High-dose oral supplementation of antioxidants and glutamine improves the antioxidant status in patients with Crohn's disease: A pilot study

Effects of glutamine supplementation on inflammatory bowel disease: A systematic review of clinical trials

CONTEXT

Glutamine supplementation has been applied clinical practice to treat inflammatory bowel disease (IBD). However, scientific evidence about this is still controversial.

OBJECTIVE

In this review, we systematically evaluated the effects of glutamine supplementation on IBD, based on evidence from randomized clinical trials.

DATA SOURCE

This review was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We used the PubMed and SciVerse Scopus databases. The Cochrane collaboration tool was used to assess the risk of bias in clinical trials.

DATA EXTRACTION

The review was carried out by two independent researchers according to the established inclusion criteria. The PICO (patient, intervention, comparison, and outcomes) strategy was used, with the descriptors: "glutamine," "supplementation," "inflammatory bowel diseases," "Crohn's disease," and "ulcerative colitis".

DATA SYNTHESIS

Seven research articles were selected for this systematic review. In these studies, glutamine was administered to the participants through oral (21-30g or 0.5g per kg of participant's body weight), enteral (7.87g-8.3 g/100g of the enteral formula), and/or parenteral (0.3  g/kg of the participant's body weight) routes. No changes in anthropometry or biochemical parameters were observed. However, in one study reduced intestinal permeability and morphometry were reported. In two other studies, a slight effect of glutamine on inflammation and oxidative stress was observed. Additionally, two other studies reported an effect of glutamine supplementation on disease activity.

CONCLUSIONS

The findings obtained through this systematic review indicate that glutamine supplementation has no effect on disease course, anthropometric measurements, intestinal permeability and morphology, disease activity, intestinal symptoms, biochemical parameters, oxidative stress and inflammation markers in patients with IBD, regardless of the route of administration, either treated at a hospital or as outpatients.

Hepato- and gastro- protective activity of purified oat 1-3, 1-4-β-d-glucans of different molecular weight

Protective and antioxidant properties of highly purified oat β-glucans of high and low molecular weight in liver and stomach were evaluated. The novelty in approach was to determine whether dietary β-glucans affect the parameters of oxidative stress directly in the stomach and indirectly in the liver, especially in inflammation states. Physicochemical properties e.g. viscoelastic was found as strictly dependent from molecular weight of oat β-glucans hence its metabolic activity could also show dependence. Three groups of rats were fed control diet and diet supplemented with low and high molecular weights oat β-glucans. Animals were divided into controls and individuals with experimentally induced intestinal inflammation. Most active in increasing of total antioxidant status was low molecular weight β-glucan. High molecular weight β-glucan supplementation inhibits lipid oxidation the most in LPS treated animals. The results obtained from experiment encourage for dietary intervention with oat β-glucans for stomach and liver protection during existing enteritis.

Antioxidant therapy for treatment of inflammatory bowel disease: Does it work?

Oxidative stress (OS) is considered as one of the etiologic factors involved in several signals and symptoms of inflammatory bowel diseases (IBD) that include diarrhea, toxic megacolon and abdominal pain. This systematic review discusses approaches, challenges and perspectives into the use of nontraditional antioxidant therapy on IBD, including natural and synthetic compounds in both human and animal models. One hundred and thirty four papers were identified, of which only four were evaluated in humans. Some of the challenges identified in this review can shed light on this fact: lack of standardization of OS biomarkers, absence of safety data and clinical trials for the chemicals and biological molecules, as well as the fact that most of the compounds were not repeatedly tested in several situations, including acute and chronic colitis. This review hopes to stimulate researchers to become more involved in this fruitful area, to warrant investigation of novel, alternative and efficacious antioxidant-based therapies.

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Major biomarkers used for evaluation of antioxidant therapy were MPO, TBARS/MDA and glutathione levels.

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Challenges were identified for the yet poor use of antioxidant therapy in IBD.

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This review stimulates the investigation of alternative and efficacious antioxidant therapies.

Extracellular micronutrient levels and pro-/antioxidant status in trauma patients with wound healing disorders: results of a cross-sectional study

Background

Disorders in wound healing (DWH) are common in trauma patients, the reasons being not completely understood. Inadequate nutritional status may favor DWH, partly by means of oxidative stress. Reliable data, however, are lacking. This study should investigate the status of extracellular micronutrients in patients with DWH within routine setting.

