Have we enough glutamine and how does it work? A clinician's view.

Area of Science:

• Biochemistry
• Clinical Nutrition
• Immunology

Background:

• A discrepancy exists between the scientific evidence and clinical belief regarding glutamine deficiency in disease states.
• Glutamine plays vital roles in immune cells, wound healing, and as a precursor for essential metabolites.

Purpose of the Study:

• To evaluate the scientific basis for glutamine supplementation in severely ill patients.
• To determine if glutamine shortage occurs in disease and if supplementation is beneficial.

Main Methods:

• Review of existing literature on glutamine metabolism in disease states.
• Analysis of isotope studies and tissue glutamine release/uptake data.
• Evaluation of clinical studies on glutamine supplementation in trauma, burn, and inflammatory conditions.

Main Results:

• Glutamine concentrations decrease in inflammatory states, but are not reliable indicators of shortage.
• Increased glutamine release from peripheral to central tissues during inflammation suggests a need for supplementation.
• Clinical benefits of parenteral glutamine supplementation are more evident in severe inflammation, trauma, and burn patients.

Conclusions:

• Parenteral glutamine supplementation, at physiological levels, can be beneficial for patients with severe inflammation, trauma, or burns.
• The increased demand for glutamine by host defense organs during critical illness supports supplementation strategies.