OBJECTIVE:: Very low birth weight (VLBW) infants receiving glutamine-enriched enteral nutrition may present with a lower infection rate, which may result from enhanced antimicrobial innate or Th1 cytokine responses. We investigated whether glutamine-enriched enteral nutrition in VLBW infants increased these cytokine responses following in vitro stimulation of whole blood cells. METHODS:: In a double-blind, placebo-controlled, randomized controlled trial, VLBW infants (gestational age <32 weeks and/or birth weight <1500 g) received enteral glutamine supplementation (0.3 g · kg · day) or isonitrogenous placebo supplementation (alanine) between days 3 and 30 of life. Cytokine responses following in vitro whole blood cell stimulation with anti-(α)CD3/αCD28 or lipopolysaccharide were analyzed by cytometric bead array at 3 time points: before the start of the study, at day 7 of life, and at day 14 of life. RESULTS:: Baseline patient and nutritional characteristics were not different between groups. At least 2 blood samples were analyzed in 25 of 52 (48%) and 38 of 50 (76%) infants in the glutamine-supplemented and control groups, respectively. Glutamine-enriched enteral nutrition was not associated with significant alterations in cytokine responses (interferon-γ, tumor necrosis factor-α, interleukin [IL]-2, IL-4, IL-5, and IL-10) of peripheral blood cells upon stimulation with either anti-αCD3/αCD28 or lipopolysaccharide. CONCLUSIONS:: We hypothesize that glutamine-enriched enteral nutrition decreases the infection rate in VLBW infants by influencing the mucosal and not the systemic immune system.

Cytokines, Enteral nutrition, Glutamine, Randomized controlled trial, Th1/Th2 cell, Very low birth weight infants
dx.doi.org/10.1097/MPG.0b013e3181805116, hdl.handle.net/1765/25088
Journal of Pediatric Gastroenterology and Nutrition
Erasmus MC: University Medical Center Rotterdam

van den Berg, A, van Elburg, R.M, Vermeij, L, van Zwol, A, van den Brink, G.R, Twisk, J.W.R, … Fetter, W.P.F. (2009). Cytokine responses in very low birth weight infants receiving glutamine-enriched enteral nutrition. Journal of Pediatric Gastroenterology and Nutrition, 48(1), 94–101. doi:10.1097/MPG.0b013e3181805116