Methods

Within a cross-sectional study, the plasma/serum status of several micronutrients (retinol, ascorbic acid, 25-hydroxycholecalciferol, α-tocopherol, β-carotene, selenium, and zinc) were determined in 44 trauma patients with DWH in addition to selected proteins (albumin, prealbumin, and C-reactive protein; CRP) and markers of pro-/antioxidant balance (antioxidant capacity, peroxides, and malondialdehyde). Values were compared to reference values to calculate the prevalence for biochemical deficiency. Correlations between CRP, albumin and prealbumin, and selected micronutrients were analyzed by Pearson’s test. Statistical significance was set at P < 0.05.

Results

Mean concentrations of ascorbic acid (23.1 ± 15.9 μmol/L), 25-hydroxycholecalciferol (46.2±30.6 nmol/L), β-carotene (0.6 ± 0.4 μmol/L), selenium (0.79±0.19 μmol/L), and prealbumin (24.8 ± 8.2 mg/dL) were relatively low. Most patients showed levels of ascorbic acid (<28 μmol/L; 64%), 25-hydroxycholecalciferol (<50 μmol/L; 59%), selenium (≤ 94 μmol/L; 71%) and β-carotene (<0.9 μmol/L; 86%) below the reference range. Albumin and prealbumin were in the lower normal range and CRP was mostly above the reference range. Plasma antioxidant capacity was decreased, whereas peroxides and malondialdehyde were increased compared to normal values. Inverse correlations were found between CRP and albumin (P < 0.05) and between CRP and prealbumin (P < 0.01). Retinol (P < 0.001), ascorbic acid (P < 0.01), zinc (P < 0.001), and selenium (P < 0.001) were negatively correlated with CRP.

Conclusions

Trauma patients with DWH frequently suffer from protein malnutrition and reduced plasma concentrations of several micronutrients probably due to inflammation, increased requirement, and oxidative burden. Thus, adequate nutritional measures are strongly recommended to trauma patients.

Bolus consumption of a specifically designed fruit juice rich in anthocyanins and ascorbic acid did not influence markers of antioxidative defense in healthy humans

Exotic fruits such as açai, camu-camu, and blackberries rich in natural antioxidants (ascorbic acid, anthocyanins) are marketed as "functional" foods supporting a pro-/antioxidant balance. Confirming data from human studies are lacking. Within a randomized controlled crossover trial, 12 healthy nonsmokers ingested 400 mL of a blended juice of these fruits or a sugar solution (control). Blood was drawn before and afterward to determine antioxidants in plasma, markers of antioxidant capacity [trolox equivalent antioxidant capacity, Folin-Ciocalteu reducing capacity, total oxidant scavenging capacity (TOSC)] and oxidative stress [isoprostane, DNA strand breaks in leukocytes in vivo], and their resistance versus H₂O₂-induced strand breaks. Compared with sugar solution, juice consumption increased plasma ascorbic acid and maintained TOSC and partly Folin-Ciocalteu reducing capacity (both P values < 0.05). Strand breaks in vivo increased after ingestion of both beverages (P < 0.001), probably due to postprandial and/or circadian effects. This anthocyanin-rich fruit juice may stabilize the pro-/antioxidant balance in healthy nonsmokers without affecting markers of oxidative stress.

Time to wound closure in trauma patients with disorders in wound healing is shortened by supplements containing antioxidant micronutrients and glutamine: a PRCT

BACKGROUND & AIMS

: We hypothesize that wound closure in trauma patients with disorders in wound healing is accelerated by supplementation of antioxidant micronutrients and glutamine.

METHODS

In a randomized, double-blind, placebo-controlled trial, 20 trauma patients with disorders in wound healing were orally supplemented with antioxidant micronutrients (ascorbic acid, α-tocopherol, β-carotene, zinc, selenium) and glutamine (verum) or they received isoenergetic amounts of maltodextrine (placebo) for 14 days. Plasma/serum levels of micronutrients, glutamine, and vascular endothelial growth factor-A (VEGF-A) were determined before and after supplementation. In the wound, several parameters of microcirculation were measured. Time from study entry to wound closure was recorded.

RESULTS

Micronutrients in plasma/serum did not change except for selenium which increased in the verum group (1.1 ± 0.2 vs. 1.4 ± 0.2 μmol/l; P = 0.009). Glutamine decreased only in the placebo group (562 ± 68 vs. 526 ± 55 μmol/l; P = 0.047). The prevalence of hypovitaminoses and the concentration of VEGF-A did not change. Considering microcirculation, only O(2)-saturation decreased in the placebo group (56.7 ± 23.4 vs. 44.0 ± 24.0 [arbitrary units]; P = 0.043). Wound closure occurred more rapidly in the verum than in the placebo group (35 ± 22 vs. 70 ± 35 d; P = 0.01).

CONCLUSIONS

Time to wound closure can be shortened by oral antioxidant and glutamine containing supplements in trauma patients with disorders in wound healing.