Glutamin in der Ernährungstherapie – Welche Indikation bleibt?

Die nichtessenzielle Aminosäure Glutamin ist ein unverzichtbares Substrat für alle rasch proliferierenden Zellen und Bestandteil in enteralen Nahrungen, während die konventionellen Aminosäurenlösungen der parenteralen Ernährung aus galenischen Gründen kein Glutamin enthalten. Der anfängliche Enthusiasmus für das Behandlungskonzept einer Glutamin-Supplementierung, insbesondere der parenteralen Ernährung, ist inzwischen einer nüchternen Betrachtung gewichen.

Abstract

Glutamine, a non-essential amino acid, is an indispensable substrate for all rapidly dividing cells. Enteral feeding solutions contain glutamine at approximately 5–6 g per liter while conventional amino acid solutions for parenteral nutrition do not contain any glutamine for pharmaceutical reasons. In critically ill patients, an association between subnormal plasma levels of glutamine and increased morbidity and mortality was noted and led to the concept of glutamine as a conditionally essential amino acid. Accordingly, supplementing glutamine, particularly in total parenteral nutrition, was expected to improve clinical outcome. The initial enthusiasm for this therapeutic concept, however, has waned and given way for a sobering view questioning the concept of glutamine as a conditionally essential amino acid and the resulting indication to supplement. Currently, the supplementation of glutamine can be considered only in critically ill patients without multi-organ failure who need to be managed on total parenteral nutrition exclusively for more than five days.

Kernaussagen

• Glutamin ist ein unabdingbares Substrat für alle rasch proliferierenden Zellen.

• Der Körper hat eine große Kapazität zur endogenen Glutaminsynthese.

• Die Handlungsrelevanz subnormaler Glutaminspiegel bei schwerer Krankheit ist weiterhin unklar.

• Die Datenlage zur klinischen Wirksamkeit bei operierten Patienten, bei onkologischen Patienten, bei Patienten mit Darmerkrankungen und in der Ernährung von Sportlern erlaubt keine Empfehlung einer Glutaminsupplementierung.

• Der Einsatz von Glutamin-Dipeptiden kann bei länger als 5 Tage ausschließlich parenteral ernährten kritisch Kranken ohne Mehrorganversagen erwogen werden.

Schlüsselwörter

enterale Ernährung - parenterale Ernährung - kritische Krankheit - Knochenmarktransplantation - Sporternährung

Keywords

enteral nutrition - parenteral nutrition - critical illness - bone marrow transplantation - sports nutrition

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