title: Clinical evidence for enteral nutritional support with glutamine: a systematic review.
abstract: OBJECTIVE
  The purpose of this systematic review was to locate and assess the quality of scientific evidence to establish a graded recommendation based on the effectiveness of glutamine-enriched enteral nutrition in different medical and surgical conditions. We were concerned with the following topics: 1) benefits of enteral administration of glutamine in different pathologic conditions, and 2) dose, duration, and time of initiation of glutamine-enriched diets.
  
  
  METHODS
  The sources consulted for the search were MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Healthstar and HSTAT. Ninety-one studies were assessed; after a methodologic review (primary review), only 16 studies met the inclusion criteria for analysis by a group of experts (secondary review). The coordinators supervised all data, and a final consensus was reached among the coordinators, experts, and methodologists.
  
  
  CONCLUSIONS
  Glutamine-enriched diets showed good overall tolerance, improvement of immunologic aspects in multiple trauma patients, cost reduction in critically ill patients, and improvement of mucositis in post-chemotherapy patients (grade B recommendations). The doses given and the duration of therapy varied widely depending on the pathologic condition. Intake of 20 to 30 g/d, early initiation of diet, and maintenance for 5 d or longer are recommended (grade C recommendations).
authors.affiliation: Department of Intensive Medicine, Madrid, Spain. agdl@servitel.es
authors.forename: Abelardo
authors.initials: A
authors.lastname: García-de-Lorenzo
authors.forename: Antonio
authors.initials: A
authors.lastname: Zarazaga
authors.forename: Pedro Pablo
authors.initials: PP
authors.lastname: García-Luna
authors.forename: Ferrán
authors.initials: F
authors.lastname: Gonzalez-Huix
authors.forename: Jorge
authors.initials: J
authors.lastname: López-Martínez
authors.forename: Alberto
authors.initials: A
authors.lastname: Miján
authors.forename: Luis
authors.initials: L
authors.lastname: Quecedo
authors.forename: César
authors.initials: C
authors.lastname: Casimiro
authors.forename: Luis
authors.initials: L
authors.lastname: Usán
authors.forename: Juan
authors.initials: J
authors.lastname: del Llano
mesh_terms: D016638:Critical Illness / Q000628:therapy*; D016206:Databases, Bibliographic; D004305:Dose-Response Relationship, Drug; D004750:Enteral Nutrition; D005973:Glutamine / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D016239:MEDLINE; D015201:Meta-Analysis as Topic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005973:Glutamine