Reference: Crit Care Med 2002;30(9):2032-7.

                       OBJECTIVE Glutamine is recognized as a conditionally indispensable amino acid. The purpose
                       of the current study was to investigate whether supplemental l-alanyl-l-glutamine to parenteral
                       nutrition can alter clinical outcome in intensive care unit patients.DESIGN Prospective, open,
                       randomized trial.SETTING Postoperative intensive care unit of a university hospital.PATIENTS
                       Male and female critically ill patients with indications for parenteral nutrition and an expected stay
                       on intensive care unit for >/=5 days.INTERVENTIONS Patients were randomized to receive
                       either standard parenteral nutrition or supplemented parenteral nutrition with l-alanyl-l-glutamine
                       (0.3 g.kg.body weight [bw] per day). Total amount of amino acids comprised 1.5 g.kg.bw per
                       day. Caloric support was managed by metabolic variables (glucose and triglyceride plasma
                       values). Target values for energy supply were 3 g.kg.bw carbohydrates and 1 g.kg.bw fat per
                       day.MEASUREMENTS AND MAIN RESULTS Medical treatment, nutritional therapy, vital
                       variables, and biochemical data were recorded. Clinical outcome was measured by average
                       length of stay in the intensive care unit and hospital and the mortality in the intensive care unit and
                       within 30 days and 6 months. A total of 144 patients were randomized; 95 patients were treated
                       for >/=5 days and 68 patients for >/=9 days under standardized conditions. In the treatment
                       group, plasma glutamine concentrations significantly increased within 6-9 days. Six-month
                       survival was significantly improved for patients treated for >/=9 days (66.7% [glutamine
                       supplemented] vs. 40% [control]).CONCLUSION Study results support the hypothesis that
                       replacement of glutamine deficiency may correct the excess mortality in intensive care unit
                       patients caused by inadequate parenteral nutrition.

                       Reference: J Nutr Biochem 2002;13(9):560.

                       The objective was to determine stress related factors and nutritional indices affecting the nitrogen
                       balance (NB) and the creatinine height index (CHI) in critically ill children on early enteral
                       nutrition (EEN). Seventy-one consecutively enrolled critically ill children aged 2 to 204 months,
                       requiring prolonged mechanical ventilation, were studied. All patients were on early intragastric
                       nutrition (Nutrison Pediatric or Standard) from day 1 (energy intake equal to 1/2, 1, 5/4, 6/4 and
                       6/4 of the predicted basal metabolic rate on days 1-5, respectively). Nitrogen balance and CHI
                       changes determined efficacy. Study patients had severe depletion of somatic protein status on
                       stress day 1 (CHI <60%) but they reached the normal range of somatic protein status at the end
                       of the EEN, on post-stress day 5 (CHI >80%, p <.004). On day 1, none of the patients had
                       positive NB but after 5 days of EEN, 44 (62%) had positive NB and only 27 (38%) had
                       negative NB (p <.0001). Multivariate stepwise regression analysis showed that only the
                       difference of daily given-recommended dietary allowances protein and the total repleted energy
                       were positively correlated (r(2) =.47, p <.001 and r(2) = 34, p =.003, respectively) and multiple
                       organ system failure negatively correlated with the NB (r(2) = -.24, p <.03) on the 5th day of the
                       EEN protocol. Our data suggest that achievement of positive protein and energy balance in
                       relation to the basic metabolic rate using an aggressive EEN protocol improves NB during the
                       acute phase of stress in 2/3 of critically ill children.

                       Reference: Ann Surg 2002;236(3):369-74.

                       OBJECTIVE: To examine the effect of arginine, beta-hydroxy-beta-methylbutyrate (HMB), and
                       glutamine supplementation on wound collagen accumulation in a double-blind, randomized study.
                       SUMMARY BACKGROUND DATA: Control of wound collagen synthesis has been an elusive
                       goal for clinicians and scientists alike. In many clinical instances, it is desired to increase collagen
                       deposition as a means of enhancing wound strength and integrity. Arginine, a semiessential amino
                       acid, has been shown to increase wound collagen accumulation in rodents and humans. HMB, a
                       metabolite of leucine, regulates muscle proteolysis in animals and humans and increases collagen
                       deposition in rodents. METHODS: Thirty-five healthy, nonsmoking human volunteers 70 years or
                       older were enrolled and underwent subcutaneous implantation of two small, sterile
                       polytetrafluoroethylene (PTFE) tubes into the deltoid region under strict aseptic techniques. The
                       tubes were 1 mm in diameter and 6 cm in length with pore size of 90 to 120 microm to allow
                       optimal ingrowth of fibroblasts and the deposition of matrix. Eighteen volunteers (mean age 75.4
                       years; 2 men, 16 women) were randomized to receive daily supplementation of 14 g arginine, 3 g
                       HMB, and 14 g glutamine (total nitrogen 3.59 g) in two divided doses. The control group (n =
                       17; mean age 75.3 years; 6 men, 11 women) received an isonitrogenous, isocaloric
                       supplementation of nonessential amino acids. Catheters were removed at 7 and 14 days
                       postimplantation and analyzed for hydroxyproline (OHP, nmol/cm catheter, an index of collagen
                       accumulation) and alpha-amino nitrogen (alpha-AN, mmol/cm, an index of total protein
                       deposition). RESULTS: Supplements were well tolerated, without any reported side effects.
                       Supplementation with the specialized amino acid mixture led to a significant rise in plasma arginine
                       and ornithine levels. The specialized amino acid supplement led to a significant increase in
                       collagen deposition (as reflected by OHP content) in the PTFE tubes without an effect on total
                       protein accumulation. CONCLUSIONS: Collagen synthesis is significantly enhanced in healthy
                       elderly volunteers by the oral administration of a mixture of arginine, HMB, and glutamine. This
                       provides a safe nutritional means for increasing wound repair in patients.
 

                       Cardiovascular disease risk factors and n-3 fatty acid status in the adult
                       population of James Bay Cree.

                       Reference:Am J Clin Nutr 2002;76(1):85-92.

                       BACKGROUND: Canadian native populations, which traditionally consume large amounts of
                       fish, have lower rates of mortality from heart disease than do Canadian nonnative populations,
                       which have low fish intakes. Fish oils rich in n-3 fatty acids may have a protective effect against
                       cardiovascular disease (CVD) risk factors. OBJECTIVES: The purposes were to examine the
                       profile of plasma phospholipid concentrations of the n-3 fatty acids eicosapentaenoic acid (EPA)
                       and docosahexaenoic acid (DHA) among James Bay Cree and to verify the relation between
                       these concentrations and CVD risk factors. DESIGN: The study population consisted of 917
                       subjects aged 18-74 y who participated in the 1991 Sante Quebec Health Survey. Data were
                       obtained through home interviews and clinic visits. Plasma samples were analyzed for
                       phospholipid fatty acid composition. RESULTS: The mean fish consumption on the day before
                       the survey was 60 g among the adult Cree population. Expressed as a percentage of total fatty
                       acids, relative concentrations of EPA and DHA were 0.65% and 2.80%, respectively. n-3 Fatty
                       acids were higher among coastal residents than among inland residents. A positive association
                       was observed between plasma HDL and n-3 fatty acids. EPA and EPA+DHA were inversely
                       associated with triacylglycerols. Among subjects aged 50-74 y, an inverse association between
                       EPA and EPA:AA and total:HDL cholesterol was observed. CONCLUSIONS: n-3 Fatty acids
                       may favorably influence some CVD risk factors. The Cree population must be encouraged to
                       maintain their traditional fish-based diet, which may be one of the factors protecting them against
                       mortality from CVD.