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The Effect of Glutamine-Enriched Enteral Nutrition on Intestinal Permeability in Very-Low-Birth-Weight Infants: A Randomized Controlled Trial

Anemone van den Berg, MD^*, Willem P. F. Fetter, MD, PhD^*, Elisabeth A. M. Westerbeek, MD^*, Ina M. van der Vegt, Hilda R. A. van der Molen and Ruurd M. van Elburg, MD, PhD^*

From the ^* Department of Pediatrics, Division of Neonatology, VU University Medical Center, Amsterdam, The Netherlands; and the Laboratory Center for Special Analyses, University Medical Center Groningen, Groningen, The Netherlands

Correspondence: Anemone van den Berg, MD, Department of Pediatrics, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. Electronic mail may be sent to a.vandenberg{at}vumc.nl.

Background: Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion. Glutamine depletion has negative effects on intestinal integrity. The lower infection rate in VLBW infants receiving glutamine-enriched enteral nutrition may originate from improved intestinal integrity, as reflected by decreased intestinal permeability. The aim of our study was to investigate whether glutamine-enriched enteral nutrition in VLBW infants enhances the normal decrease in intestinal permeability, as measured by the sugar absorption test (SAT). Methods: In a double-blind, randomized, placebo-controlled trial, VLBW infants (gestational age <32 weeks or birth weight <1500 g) received enteral glutamine supplementation (0.3 g/kg/d) or an isonitrogenous placebo supplementation (alanine) between days 3 and 30 of life. Intestinal permeability, determined from the urinary lactulose/mannitol (L/M) ratio after an oral dose of lactulose and mannitol, was assessed at 4 time points: before the start of the study, and at days 7, 14, and 30 of life. Results: At least 2 SATs were performed in 45/52 (86%) and 45/50 (90%) infants in the glutamine-supplemented and control groups, respectively. Baseline patient and nutrition characteristics were not different between the groups. There was no effect of glutamine-enriched enteral nutrition on the decrease of the L/M ratio between the start and end of the study (p = .78). In both treatment groups, median urinary lactulose concentrations decreased (p < .001), whereas median urinary mannitol concentrations increased (p = .003). Conclusions: Glutamine-enriched enteral nutrition does not enhance the postnatal decrease in intestinal permeability in VLBW infants. Any beneficial effect of glutamine may involve other aspects of intestinal integrity; for example, modulation of the intestinal inflammatory response.

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