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VOLUME 23 , ISSUE 8 ( August, 2019 ) > List of Articles

Original Article

Effects of Early Enteral Glutamine Supplementation on Intestinal Permeability in Critically Ill Patients

Zahra Vahdat Shariatpanahi, Ghazaleh Eslamian, Seyed Hossein Ardehali, Ahmad-Reza Baghestani

Keywords : Antiendotoxin immunoglobulin, Endotoxin, Enteral nutrition, Glutamine, Zonulin

Citation Information : Shariatpanahi ZV, Eslamian G, Ardehali SH, Baghestani A. Effects of Early Enteral Glutamine Supplementation on Intestinal Permeability in Critically Ill Patients. Indian J Crit Care Med 2019; 23 (8):356-362.

DOI: 10.5005/jp-journals-10071-23218

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background and aims: Enteral administration of glutamine has been proposed as an effective recovery of intestinal barrier function. This amino acid has a modulating effect on the reducing bacterial translocation, which can influence immune functions of the intestine. The objective was to evaluate the effects of early enteral glutamine supplementation on intestinal permeability in critically ill patients. Materials and methods: A total of 80 critically ill patients older than 18 years were randomly assigned to one of two groups according to the stratified blocked randomization by age and admission category. Consecutive participants took enteral formula plus 0.3 g/kg/day glutamine powder or enteral formula plus maltodextrin during the ICU stay for a maximum of 10 days. Plasma glutamine, endotoxin, zonulin, and antiendotoxin immunoglobulin (Ig)G/IgM concentrations were measured on days 5 and 10 of intervention. Results: Out of 80 participants, 36 patients in the glutamine group and 34 patients in the control group were included in the analysis of the outcomes. Enteral glutamine significantly reduced plasma zonulin concentration up to 40% during 10 days. This reduction was significantly greater compared with that of the placebo group (P<0.001). Endotoxin concentration decreased in both groups; this reduction was significantly greater in the glutamine group (p = 0.014). The antiendotoxin IgM and IgG antibody levels increased in the glutamine group but decreased in the control group (p <0.001). There were no significant differences in clinical outcomes between two groups. Conclusion: Early enteral glutamine supplementation led to a declined intestinal permeability in critically ill patients.


