Background and aims-To determine whether the inclusion of 20 g free glutamine as part of the nitrogen source of parenteral feeds reduces length of hospital stay or mortality. Methods-In a randomised, double blind, controlled trial in 168 patients clinically accepted for parenteral nutrition, standard feeds were compared with feeds in which 3.8 g of the total nitrogen was replaced with the equivalent 20 g glutamine. A minimum of 11 g nitrogen/ day was used in all patients. Daily intakes of energy and nitrogen were determined using a validated computer protocol and were similar for the two groups. All feeds included trace elements, vitamins, electrolytes, and minerals. (Gut 1999;45:82-88)

Objectives: To assess the changes in measures of fatigue after meals of varying composition, and to compare the relation of the fatigue with changes in the plasma tryptophan:large neutral amino acids (Trp:LNAA) ratio. Subjects: Sixteen healthy volunteers were recruited from staff and students at the College. Design: Subjects were tested for central and peripheral fatigue using a visual analogue scale,¯icker fusion frequency, grip strength, reaction time and wrist ergometry. In addition, plasma amino acid concentrations and Trp:LNAA ratio were determined. Measurements were made before, and at 1, 2, 3 and 4 h after drinking one of three liquid test meals. The meals were isoenergetic (1672 kJ) and were of mixed carbohydrate, fat and protein, or of pure carbohydrate or pure fat. Setting: Department of Human Nutrition. Results: Subjects consuming the pure carbohydrate meal reported more subjective feelings of fatigue and had slower reaction times. Aspects of central fatigue were greater in subjects consuming a pure fat meal. The Trp:LNAA ratio was depressed in those consuming a pure fat or mixed meal and raised only after pure carbohydrate. Conclusions: Central and subjective fatigue may be in¯uenced by raised plasma free tryptophan to competitor amino acid ratios induced by carbohydrate intake but other aspects of central arousal are affected by fat intake.

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