Open AccessIntervention and Mechanisms of Alanyl‐glutamine for Inflammation, Nutrition, and Enteropathy
Author(s) -
Moore Sean R.,
Quinn Laura A.,
Maier Elizabeth A.,
Guedes Marjorie M.,
Quetz Josiane S.,
Perry Madeline,
Ramprasad Chethan,
Lanzarini Lopes Gabriela M.L.,
MaynerisPerxachs Jordi,
Swann Jonathan,
Soares Alberto M.,
Filho José Q.,
Junior Francisco S.,
Havt Alexandre,
Lima Noelia L.,
Guerrant Richard L.,
Lima Aldo A.M.
Publication year - 2020
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000002834
Subject(s) - medicine , glutamine , lactulose , gastroenterology , excretion , randomized controlled trial , placebo , urine , feces , malabsorption , overweight , physiology , body mass index , biology , paleontology , biochemistry , alternative medicine , amino acid , pathology
Objective: Determine the minimum dosage of alanyl‐glutamine (Ala‐Gln) required to improve gut integrity and growth in children at risk of environmental enteropathy (EE). Methods: This was a double‐blinded randomized placebo‐controlled dose‐response trial. We enrolled 140 children residing in a low‐income community in Fortaleza, Brazil. Participants were 2 to 60 months old and had weight‐for‐age (WAZ), height‐for‐age (HAZ), or weight‐for‐height (WHZ) z ‐scores less than −1. We randomized children to 10 days of nutritional supplementation: Ala‐Gln at 3 g/day, Ala‐Gln at 6 g/day, Ala‐Gln at 12 g/day, or an isonitrogenous dose of glycine (Gly) placebo at 12.5 g/day. Our primary outcome was urinary lactulose‐mannitol excretion testing. Secondary outcomes were anthropometry, fecal markers of inflammation, urine metabolic profiles, and malabsorption (spot fecal energy). Results: Of 140 children, 103 completed 120 days of follow‐up (24% dropout). In the group receiving the highest dose of Ala‐Gln, we detected a modest improvement in urinary lactulose excretion from 0.19% on day 1 to 0.17% on day 10 ( P = 0.05). We observed significant but transient improvements in WHZ at day 10 in 2 Ala‐Gln groups, and in WHZ and WAZ in all Ala‐Gln groups at day 30. We detected no effects on fecal inflammatory markers, diarrheal morbidity, or urine metabolic profiles; but did observe modest reductions in fecal energy and fecal lactoferrin in participants receiving Ala‐Gln. Conclusions: Intermediate dose Ala‐Gln promotes short‐term improvement in gut integrity and ponderal growth in children at risk of EE. Lower doses produced improvements in ponderal growth in the absence of enhanced gut integrity.