The Journal of nutrition
-
The Journal of nutrition · Sep 2001
Review Comparative StudyGlutamine alimentation in catabolic state.
Glutamine should be reclassified as a conditionally essential amino acid in the catabolic state because the body's glutamine expenditures exceed synthesis and low glutamine levels in plasma are associated with poor clinical outcome. After severe stress, several amino acids are mobilized from muscle tissue to supply energy and substrate to the host. Glutamine is one of the most important amino acids that provide this function. ⋯ Several excellent clinical trials have been performed to prove efficacy and feasibility of the use of glutamine supplementation in parenteral and enteral nutrition. The increased intake of glutamine has resulted in lower septic morbidity in certain critically ill patient populations. This review will focus on the efficacy and the importance of glutamine supplementation in diverse catabolic states.
-
The Journal of nutrition · Sep 2001
ReviewGlutamine supplementation in cancer patients receiving bone marrow transplantation and high dose chemotherapy.
Glutamine supplementation of enteral and parenteral nutrition support has received increased attention in the research community over the past decade. Glutamine may become a conditionally essential nutrient during certain catabolic states, including after bone marrow transplantation (BMT). The administration of enteral or parenteral glutamine seems safe and also potentially efficacious in some patient groups undergoing intensive treatment for cancer. ⋯ Although not all studies demonstrate benefit, there are sufficient positive data to suggest that this nutrient should be considered in the metabolic support of many individuals undergoing the catabolic process of marrow transplantation. Given the available data, randomized, double-blind, controlled clinical trials of glutamine-enriched nutrition in patients receiving BMT and high dose chemotherapy protocols are indicated to further define the utility of this amino acid as adjunctive therapy. Studies of glutamine nutrition combined with current combinations of cytoreductive agents and hematopoietic growth factors in BMT will be particularly pertinent.
-
Severe infection causes marked derangements in the flow of glutamine among organs, and these changes are accompanied by significant alterations in regional cell membrane transport and intracellular glutamine metabolism. Skeletal muscle, the major repository of glutamine, exhibits a twofold increase in glutamine release during infection, which is associated with a significant increase in endogenous glutamine biosynthesis. Despite an increase in glutamine synthetase activity in skeletal muscle, the intracellular glutamine pool becomes depleted, indicating that release rates exceed rates of synthesis. ⋯ Recent studies suggest that IGF-1 has a direct effect on stimulating glutamine transport across the gut lumen and thus may represent a therapeutic avenue for improving gut nutrition during severe infection. The cells of the immune system (lymphocytes, macrophages) are also major glutamine consumers during inflammatory states in which cell proliferation is increased. Under these conditions, glutamine availability can become rate limiting for key cell functions, such as phagocytosis and antibody production.
-
The Journal of nutrition · May 2001
Alanyl-glutamine dipeptide does not affect hemodynamics despite a greater increase in myocardial heat shock protein 72 immunoreactivity in endotoxemic sheep.
The possible beneficial effect of supplemental glutamine (Gln) in critically ill patients has been suggested to be mediated by the induction of the cytoprotective heat shock proteins (HSP)32 and HSP72. There is evidence that HSP72 and HSP32 have opposite effects on the hemodynamic situation during endotoxemia. Therefore, the effect of Gln supplementation on the cardiovascular system is not clear. ⋯ Ala-Gln treated sheep had a greater increase in myocardial HSP72 immunoreactivity compared with controls after (P < 0.05) but not before endotoxemia. In summary, Ala-Gln increased HSP72 immunoreactivity after endotoxemia, but did not alter hemodynamic parameters. Thus, Ala-Gln supplementation does not seem to aggravate the hyperdynamic circulation in endotoxemic shock.
-
The Journal of nutrition · May 2001
The role of a new noninvasive imaging technology in the diagnosis of anemia.
Traditionally, numerical data regarding the status of a patient are a combination of measurements made at the point of care (POC) and those made in the laboratory on specimens withdrawn from the patient. We report here on our experiences with a new method for a noninvasive determination of anemia, as defined by blood hemoglobin (Hb) concentration. This method is based on a novel technology, orthogonal polarization spectral imaging, which provides high quality digitized images of the microcirculation using reflected light. ⋯ This information may give earlier and different insights regarding the patient status in nutritional deficiency anemia than an Hb concentration only. However, additional research will be required to confirm the accuracy and utility of this measurement, especially in adult and pediatric populations, where anemia is more commonly encountered. The ultimate success of POC testing will require collaboration between the attending health care professional, the laboratory and institutional management to rapidly assimilate improved methodologies and new information to provide benefits to the patient.