Glutamine Supplementation May Protect Very Low-Birth-Weight Infants From Atopic Dermatitis

Laurie Barclay, MD

November 06, 2007

November 5, 2007 -- Early supplementation with glutamine-enriched enteral nutrition lowers the risk for atopic dermatitis by 87% in very low-birth-weight (VLBW) infants, according to the results of a randomized controlled trial reported in the November issue of the Archives of Pediatric and Adolescent Medicine.

"Several studies in...VLBW...infants have investigated the effect of parenteral or enteral glutamine supplementation on morbidity and outcome in the neonatal period," write Anemone van den Berg, MD, PhD, from the VU University Medical Center, Amsterdam, the Netherlands, and colleagues. "However, little is known about the long-term effects of this nutritional intervention.... Knowledge about the effect of nutritional interventions on long term outcome and disease later in life (eg, allergy and asthma) may contribute to deliberate choices in neonatal nutritional support in VLBW infants."

This was a follow-up study at 1 year of all surviving VLBW infants born in a tertiary care hospital who participated in a randomized trial of glutamine-enriched enteral nutrition in infants. In that trial, infants were randomly assigned to either enteral glutamine supplementation (L-glutamine, 0.3 g/kg per day) from 3 through 30 days of life or to a control group. During the first year of life, the incidence of allergic and infectious diseases was assessed with validated questionnaires.

Of 90 infants who survived, 77 (86%) took part in the follow-up study. The glutamine-supplemented (n = 37) and control (n = 40) groups were not significantly different in baseline patient, maternal, and environmental characteristics, except for incidence of serious neonatal infections and child care attendance.

Risk for atopic dermatitis was lower in the glutamine-supplemented group than in the control group after adjusting for confounding factors (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.02 - 0.97). Both groups had similar incidence of bronchial hyperreactivity (OR, 0.34; 95% CI, 0.10 - 1.21) and infections of the upper respiratory (OR, 0.99; 95% CI, 0.35 - 2.79), lower respiratory (OR, 0.39; 95% CI, 0.13 - 1.24), and gastrointestinal (OR, 1.25; 95% CI 0.23 - 6.86) tracts.

"Glutamine-enriched enteral nutrition in very low-birth-weight infants decreased the incidence of atopic dermatitis during the first year of life but had no effect on the incidence of bronchial hyperreactivity and infectious diseases during the first year of life," the study authors write.

Study limitations include relatively small sample size of the follow-up study, parental report of disease by questionnaire is subject to reporting bias, physician-diagnosed events reported by the parents was subject to information bias, corrected age of 1 year may be too early to investigate the incidence of allergies and infections, and lack of data on underlying pathophysiological processes.

"Glutamine supplementation in VLBW infants may lead to long-term health benefits," the study authors conclude. "Further follow-up of this well-defined cohort of VLBW infants with respect to the incidence of allergic and infectious diseases may contribute to a better understanding of the maturation of the immune response and the role of glutamine supplementation in this process."

Nutricia Nederland BV provided Nenatal, glutamine, and placebo supplementation for the initial study. The authors have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2007;161(11):1095-1101.

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