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Intestinal Barrier Function and Weight Gain in Malnourished Children Taking Glutamine Supplemented Enteral Formula

Lima, Aldo A. M.*§; Brito, Lúcia F. B.†; Ribeiro, Hildênia B.†; Martins, Ma Ceci V.†; Lustosa, Amália P.†; Rocha, Edna M.†; Lima, Noélia L.*; Monte, Cristina M. G.*; Guerrant, Richard L.*§

Journal of Pediatric Gastroenterology & Nutrition:
Original Articles: Hepatology and Nutrition

Objective: We examined the effect of standard formula and glutamine or glycine supplemented enteral formula on intestinal permeability and weight gain in children with malnutrition.

Methods: 80 children aged 2 to 60 months with a weight-for-age z-score less than −2 were studied. From December 1996 to April 1999, 27 study patients received nonsupplemented formula. From June 2001 to June 2002 an additional 53 patients were randomly assigned to receive formula supplemented with glutamine or glycine (isosmolar concentrations) for 10 days. Lactulose/mannitol excretion ratio was used as a measure of intestinal permeability and was performed before and after 10 days of nutritional rehabilitation. Weight was measured before and after treatment.

Results: Patients were similar on admission with regard to age, sex, nutritional status and lactulose/mannitol ratio. The lactulose/mannitol ratio significantly improved (decreased) in children receiving formula supplemented with glutamine for 10 days but not in those receiving glycine or nonsupplemented formula. Weight gain occurred during therapy in all groups and was not statistically different among groups.

Conclusion: Formula supplemented with glutamine improves intestinal barrier function compared with nonsupplemented formula but does not augment weight gain.

Author Information

*Clinical Research Unit & Institute of Biomedicine, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil; †Hospital Infantil Albert Sabin, State of Ceara Health Foundation, Fortaleza, CE, Brazil; §Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia

Received March 4, 2004; accepted July 27, 2004.

This research was funded in part by Clinical Research Unit & Institute of Biomedicine, Faculty of Medicine, Federal University of Ceará, Howard Hughes Medical Institute grant 55000645 and in part by National Institutes of Health grant AI26512.

Address correspondence and reprint requests to Aldo A.M. Lima, Clinical Research Unit & Institute of Biomedicine, Av. José Bastos no. 3312, Porangabussu, Fortaleza, Ce, Brazil CEP 60.000-000 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.