title: Wasting and intestinal barrier function in children taking alanyl-glutamine-supplemented enteral formula.
abstract: OBJECTIVE
  We examined the effect of a diet supplemented with alanyl-glutamine (AG) or placebo glycine (G) on intestinal barrier function and growth in children in northeastern Brazil.
  
  
  METHODS
  One hundred seven children ages 7.9 to 82.2 months with a weight-for-age (WAZ), height-for-age (HAZ), or weight-for-height (WHZ) z-score less than -1 were studied. From July 2003 to November 2004, 51 study patients received AG (24 g/d) and 56 received G (25 g/d; isonitrogenic concentration) control for 10 days. Lactulose/mannitol excretion ratio was used as a measure of intestinal permeability and was performed on days 1 and 10 of nutritional supplementation. Weight and height were measured on days 1, 10, 30, and 120 of the protocol.
  
  
  RESULTS
  The patients were similar on admission with regard to age, sex, birth weight, nutritional status, lactulose/mannitol ratio, and serum concentrations of glutamine and arginine. The percentage of lactulose urinary excretion significantly improved (decreased) in children receiving AG for 10 days but not in those receiving glycine controls. AG significantly increased cumulative change over 120 days in WHZ and WAZ scores but not HAZ scores after adjustment for age and season in comparison with the placebo glycine group.
  
  
  CONCLUSIONS
  Children tolerated AG-supplemented enteral formula well, and it significantly improved cumulative WHZ and WAZ over 120 days in comparison with children in the placebo glycine group. The data also suggested a beneficial effect of AG in the barrier function paracellular pathway, albeit with reduced mannitol excretion. Thus, although the effect of AG on reduced mannitol concentration requires clarification, AG appears to improve nutrition and barrier function.
authors.affiliation: Clinical Research Unit & Institute of Biomedicine/Center for Global Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: Noélia L
authors.initials: NL
authors.lastname: Lima
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Soares
authors.forename: Rosa M S
authors.initials: RM
authors.lastname: Mota
authors.forename: Helena S A
authors.initials: HS
authors.lastname: Monteiro
authors.forename: Richard L
authors.initials: RL
authors.lastname: Guerrant
authors.forename: Aldo A M
authors.initials: AA
authors.lastname: Lima
mesh_terms: D001938:Brazil; D002648:Child; D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D019049:Developed Countries; D019587:Dietary Supplements; D004151:Dipeptides / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005998:Glycine / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007408:Intestinal Absorption / Q000502:physiology; D007413:Intestinal Mucosa / Q000378:metabolism*; D007583:Jejunum / Q000378:metabolism; D008297:Male; D009748:Nutrition Disorders / Q000178:diet therapy; D052756:Nutritional Sciences; D010539:Permeability; D011446:Prospective Studies; D014505:Urban Population; D019282:Wasting Syndrome / Q000178:diet therapy*
chemical_list: D004151:Dipeptides; D005998:Glycine; C054122:alanylglutamine