A suplementação de glutamina é benéfica em crianças com doenças graves?
Palavras-chave:
criança, glutamina, nutrição enteral, nutrição parenteral, suplementação, terapia intensivaResumo
Embora haja vários estudos clínicos randômicos avaliando os benefícios da suplementação de glutamina em pacientes adultos, há pouca informação em pacientes pediátricos, particularmente naqueles com doenças graves. O objetivo deste estudo foi avaliar criticamente os estudos sobre suplementação de glutamina, para verificar os possíveis benefícios clínicos desta suplementação em crianças gravemente doentes. Levou-se a cabo uma pesquisa dos estudos publicados entre 1992 e 2003, do tipo prospectivo, randômico e controlado, conduzidos em pacientes pediátricos gravemente doentes, divididos em dois grupos: o dos que receberam suplementos de glutamina por via enteral ou parenteral, e o dos que receberam placebo. As variáveis de desfecho foram: tempo para atingir oferta plena de dieta enteral, tempo de hospitalização, complicações e mortalidade. Foram utilizadas as bases de dados Medline, LILACS e Cochrane, com as palavras-chave: glutamine, critically ill, trauma, sepsis, burned, injured, bone marrow transplantation, intensive care, mechanical ventilation. Dos 33 estudos inicialmente identificados, 7 preencheram os critérios de inclusão. A análise dos resultados mostrou que nos pacientes suplementados com glutamina, houve melhor aceitação por via enteral e redução do tempo de nutrição parenteral em recém-nascidos, não havendo efeito sobre o tempo de internação, custos hospitalares e mortalidade. Os estudos controlados na faixa etária pediátrica, não permitem que se adote o uso rotineiro da glutamina em crianças gravemente enfermas. O número reduzido de pacientes e a heterogeneidade quanto ao grupo etário, doenças e via de administração são fatores que limitam a interpretação dos resultados.
Referências
Hall JC, Heel K, McCauley R. Glutamine. Br J Surg. 1996; 83(3):305-12.
Lacey JM, Wilmore DW. Is glutamine conditionally essential amino acid? Nutr Rev. 1990; 48(8): 297-309.
Muhlbacher F, Kapadia CR, Colpoys MF, Smithth WDW. Effects of glucocorticoids on glutamine metabolism in skeletal muscle. Am J Physiol. 1984; 247(1):75-83.
Murphy C, Newsolme P. Macrophage mediated lysis of a beta-cell line, tumor necrosis factor-alpha release from bacillus Calmetti-Guerin (BCG) activated murine macrophages and interleukin-8 release from human monocytes are dependent on
extracellular glutamine concentration and glutamine metabolism. Clin Sci. 1999; 96(1): 89-97.
Wilmore DW, Shabert JK. Role of glutamine in immunologic responses. Nutrition. 1998; 14 (7-8):618-26.
Alverdy JC Effects of glutamine suplemented diets on imunology of the gut. JPEN J Parenter Enteral Nutr. 1990; 14(4):109S-13S.
Kelly D, Wischmeyer PE. Role of L-glutamine in critical illness: new insights. Curr Opin Clin Nutr Metab Care. 2003; 6(2):217-22.
Novak F, Heyland DK, Avenell A, Drover JW, Su X. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med. 2002; 30(9):2022-9.
Anderson PM, Schroeder G, Skubitz KM. Oral glutamine reduces the duration and severity of stomatitis after cytotoxic cancer chemotherapy. Cancer. 1998; 83(7):1433-9.
Barbosa E, Moreira EA, Goes JE, Faintuch J. Pilot study with a glutamine-supplemented enteral formula in critically ill infants. Rev Hosp Clin Fac Med São Paulo. 1999; 54(1):21-4.
Dallas MJ, Bowling D, Roig JC, Auestad N, Neu J. Enteral glutamine supplementation for very-low- -birth-weight infants decreases hospital costs. J Parenter Enteral Nutr 1998; 22(6):352-6.
Lacey JM, Crouch JB, Benfell K, Ringer SA, Wilmore CK, Maguire D, et al. The effects of glutaminesupplemented parenteral nutrition in premature infants. J Parenter Enteral Nutr. 1996; 20:74-80.
Neu J, Roig JC, Meetze WH, Veerman M, Carter C, Millsaps M, et al. Enteral glutamine supplementation for very low birth weight infants decreases morbidity. J Pediatr. 1997; 131:691-9.
Vaughn P, Thomas P, Clark R, Neu J. Enteral glutamine supplementation and morbidity in low birth weight infants. J Pediatr. 2003; 142(6): 662-8.
