Use of L-glutamine in total parenteral nutrition

Gut atrophy develops during prolonged total parenteral nutrition (TPN). TPN solutions do not contain glutamine, an energy substrate of the intestinal tract. This study evaluated the effect of addition of L-glutamine to TPN on gut nitrogen content, histology, and disaccharidase enzyme activity. Five groups of six Fisher 344 rats received rat chow, D5W, TPN (23% calories as lipid), or TPN with 1 or 2% L-glutamine. Animals given TPN received 30 kcal and 0.22 g nitrogen/100 g/day. Metabolic cages allowed nitrogen balance for each group. After 6 days infusion, stomach, small bowel, and colon were assayed for total nitrogen and sucrase, lactase, and maltase activity. Mucosal height and fatty infiltration of the liver were determined from histologic sections. Adding either 1 or 2% L-glutamine resulted in no toxic clinical effects. Glutamine preserved intestinal nitrogen content of the stomach and colon compared to standard TPN and increased nitrogen content of small bowel to greater than that in chow-fed animals. Glutamine maintained mucosal height of the stomach and colon, but was no better than TPN alone in maintenance of small bowel mucosal height. One percent glutamine increased and standard TPN depressed maltase activity compared to chow. Standard TPN and 1% glutamine both stimulated sucrase and lactase activity compared to chow. Addition of 1 or 2% glutamine protected the liver from fatty infiltration seen with standard TPN. These studies would suggest the addition of glutamine might be beneficial during provision of standard total parenteral nutrition.