. Short bowel syndrome. Gastr Latinoam 2007; 18: 175-178.
Buchman AL. Glutamine: commercially essential or conditionally essential? Am J Clin Nutr 2001; 74: 25-32.
Tian J, Hao L, Chandra P et al. Dietary glutamine and oral antibiotics each improve indexes of gut barrier function in rat short bowel syndrome. Am J Physiol Gastrointest Liver Physiol 2009; 296: 348-355.
Rau BM, Bothe A, Kron M, Beger HG. Role of early multisystem organ failure as major risk factor for pancreatic infections and death in severe acute pancreatitis. Clin Gastroenterol Hepatol 2006; 4: 1053-1061.
Zhang Q, Ni Q, Cai D, Zhang Y, Zhang N, Hou L. Mechanisms of multiple organ damages in acute necrotizing pancreatitis. Chin Med J 2001; 114: 738-742.
Zhang XP, Ye Q, Jiang XG, Ma ML, Zhu FB, Zhang RP, Cheng QH. Preparation method of an ideal model of multiple organ injury of rat with severe acute pancreatitis. World J Gastroenterol 2007; 13: 4566-4573.
Beckingham IJ, Bornman PC. ABC of diseases of liver, pancreas, and biliary system. Acute pancreatitis. BMJ 2001: 322: 595-598.
Wiedeck H, Geldner G. Enteral nutrition in acute pancreatitis. Zentralbl Chir 2001; 126: 10-14.
Xue P, Deng LH, Xia Q et al. Impact of alanyl-glutamine dipeptide on severe acute pancreatitis in early stage. World J Gastroenterol 2008; 14: 474-478.
Curtis CS, Kudsk KA. Nutrition support in pancreatitis. Surg Clin North Am 2007; 87: 1403-1415.
Ockenga J, Borchert K, Rifai K et al. Effect of glutamine-enriched total parenteral nutrition in patients with acute pancreatitis. Clin Nutr 2002; 21: 409-416.
Yang SQ, Xu JG. Effect of glutamine on serum interleukin-8 and tumor necrosis factor-alpha levels in patients with severe pancreatitis. Department of General Surgery 2008; 28: 129-131.
Oláh A, Romics L. Early enteral nutrition in acute pancreatitis-benefits and limitations. Langenbecks Arch Surg 2008; 393: 261-269.
Pérez C, Puebla A, Miján A. Tratamiento nutricional en la enfermedad inflamatoria intestinal. Nutr Hosp 2008; 23: 417-427.
Moum B, Ebkonm A, Vant MH et al. Inflammatory bowel disease: reevaluation of the diagnosis in a prospective population based study in south eastern Norway. Gut 1997: 328-332.
ASPEN. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN 2002: 26(1).
Lecleire S, Hassan A, Marion-Letellier R et al. Combined glutamine and arginine decrease proinflammatory cytokine production by biopsies from Crohn’s patients in association with changes in nuclear factor-kappaB and p38 mitogen-activated protein kinase pathways. J Nutr 2008; 138: 2481-2486.
Tan H, Sun MY, Yang J. Effect of retention enema with combination of compound glutamine entero-soluble capsule and glucocorticoids for treatment of ulcerative colitis. Zhongguo Zhong Xi Yi Jie He Za Zhi 2008; 28: 645-647.
Bourreille A, Humbert B, Maugère P, Galmiche JP, Darmaun D. Glutamine metabolism in Crohn’s disease: a stable isotope study. Clin Nutr 2004; 23: 1167-1175.
Ockenga J, Borchert K, Stuber E, Lochs H et al. Glutamine-enriched total parenteral nutrition in patients with inflammatory bowel disease. Eur J Clin Nutr 2005; 59: 1302-1309.
Kenneth A, Kudsk MD, Yong W et al. Glutamine enriched total parenteral nutrition maintains intestinal IL4 and mucosal IgA levels. J Parenter Enteral Nutr 2000; 24: 270-275.
Shinozaki M, Saito H, Muto T. Excess glutamine exacerbates trinitrobenzenesulfonic acid-induced colitis in rats. Dis Colon Rectum 1997; 40: 59-63.
Den Hond E, Hiele M, Peeters M et al. Effect of long-term oral glutamine supplements on small intestinal permeability in patients with Crohn’s disease. J Parenter Enteral Nutr 1999; 23: 7-11.
Akobeng AK, Miller V, Stanton J et al. Double-blind randomized controlled trial of glutamine enriched polymeric diet in the treatment of active Crohn’s disease. J Pediatr Gastroenterol Nutr 2000; 30: 78-84.
Wernerman J, Hammarqvist F, Ali MR, Vinnars E. Glutamine and alpha-ketoglutarate but not branched amino-acids reduce the loss of muscle glutamine after surgical trauma. Metabolism 1989; 38: 63-66.
