title: Enteral nutrition supplemented with L-glutamine in patients with systemic inflammatory response syndrome due to pulmonary infection.
abstract: OBJECTIVE
  To evaluate the effect of enteral nutrition (EN) supplemented with l-glutamine on glycolytic parameters, inflammation, immune function, and oxidative stress in moderately ill intensive care patients with sepsis.
  
  
  METHODS
  Thirty patients received EN. Fifteen patients received EN supplemented with glutamine (30 g; GLN group) for 2 d followed by EN supplemented with calcium caseinate (30 g, CAS group), also over 2 d. The other 15 patients received EN with calcium caseinate (30 g; CAS group) for 2 d followed by EN with glutamine (30 g; GLN group), also over 2 days. One washout day with only EN was provided between every 2-d period of EN plus supplementation to all patients. Blood samples were taken before and after supplementation.
  
  
  RESULTS
  There were no changes in glycolytic parameters in either group. Leukocytes decreased in the two groups (from 13 650 to 11 500 in the CAS group, P = 0.019; from 12.850 to 11.000 in the GLN group, P = 0.046). Lymphocytes increased in the GLN group (from 954 to 1916, P < 0.0001) and were more numerous after glutamine supplementation (from 1916 to 1085, P < 0.0001, GLN versus CAS). No significant changes were observed in interleukin levels, but urea levels were higher in the GLN compared with the CAS group (50.0-47.0, P = 0.030). Glutathione plasma concentrations did not differ significantly between the groups. No significant changes were observed in the plasma glutamine and glutamate concentrations.
  
  
  CONCLUSIONS
  The EN supplemented with glutamine increased the lymphocyte count and helped to decrease lipid peroxidation but presented no effect on the antioxidant glutathione capacity and on cytokine concentrations or glycolytic parameters.
authors: Department of Surgery, Federal University of Ceará School of Medicine, Fortaleza, Ceará, Brazil. monteirocavalcante@yahoo.com.br
authors: Ana Augusta Monteiro
authors: AA
authors: Cavalcante
authors: Márcio Wilker Soares
authors: MW
authors: Campelo
authors: Marcelo Pinho Pessoa
authors: MP
authors: de Vasconcelos
authors: Camila Marques
authors: CM
authors: Ferreira
authors: Sergio Botelho
authors: SB
authors: Guimarães
authors: José Huygens Parente
authors: JH
authors: Garcia
authors: Paulo Roberto Leitão
authors: PR
authors: de Vasconcelos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002364:Caseins / Q000494:pharmacology; D019587:Dietary Supplements; D004311:Double-Blind Method; D004750:Enteral Nutrition; D005260:Female; D005973:Glutamine / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D005978:Glutathione / Q000097:blood; D006801:Humans; D015227:Lipid Peroxidation / Q000187:drug effects; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000097:blood / Q000150:complications*; D018805:Sepsis / Q000097:blood / Q000209:etiology / Q000628:therapy*; D018746:Systemic Inflammatory Response Syndrome; D014508:Urea / Q000097:blood
chemical_list: D002364:Caseins; C484216:calcium caseinate; D005973:Glutamine; D014508:Urea; D005978:Glutathione