Glutamine-Enriched Enteral Nutrition in Very Low-Birth-Weight Infants

Abstract

Objective: To determine the effect of glutamineenriched enteral nutrition in very low-birth-weight infants on the incidence of allergic and infectious diseases during the first year of life.Design: Follow-up study.Setting: Tertiary care hospital.Participants: All surviving infants who participated in a trial of glutamine-enriched enteral nutrition in very lowbirth-weight infants.Intervention: Enteral glutamine supplementation (L-glutamine, 0.3 g/kg per day) from 3 through 30 days of life. Main Outcome Measures:The incidence of allergic and infectious diseases during the first year of life, as assessed by means of validated questionnaires.Results: Seventy-seven of 90 infants (86%) participated in the follow-up study. Baseline patient, maternal, and environmental characteristics did not differ between the glutamine-supplemented (n=37) and control (n=40) groups, except for the incidence of serious neonatal infections and child care attendance. After adjustment for confounding factors, the risk for atopic dermatitis was lower in the glutamine-supplemented group (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.02-0.97). However, the incidence of bronchial hyperreactivity (OR, 0.34; 95% CI, 0.10-1.21) and infections of the upper respiratory (OR, 0.99; 95% CI, 0.35-2.79), lower respiratory (OR, 0.39; 95% CI, 0.13-1.24), and gastrointestinal (OR 1.25, 95% CI 0.23-6.86) tracts was not different between the treatment groups.Conclusions: Glutamine-enriched enteral nutrition in very low-birth-weight infants decreased the incidence of atopic dermatitis during the first year of life but had no effect on the incidence of bronchial hyperreactivity and infectious diseases during the first year of life.

Cytokine profiles in 1‐yr‐old very low‐birth‐weight infants after enteral glutamine supplementation in the neonatal period

“…In our previous study (7), we found no effect of glutamine-enriched enteral nutrition in VLBW infants in the neonatal period on cytokine profiles in neonatal period. In the current study, we specifically addressed whether glutamine administration would positively affect the immunological process, characterized by a physiological switch from a Th 2 cytokine profile in the neonatal period into a modified Th 2 profile later in life.…”

“…5 μl of the mixed beads solution was mixed with 5 μl phycoerythrin‐conjugated detection antibodies and 5 μl recombinant standards or test samples to form sandwich complexes. IL‐4 was measured by ELISA (PeliKine, Sanquin Reagents, Amsterdam, the Netherlands) (7).…”

Glutamine Supplementation in Sick Children: Is It Beneficial?

“…Specifically, supplementation with Gln or isonitrogenous control equally decreased urinary concentrations of lactulose and increased urinary mannitol [116]. More recently, followup of all surviving participants ( n = 77) revealed that Gln-enriched EN in VLBW infants may lower the incidence of atopic dermatitis (OR [95% CI]: 0.13 [0.02–0.97]) during the first year of life but has no effect on the incidence of bronchial hyperactivity or infectious diseases [117]. Further followup of this cohort of VLBW infants ( n = 76) at 6 y of age also found a decreased risk of atopic dermatitis (adjusted OR [95% CI]: 0.23 [0.06–0.95]) and gastrointestinal infections (adjusted OR [95% CI]: 0.10 [0.01–0.93]) in the Gln-supplemented group [118].…”

“…Moreover, the results are conflicting for other short-term clinical outcomes such as feeding tolerance [99, 100, 102, 104, 107, 111, 113], serious infections/sepsis [100, 102, 107, 111, 113], ventilator use [99, 102, 104, 107, 113], and severe neurological sequelae [111]. Few data have been reported for the effects of Gln supplementation in VLBW infants on long-term clinical outcomes such as growth at 4 months [123], allergic and infectious morbidity at 1 y [117] and 6 y [118], and neurodevelopmental outcomes at 2 y corrected age [122]. Larger well-controlled studies are needed.…”

Primary atopic disorders

“…These data suggest that a selective bias away from mTORC1 utilization may promote allergic phenotypes in humans, as has been demonstrated in mouse models ( Delgoffe et al, 2011 ). A previous genome-wide association study independently identified CARD11 as a major susceptibility locus for atopic dermatitis ( Hirota et al, 2012 ), and a trial providing glutamine-enriched formula to premature infants demonstrated a protective effect on incident atopic dermatitis ( van den Berg et al, 2007 ), suggesting glutamine supplementation could be of clinical value in select individuals with atopic dermatitis.…”