[Glutamine supplemented nutrition in clinical practice--use of glutamine-containing dipeptides].

Objective: In this review, the central role of glutamine in a large number of pathways is elucidated and the consequences of bodily glutamine deprivation observed during trauma, hypercatabolism and malnutrition on vital functions of organs and tissues are discussed. Subsequently, the use of glutamine and glutamine-containing dipeptides in the frame of clinical nutrition is critically evaluated. Finally, the prospective importance of glutamine nutrition in routine clinical settings is discussed.

Design: For this compilation basic work from human physiology and nutrition science as well as all actual research work dealing with the use of glutamine and glutamine dipeptide supplements in clinical nutrition have been considered.

Results: In various diseased states (like trauma, hypercatabolism, intestinal dysfunction, immunedeficiency) glutamine has to he considered a conditionally indispensable substrate and thus should be essential part of all nutritional efforts. Only adequate glutamine supply (about 10-15 g/day) can prevent bodily glutamine deprivation which may beneficially influence the clinical situation. The use of highly soluble and stable glutamine-containing dipeptides facilitates for the first time a safe and efficient glutamine supply within parenteral nutrition.

Conclusions: Enteral/parenteral glutamine therapy may contribute to improve nitrogen economy, to diminish the incidence of bacterial infections, to reduce the risk for bacterial translocation, and presumably to reduce hospital stay in various patient groups.