Planas M, Schwartz S, Arbos MA, Farriol M. Plasma glutamine levels in septic patients. JPEN 1993; 17: 299-300.
Wilmore DW. The effect of glutamine supplementation in patients following elective surgery and accidental injury. J Nutr 2001; 131: 2543-2549.
Parry-Billings M, Evans J, Calder PC, Newsholme EA. Does glutamine contribute to immunosuppression after major burns? Lancet 1990; 336: 523-525.
Lacey JM, Wilmore DW. Is glutamine a conditional essential amino acid? Nutr Rev 1990; 48: 297-309.
Novak F, Heyland DK, Avenell A, Drover JW, Su X. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med 2002; 30: 2022-2029.
García de Lorenzo A, Zarazaga A, García-Luna PP, Gonzales-Huix F, López-Martínez J, Millán A et al. Clinical evidence for enteral nutritional support with glutamine: A Systemaic review. Nutrition 2003; 19: 805-811.
Wischmeyer PE. Clinical applications of L-Glutamine: past, present, and future. Nutr Clin Pract 2003; 18: 377-385.
Hall JC, Dobb G, Hall J, de Sousa R, Brennen L McCauley R. A prospective randomized trial of enteral glutamin in critical illness. Intensive Care Med 2003; 29: 1710-1716.
Goeters C, Wenn A, Mertes N, Wempe C, Van Aken H Stehle P et al. Parenteral L-alanyl-L-glutamine improves 6 mont outcome in critically ill patients. Crit Care Med 2002; 30: 2032-2037.
Saalwachter A, Welcutts KF, Clavedge JA, Evans HL, Radigar AE, O’Donnell KB et al. Does the addition of glutamine enteral feeds affect patients mortality. Crit Care Med 2005; 33: 2501-2506.
Mercadal-Orfila G, Llop-Talaverón JM, Gracia-García B, Martorell-Puigserver C, Badía-Tahull MB, Tubau-Molas M, Jodar R. Utilización de glutamina en nutrición parenteral en paciente crítico: efectos sobre la morbi-mortalidad. Nutr Hosp 2007; 22: 61-67.
Davies AR. Practicalities of nutrition support in the intensive care unit. Curr Opin Clin Nutr Metab Care 2007; 10: 284-290.
Fuentes-Orozco C, Anaya-Prado R, González-Ojeda A et al. L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis. Clin Nutr 2004; 23: 13-21.
Medina MA. Glutamine and Cancer. J Nutr 2001; 131: 2539 S-2542S.
Grimble R. Inmunonutrition. Curr Opin Gastroenterol 2005; 21: 216-222.
Klimberg VS, McClellan JL, Claude H, Organ Jr, Honorary. Glutamine, cancer, and its therapy. Am J Surg 1996; 172: 418-424.
Decker-Baumann C, Buhl K, Frohmüller S et al. Reduction of chemotherapy-induced side-effects by parenteral glutamine supplementation in patients with metastatic colorectal cancer. Eur J Cancer 1999; 35: 202-207.
Oguz M, Kerem M, Bedirli A et al. L-alanin-L-glutamine supplementation improves the outcome after colorectal surgery for cancer. Colorectal Dis 2007; 9: 515-520.
Sornsuvit C, Komindr S, Chuncharunee S et al. Pilot study: effects of parenteral glutamine dipeptide supplementation on neutrophil functions and prevention of chemotherapy-induced side-effects in acute myeloid leukaemia patients. J Int Med Res 2008; 36: 1383-1391.
Gómez C, Castillo R, Cos A et al. Efectos de la glutamina parenteral en pacientes sometidos a trasplante de médula ósea. Nutr Hosp 2006; 21: 13-21.
Schloerb PR, Skikne BS. Oral and parenteral glutamine in bone marrow transplantation: a randomized, double-blind study. J Parenter Enteral Nutr 1999; 23: 117-122.
Lorenzo D, Francesca R, Andrea P, Andrea I. The rationale of early enteral nutrition. Acta Bio Medica 2003; 74: 41-44.
Nicola W. Nutrition support to patients undergoing gastrointestinal surgery. Nutrition Journal 2003; 2: 18-20
Furst P, Pogan K, Stehle P. Glutamine dipeptides in clinical nutrition. Nutrition 1997; 13: 731-737.
Savy G. Applications for glutamine supplementation in oncology. J Amer Diet Assoc 2000; 8: 9-11.
Papaconstantinou H, Chung D, Zhang W et al. Prevention of mucosal atrophy: role of glutamine and caspases in apoptosis in intestinal epithelial cells. J Gastrointest Surg 2000; 4: 416-423.