Thompson SW, McClure BG, Tubman TRJ. A randomized, controlled trial of parenteral glutamine in ill, very low birth-weight neonates. J Pediatr Gastroenterol Nutr. 2003; 37(5):550-3.
Houdijk AP, Nijveldt RJ, van Leeuwen PA. Glutamine-enriched enteral feeding in trauma patients: reduced infectious morbidity is not related to changes in endocrine and metabolic responses. J Parenter Enteral Nutr. 1999; 23(5): 52S-8S.
Schloerb PR, Skikne BS. Oral and parenteral glutamine in bone marrow transplantation: a randomized, double-blind study. J Parenter Enteral Nutr 1999; 23(3):117-22.
Ziegler TR, Benfell K, Smith RJ, Young LS, Brown E, Ferrari-Baliviera E, et al. Safety and metabolic effects of glutamine administration in humans. J Parenter Enteral Nutr. 1990; 14:137S-46S.
Neu J, DeMarco V, Li N. Glutamine: clinical applications and mechanisms of action. Curr Opin Clin Nutr Metab Care. 2002; 5(1):69-75.
Tubman TR, Thompson SW. Glutamine supplementation for prevention of morbidity in preterm infants. Cochrane Database Syst Rev. 2001; (4):CD001457.
Poindexter BB, Ehrenkranz RA, Stoll BJ, Koch MA, Wright LL, Oh W, et al. Effect of parenteral glutamine supplementation on plasma amino acid concentrations in extremely low-birth-weight infants. Am J Clin Nutr. 2003; 77(3):737-4
Coghlin Dickson TM, Wong RM, Offrin RS, Shizuru JA, Johnston LJ, Hu WW, et al. Effect of oral glutamine supplementation during bone marrow transplantation. J Parenter Enteral Nutr. 2000; 24(2):61-6.
Gianotti L, Alexander JW, Gennari R, Pyles T, Babcock GF. Oral glutamine decreases bacterial translocation and improves survival in experimental gut-origin sepsis. J Parenter Enteral Nutr. 1995; 19(1):69-74.
Karinch AM, Pan M, Lin CM, Strange R, Souba WW. Glutamine metabolism in sepsis and infection. J Nutr. 2001; 131(9):2535S-8S.
Wischmeyer PE, Lynch J, Liedel J, Wolfson R, Riehm J, Gottlieb L, et al. Glutamine administration reduces Gram-negative bacteremia in severely burned patients: a prospective, randomized, double-blind trial versus isonitrogenous control. Crit Care Med. 2001; 29(11):2075-80.
Houdijk AP, Rijnsburger ER, Jansen J, Wesdorp RI, Weiss JK, McCamish MA, et al. Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple traumas. Lancet. 1998; 352(9130):772-6.
Garcia-de-Lorenzo A, Zarazaga A, Garcia-Luna PP, Gonzalez-huiz F, Lopez-Martinez J, Mijan A. Clinical evidence for enteral nutritional support with glutamine: a systematic review. Nutrition. 2003; 19(9):805-11.
Schloerb PR, Amare M. Total parenteral nutrition with glutamine in bone marrow transplantation and other clinical applications. J Parenter Enteral Nutr. 1993; 17(5):407-13.
Goeters C, Wenn A, Mertes N, Wempe C, Van Aken H, Stehle P, et al. Parenteral L-alanyl-L-glutamimine improves 6 month outcome in critically ill patients. Crit Care Med. 2002; 30(9):2032-7.
Griffiths RD, Allen KD, Andrews FJ, Jones C. Infection, multiple organ failure, and survival in the intensive care unit: influence of glutamine- -supplemented parenteral nutrition on acquired infection. Nutrition. 2002; 18(7-8):546-52.
Mertes N, Schulzki C, Goeters C, Winde G, Benzing S, Keihn KS. et al. Cost containment through L-alanyl-L-glutamine supplemented total parenteral nutrition after major abdominal surgery: a prospective randomized double-blind controlled study. Clin Nutr. 2000; 19(6):395-401.
Powell-Tuck J. Total parenteral nutrition with glutamine dipeptide shortened hospital stays and improved immune status and nitrogen economy after major abdominal surgery. Gut. 1999; 44(2):155
Ziegler TR, Bazargan N, Galloway JR. Glutamine supplemented nutrition suport: saving nitrogen and saving money? Clin Nutr. 2000; 19(6):375-7.
Ball PA, Hardy G. Glutamine in pediatrics: where next? Nutrition. 2002; 18(6):451-4.
Neu J. Glutamine supplements in premature infants: why and how. J Pediatr Gastroenterol Nutr. 2003; 37(5):533-5.
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