A systematic literature review and meta-analysis of randomized clinical trials of parenteral glutamine supplementation

Bollhalder, Lea; Pfeil, Alena M.; Tomonaga, Yuki; Schwenkglenks, Matthias

doi:10.1016/j.clnu.2012.11.003

Cited by 152 publications

(118 citation statements)

References 62 publications

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“…Four of six meta-analyses that performed subgroup analysis on high vs. low dose glutamine supplementation observed that the mortality rate was lower with high dose compared to low dose glutamine supplementation, but the differences between groups were never statistically significant (12,(14)(15)(16)22,30). Of the three meta-analyses that performed subgroup analyses comparing critically ill vs. surgical patients, it also appears that there was no significant difference between these two groups in their response to glutamine supplementation (12,15,16).…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic benefits of glutamine: An umbrella review of meta-analyses

McRae

2017

Biomedical Reports

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Abstract. Glutamine may be an essential amino acid in patients with catabolic disease, as it has been demonstrated that circulating glutamine levels drop during critical illness and following major surgery; this may result in an increase in secondary infection risk, recovery time and mortality rates. However, there is much discrepancy in the literature with regards to randomized controlled studies, and therefore, the present study is an umbrella review of published meta-analyses, conducted to examine the effectiveness of glutamine's role as a therapeutic agent. A search using PubMed, Cochrane Library and CINAHL from January 1st, 1980 to December 31st, 2016 was conducted using the following strategy: 'Glutamine AND (meta-analysis OR systematic review)' and publications were retrieved, which provided quantitative statistical analysis of pooled treatment effects on the relative risks of infectious complications, mortality and length of stay in hospital. A total of 22 meta-analyses were entered into the current umbrella review. As displayed in Tables I, II and III, these analyses are split into three groups, based on different parameters. Of the 19 meta-analyses investigating the effects of infectious complications, 15 identified statistically significant reductions in complications, with relative risks ranging between 0.42 and 0.93. In addition, 12 of the 18 meta-analyses analyzing the length of hospital stays presented statistically significant reductions in the length of stay, with reductions ranging between 0.19 to 4.73 days. Only 4 of the 15 meta-analyses studying mortality effects identified statistically significant reductions in mortality with relative risks ranging between 0.64 and 1.28. Statistically significant heterogeneity was observed in 16 of 22 meta-analyses, and publication bias was observed in five of 11 meta-analyses. Glutamine supplementation for critically ill or surgical patients through parenteral or enteral routes appears to reduce the rate of hospital acquired infectious complications and shortening of the length of stay in hospital. Furthermore, glutamine supplementation appeared to reduce the rate of in-patient mortality, but the majority of meta-analyses did not reach statistical significance. However, researchers must appreciate the positive results with caution in light of the fact that there exists statistically significant heterogeneity for the majority of meta-analyses, and statistically significant publication bias in almost half.

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Section: Discussionmentioning

confidence: 99%

“…Of the three meta-analyses that performed subgroup analyses comparing critically ill vs. surgical patients, it also appears that there was no significant difference between these two groups in their response to glutamine supplementation (12,15,16).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic benefits of glutamine: An umbrella review of meta-analyses

McRae

2017

Biomedical Reports

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“…Cysteine is essential in critically ill patients 5 . Supplementation of glutamine may improve protein status and immunocompetence, enhance nutritional management, reduce the number of infections and augment recovery of the seriously ill while minimizing hospital stay 30,32,[34][35][36][37] . Leucin stimulates skeletal muscle protein synthesis and inhibits muscle proteolysis, even during sepsis 5,56,57 .…”

Section: Resultsmentioning

confidence: 99%

“…Provision of supplemental glutamine in specialized enteral or parenteral feeding may improve protein status and immunocompetence, enhance nutritional management, reduce the number of infections and augment recovery of the seriously ill while minimizing hospital stay (Table 4) (ref. 30,32,34,35,37 ). The effect of Gln is dose dependent (Table 5).…”

Section: Author Effect Of Supplementationmentioning

confidence: 99%

“…Cysteine and glutathione (GSH) metabolism is impaired in neonates and the critically ill. Improving protein status Smith et al 31 Increasing protein synthesis and decreasing protein degradation in skeletal muscle and stimulating glycogen synthesis in the liver Houdijk et al 35 Decreasing the number of infections, a low frequency of pneumonia, sepsis, and bacteraemia Bollhalder et al 37 Reducing infections, length of stay and mortality 29 . Cysteine is essential in premature infants and in critically ill patients 5 .…”

Section: Author Effect Of Supplementationmentioning

confidence: 99%

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The importance and dosage of amino acids in nutritional support of various pathological conditions in ICU patients

Aimova¹,

Hronek²,

Zadák³

2014

BIOMED PAP

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Background. Normal adults require twenty L-amino acids (AA) for protein synthesis. Functional AA regulate key metabolic pathways that are necessary for maintenance, growth, reproduction and immunity. Dietary supplementation with one or a mixture of these AA may be beneficial for ameliorating health problems at various stages of the life cycle and for optimizing of the efficiency of metabolic transformations. During disease, other amino acids also become essential. The principal goal of protein/amino acid administration in various pathological conditions in intensive care unit (ICU) patients is to provide the precursors of protein synthesis in tissues with high turnover and to protect skeletal muscle mass and function. Amino acid requirements in parenteral nutrition (PN) are higher when the patient is stressed/ traumatized/infected than in the unstressed state. In severely ill ICU patients a higher provision of protein and amino acids has been associated with a lower mortality. Methods and Results. An overview of the effects and dosage of amino acids in nutritional support of various pathological conditions in ICU patients is presented. Conclusion. It was demonstrated that 2.0-2.5 g protein substrate/kg normal body weight/day is safe and could be optimal for the most critically ill adults to decrease the risk of morbidity and mortality in some pathological conditions.

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