|Protein-Energy Interactions (International Dietary Energy Consultative Group - IDECG, 1991, 437 pages)|
|Effects of disease on desirable protein/energy ratios|
|5. Possible role of specific amino acids|
Interest in glutamine has developed over the last few years subsequent to developments in two areas:
(a) the understanding of the metabolic importance of glutamine as a fuel for lymphocytes, macrophages and other rapidly dividing cells,
(b) understanding of the importance and regulation of the skeletal muscle glutamine pool.
Thus, as a potential fuel for the immune system, concern has been expressed that inadequate provision of glutamine from skeletal muscle as a result of stress from infections and burns may be deleterious (FURST, ALBERS and STEHLE, 1987; JEPSON et al., 1988; NEWSHOLME et al., 1988). Concern has also been expressed that the ability of the gut mucosa to act as a barrier to pathogens in sepsis or trauma may be limited by inadequate mucosal synthesis subsequent to reduced availability of glutamine (WILMORE et al., 1988; LACEY and WILMORE, 1990). Finally, the suggestion that glutamine in skeletal muscle may act to regulate protein balance in this tissue has also led to attempts to limit the negative nitrogen balance in trauma by the provision of glutamine (ABUMRAD et al., 1989; HAMMARQVIST et al., 1989).
In parenteral nutrition solutions, the instability of glutamine during autoclaving has resulted in its omission from such solutions. Several authors have suggested the inclusion of glutamine containing dipeptides in TPN solutions. The suggestion has been made that enteral provision of glutamine could also be advantageous. To date there is no quantitative information about the dose-response of either immune function or gut-mucosal function to provide a basis for recommendations.