Glutamine – from conditionally essential to totally dispensable?

Wernerman, Jan

doi:10.1186/cc13964

Cited by 8 publications

(6 citation statements)

References 12 publications

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“…These findings contradict the hypothesis that glutamine is a conditional essential amino acid during critical illness [5]. …”

Section: Discussioncontrasting

confidence: 89%

“…It has been suggested that supplementation with immune-modulating nutrients should be reserved for specifically identified patients with compromised availability and plasma levels should be measured before supplementation [5]. However, low plasma levels could reflect adaptive and beneficial stress responses rather than conditional deficiency.…”

Section: Introductionmentioning

confidence: 99%

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Glutamine, fish oil and antioxidants in critical illness: MetaPlus trial post hoc safety analysis

Hofman

Swinkels

Zanten

2016

Ann. Intensive Care

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Background The role of plasma glutamine, fish oil and antioxidants concentrations in the treatment effect of immune-modulating high-protein versus high-protein enteral nutrition on 6-month mortality in critically ill patients is explored, as unexpected negative outcomes of recent large randomized controlled trials on immune-modulating nutrients have raised questions about safety of these interventions.MethodsPost hoc analysis of the MetaPlus randomized controlled trial which was performed in a total of 301 medical, surgical and trauma critically ill patients in fourteen European intensive care units. Patients received either immune-modulating (glutamine, fish oil and antioxidant enriched) high-protein (IMHP) or isocaloric high-protein (HP) enteral nutrition. Six-month mortality and baseline, day 4 and day 8 plasma concentrations of glutamine, (eicosapentaenoicacid + decosahexaenoicacid)/long-chain fatty acid plasma level ratio ((epa + dha)/lcf ratio), selenium, vitamin c, vitamin e and zinc were measured.Results The harmful treatment effect of the IMHP versus HP enteral nutrition on 6-month mortality was only demonstrated in the medical subgroup (HR 2.52, 95% CI 1.36–4.78, P = 0.004). Among medical patients, when corrected for age groups and APACHE-II scores, there were no statistically significant associations between baseline plasma levels and 6-month mortality, except for zinc (HR 1.06, 95% CI 1.00–1.12, P = 0.026). IMHP feeding resulted in statistically significant increase in plasma levels of glutamine, vitamin e, vitamin c and (epa + dha)/lcf ratio from baseline to day 4, while only the change from baseline to day 4 of (epa + dha)/lcf ratio was statistically significant associated with 6-month mortality (HR 1.18, 95% CI 1.02–1.35, P = 0.021) and identified as mediator for the harmful treatment effect of IMHP enteral nutrition among medical ICU patients.ConclusionWe hypothesize that the harmful effect of IMHP compared to HP enteral nutrition in a heterogeneous group of critically ill patients is limited to the medical critically ill patients and mediated by an early increase in (epa + dha)/lcf ratio. Trial Registration Dutch Trial Register 26 January 2010 (NTR2181 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2181).Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0220-y) contains supplementary material, which is available to authorized users.

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“…These findings contradict the hypothesis that glutamine is a conditional essential amino acid during critical illness [5]. …”

Section: Discussioncontrasting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Glutamine, fish oil and antioxidants in critical illness: MetaPlus trial post hoc safety analysis

Hofman

Swinkels

Zanten

2016

Ann. Intensive Care

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“…Acute fulminant liver failure is therefore regarded a contraindication for glutamine substitution during critical illness [ 11 , 12 ]. It is less clear if patients with chronic and acute-on-chronic liver failure should also be exempted from glutamine supplementation.…”

Section: Introductionmentioning

confidence: 99%

Plasma Glutamine Concentrations in Liver Failure

et al. 2016

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BackgroundHigher than normal plasma glutamine concentration at admission to an intensive care unit is associated with an unfavorable outcome. Very high plasma glutamine levels are sometimes seen in both acute and chronic liver failure. We aimed to systematically explore the relation between different types of liver failure and plasma glutamine concentrations.MethodsFour different groups of patients were studies; chronic liver failure (n = 40), acute on chronic liver failure (n = 20), acute fulminant liver failure (n = 20), and post-hepatectomy liver failure (n = 20). Child-Pugh and Model for End-stage Liver Disease (MELD) scores were assessed as indices of liver function. All groups except the chronic liver failure group were followed longitudinally during hospitalisation. Outcomes were recorded up to 48 months after study inclusion.ResultsAll groups had individuals with very high plasma glutamine concentrations. In the total group of patients (n = 100), severity of liver failure correlated significantly with plasma glutamine concentration, but the correlation was not strong.ConclusionLiver failure, regardless of severity and course of illness, may be associated with a high plasma glutamine concentration. Further studies are needed to understand whether high glutamine levels should be regarded as a biomarker or as a contributor to symptomatology in liver failure.

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“…According to them there are not recommendations for routine use of Gln in all patients of intensive care units [ 51 , 52 , 53 , 54 , 55 ]. Therefore, Gln use in intensive care patients is also controversial [ 57 , 58 ].…”

Section: Glutamine (Gln)mentioning

confidence: 99%

The Role of Immunonutrition in Patients Undergoing Pancreaticoduodenectomy

Jabłońska

Mrowiec

2020

Nutrients

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Pancreaticoduodenectomy (PD) is one of the most difficult and complex surgical procedures in abdominal surgery. Malnutrition and immune dysfunction in patients with pancreatic cancer (PC) may lead to a higher risk of postoperative infectious complications. Although immunonutrition (IN) is recommended for enhanced recovery after surgery (ERAS) in patients undergoing PD for 5–7 days perioperatively, its role in patients undergoing pancreatectomy is still unclear and controversial. It is known that the proper surgical technique is very important in order to reduce a risk of postoperative complications, such as a pancreatic fistula, and to improve disease-free survival in patients following PD. However, it has been proven that IN decreases the risk of infectious complications, and shortens hospital stays in patients undergoing PD. This is a result of the impact on altered inflammatory responses in patients with cancer. Both enteral and parenteral, as well as preoperative and postoperative IN, using various nutrients, such as glutamine, arginine, omega-3 fatty acids and nucleotides, is administered. The most frequently used preoperative oral supplementation is recommended. The aim of this paper is to present the indications and benefits of IN in patients undergoing PD.

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Glutamine – from conditionally essential to totally dispensable?

Cited by 8 publications

References 12 publications

Glutamine, fish oil and antioxidants in critical illness: MetaPlus trial post hoc safety analysis

Glutamine, fish oil and antioxidants in critical illness: MetaPlus trial post hoc safety analysis

Plasma Glutamine Concentrations in Liver Failure

The Role of Immunonutrition in Patients Undergoing Pancreaticoduodenectomy

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