Intervention and Mechanisms of Alanyl-glutamine for Inflammation, Nutrition, and Enteropathy: A Randomized Controlled Trial.
Intervention and Mechanisms of Alanyl-glutamine for Inflammation, Nutrition, and Enteropathy: A Randomized Controlled Trial.
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DOI：
10.1097/mpg.0000000000002834
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发表时间：
2020-09
影响因子：
2.9
通讯作者：
Lima AAM
中科院分区：
文献类型：
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作者：
Moore SR;Quinn LA;Maier EA;Guedes MM;Quetz JS;Perry M;Ramprasad C;Lanzarini Lopes GML;Mayneris-Perxachs J;Swann J;Soares AM;Filho JQ;Junior FS;Havt A;Lima NL;Guerrant RL;Lima AAM
确定改善环境性肠病（EE）患儿肠道完整性和生长所需的丙氨酰-谷氨酰胺（Ala-Gln）的最小剂量。这是一项双盲随机安慰剂对照剂量-反应试验。我们招募了140名居住在巴西福塔莱萨一个低收入社区的儿童。参与者为2至60个月大，年龄体重（WAZ）、年龄身高（HAZ）或身高体重（WHZ） z-得分小于- 1。我们将儿童随机分配到10天的营养补充：Ala-Gln 3 g/天，Ala-Gln 6 g/天，Ala-Gln 12 g/天，或等氮剂量的甘氨酸（Gly）安慰剂12.5 g/天。我们的主要结果是尿乳果糖-甘露醇排泄测试。次要结果是人体测量、粪便炎症标志物、尿液代谢谱和吸收不良（粪便能量点）。在140名儿童中，103名完成了120天的随访（24%辍学）。在接受最高剂量Ala-Gln的组中，我们检测到尿乳果糖排泄量从第1天的0.19%适度改善到第10天的0.17% （P=0.05）。我们观察到2个Ala-Gln组的WHZ在第10天有显著但短暂的改善，所有Ala-Gln组的WHZ和WAZ在第30天有显著改善。我们没有检测到对粪便炎症标志物、腹泻发病率或尿液代谢谱的影响；但确实观察到服用Ala-Gln的参与者粪便能量和粪便乳铁蛋白的适度减少。中剂量Ala-Gln促进有EE风险儿童肠道完整性和肠道生长的短期改善。在没有增强肠道完整性的情况下，低剂量可改善肠道生长。
Determine the minimum dosage of alanyl-glutamine (Ala-Gln) required to improve gut integrity and growth in children at risk of environmental enteropathy (EE). 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). 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. 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.