GLUTAMITALY 2003: Consensus Paper SINPE sull'impiego della glutamina nella nutrizione artificiale dell'adulto

From among the several nutrients believed to exert pharmacological actions, the amino acid Glutamine (GLN) is by far the most extensively studied during the last fifteen years. As an example, more than 970 papers appeared in Medline® between 1990 and 2003, matching the terms glutamine and nutrition, more than 300 of which in the form of review articles. The interest for this 'conditionallly essential' amino acid stems from the observation that it fulfills a number of biochemical needs. It operates as a nitrogen shuttle, may contribute to the formation of other amino acids, glucose, nucleotides, protein and glutathione, and represents the primary energy fuel for rapidly dividing cells, such as enterocytes, lymphocytes, macrophages and fibroblasts. In situations where a certain tissue is in greater need of GLN, inter-organ transfer of GLN usually fulfills site-specific requirements. Under certain conditions, however, endogenous GLN synthesis is not adequate to satisfy tissue needs and exogenous supplementation becomes necessary. Although exogenous parenteral and enteral GLN administation has been proven safe in the clinical setting, precise guidelines and recommendations for its use in clinical practice are still lacking, due to the non univocal interpretation of the clinical trials so far performed. The present article represents the Consensus Paper based on the results of the Glutamitaly 2003 SINPE Consensus Meeting on GLN in adult artificial nutrition. Rationale of use, indications, results of available clinical trials on GLN supplementation have been critically reviewed by a board of experts in the field of clinical nutrition with the aim to develop the methodology for possible future clinical trials evaluating the efficacy of parenteral or entreral GLN supplementation in surgery, ICU, gastroenterology, oncology and haematology patients.