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  1. Hill LT. Gut dysfunction in the critically ill− mechanisms and clinical implications. Southern African Journal of Critical Care. 2013;29(1):11–15.
  2. De-Souza DA, Greene LJ. Intestinal permeability and systemic infections in critically ill patients: effect of glutamine. Crit Care Med. 2005;33(5):1125–1135.
  3. Sertaridou E, Papaioannou V, Kolios G, Pneumatikos I. Gut failure in critical care: old school versus new school. Ann Gastroenterol. 2015;28(3):309–322.
  4. Deitch EA. Gut-Origin sepsis; evolution of a concept. Surgeon. 2012;10(6):350–356.
  5. Savy GK. Glutamine supplementation. Heal the gut, help the patient. J Infus Nurs. 2002;25(1):65–69.
  6. Achamrah N, Dechelotte P, Coeffier M. Glutamine and the regulation of intestinal permeability: from bench to bedside. Curr Opin Clin Nutr Metab Care. 2017;20(1):86-91.
  7. Coeffier M, Dechelotte P. The role of glutamine in intensive care unit patients: mechanisms of action and clinical outcome. Nutr Rev. 2005;63(2):65–69.
  8. Labow BI, Souba WW. Glutamine. World J Surg. 2000;24(12):1503–1513.
  9. Galipeau HJ, Verdu EF. The complex task of measuring intestinal permeability in basic and clinical science. Neurogastroenterol Moti. 2016;28(7):957–965.
  10. Uranjek J, Vovk I, Kompan L. Effect of the route of glutamine supplementation (enteral versus parenteral) on intestinal permeability on surgical intensive care unit patients: a pilot study. Surgical Practice. 2013;17(4):153–160.
  11. Conejero R, Bonet A, Grau T, Esteban A, Mesejo A, Montejo JC, et al. Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically ill patients with systemic inflammatory response syndrome: a randomized, single-blind, prospective, multicenter study. Nutrition. 2002;18(9):716–721.
  12. Peng X, Yan H, You Z, Wang P, Wang S. Effects of enteral supplementation with glutamine granules on intestinal mucosal barrier function in severe burned patients. Burns. 2004;30(2):135–139.
  13. Zhou YP, Jiang ZM, Sun YH, Wang XR, Ma EL, Wilmore D. The effect of supplemental enteral glutamine on plasma levels, gut function, and outcome in severe burns: a randomized, double-blind, controlled clinical trial. JPEN J Parenter Enteral Nutr. 2003;27(4):241–245.
  14. Velasco N, Hernandez G, Wainstein C, Castillo L, Maiz A, Lopez F, et al. Influence of polymeric enteral nutrition supplemented with different doses of glutamine on gut permeability in critically ill patients. Nutrition. 2001;17(11-12):907–911.
  15. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J Parenter Enteral Nutr. 2016;40(2):159–211.
  16. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–829.
  17. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–710.
  18. Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care. 2011;15(6):R268.
  19. Harmon P, Cabral-Lilly D, Reed RA, Maurio FP, Franklin JC, Janoff A. The release and detection of endotoxin from liposomes. Anal Biochem. 1997;250(2):139–146.
  20. van Eijk HM, Wijnands KA, Bessems BA, Olde Damink SW, Dejong CH, Poeze M. High sensitivity measurement of amino acid isotope enrichment using liquid chromatography-mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2012;905:31–36.
  21. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20(6):864–874.
  22. Wang B, Wu G, Zhou Z, Dai Z, Sun Y, Ji Y, et al. Glutamine and intestinal barrier function. Amino acids. 2015;47(10):2143–2154.
  23. Calder PC, Yaqoob P. Glutamine and the immune system. Amino acids. 1999;17(3):227–241.
  24. Swank GM, Deitch EA. Role of the gut in multiple organ failure: bacterial translocation and permeability changes. World J Surg. 1996;20(4):411–417.
  25. Kim MH, Kim H. The Roles of Glutamine in the Intestine and Its Implication in Intestinal Diseases. Int J Mol Sci. 2017;18(5).
  26. Dorshow RB, Hall-Moore C, Shaikh N, Talcott MR, Faubion WA, Rogers TE, et al. Measurement of gut permeability using fluorescent tracer agent technology. Sci Rep. 2017;7.
  27. Rietschel ET, Kirikae T, Schade FU, Mamat U, Schmidt G, Loppnow H, et al. Bacterial endotoxin: molecular relationships of structure to activity and function. FASEB J. 1994;8(2):217–225.
  28. Fasano A. Zonulin, regulation of tight junctions, and autoimmune diseases. Ann N Y Acad Sci. 2012;1258:25–33.
  29. Greis C, Rasuly Z, Janosi RA, Kordelas L, Beelen DW, Liebregts T. Intestinal T lymphocyte homing is associated with gastric emptying and epithelial barrier function in critically ill: a prospective observational study. Crit Care. 2017;21(1):70.
  30. Klaus DA, Motal MC, Burger-Klepp U, Marschalek C, Schmidt EM, Lebherz-Eichinger D, et al. Increased plasma zonulin in patients with sepsis. Biochem Med. 2013;23(1):107–111.
  31. Wang J, Li Y, Qi Y. Effect of glutamine-enriched nutritional support on intestinal mucosal barrier function, MMP-2, MMP-9 and immune function in patients with advanced gastric cancer during perioperative chemotherapy. Oncol Lett. 2017;14(3):3606–3610.
  32. Oldani M, Sandini M, Nespoli L, Coppola S, Bernasconi DP, Gianotti L. Glutamine Supplementation in Intensive Care Patients: A Meta-Analysis of Randomized Clinical Trials. Medicine. 2015;94(31):e1319.
  33. Chen QH, Yang Y, He HL, Xie JF, Cai SX, Liu AR, et al. The effect of glutamine therapy on outcomes in critically ill patients: a meta-analysis of randomized controlled trials. Crit Care. 2014;18(1):R8.
  34. van Zanten AR, Dhaliwal R, Garrel D, Heyland DK. Enteral glutamine supplementation in critically ill patients: a systematic review and meta-analysis. Crit Care. 2015;19:294.
  35. Heyland D, Muscedere J, Wischmeyer PE, Cook D, Jones G, Albert M, et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med. 2013;368(16):1489–1497.
  36. van Zanten AR, Sztark F, Kaisers UX, Zielmann S, Felbinger TW, Sablotzki AR, et al. High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition and nosocomial infections in the ICU: a randomized clinical trial. JAMA. 2014;312(5):514–524.
  37. Novak F, Heyland DK, Avenell A, Drover JW, Su X. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med. 2002;30(9):2022–2029.
  38. Avenell A. Glutamine in critical care: current evidence from systematic reviews. Proc Nutr Soc. 2006;65(3):236–241.
  39. Oudemans-van Straaten HM, Bosman RJ, Treskes M, van der Spoel HJ, Zandstra DF. Plasma glutamine depletion and patient outcome in acute ICU admissions. Intensive Care Med. 2001;27(1):84–90.
  40. Reintam A, Parm P, Kitus R, Kern H, Starkopf J. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand. 2009;53(3):318–324.
  41. Jolfaie NR, Mirzaie S, Ghiasvand R, Askari G, Miraghajani M. The effect of glutamine intake on complications of colorectal and colon cancer treatment: A systematic review. J Res Med Sci. 2015;20(9):910–918.
  42. Hall JC, Dobb G, Hall J, de Sousa R, Brennan L, McCauley R. A prospective randomized trial of enteral glutamine in critical illness. Intensive Care Med. 2003;29(10):1710–1716.
  43. Yalcin SS, Yurdakok K, Tezcan I, Oner L. Effect of glutamine supplementation on diarrhea, interleukin-8 and secretory immunoglobulin A in children with acute diarrhea. J Pediatr Gastroenterol Nutr. 2004;38(5):494–501.
  44. Zhang Y, Lu T, Han L, Zhao L, Niu Y, Chen H. L-Glutamine Supplementation Alleviates Constipation during Late Gestation of Mini Sows by Modifying the Microbiota Composition in Feces. BioMed Research International. 2017;2017.
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