Dear Readers:

Along with careful diagnosis, alleviating causes of tissue damage, such as pressure, impaired circulation or infection and providing an optimal healing environment, nutrition plays a key role in wound care.^1,2 The role of nutritional supplements becomes increasingly urgent in healing patients with more invasive injuries or conditions that deplete body stores of important nutrients. The articles presented in this Evidence Corner teach us how nutritional supplements support immunologic and healing functions in patients with major burns, and one reminds us that nutrient absorption through the gastrointestinal tract is not always optimal.

Enteral Glutamine Improves Severely Burned Patients’ Recovery
Reference: Peng X,Yan H,You Z,Wang P,Wang S. Glutamine granule-supplemented enteral nutrition maintains immunological function in severely burned patients. Burns. 2006;32(5):589–593.
Rationale: In appropriate concentrations, glutamine fuels immune cell function and nourishes proliferating cells.
Objective: Explore effects of supplementing enteral nutrition with glutamine granules on immunologic function in severely burned patients.
Methods: A double-blind controlled trial randomly assigned patients admitted to a burn intensive care unit (ICU) with 30%–75% total body surface area (TBSA) burns (20%–58% of TBSA full-thickness burns) to receive an enteral diet supplemented with either 0.5 mg/kg per day glutamine (n = 23) or an isocaloric, isonitrogenous control diet containing 0.5 mg/kg per day of glycine as placebo (n = 25) on days 1–14 post burn. Plasma glutamine level, cell immunity function (CD4/CD8 cell ratios, IL-2, lymphocyte transformation ratio, and neutrophil phagocytosis index), and plasma humoral immunity factors (IgA, IgG, IgM, C3, C4) were determined from peripheral blood samples on days 1 and 14. Burn dimensions on day 1 and length of hospital stay were also recorded.
Results: Glutamine and control groups were comparable on day 1 in patient, burn, and immunologic measures, with equally depressed plasma glutamine, and cellular immunity measures compared to those of 10 healthy volunteers (P < 0.01). These values were restored to normal levels after 14 days of enteral glutamine, but not glycine control supplement. There were no significant effects on the humoral immunity function measures with the glutamine diet. Glutamine supplemented patients experienced a shorter average length of hospital stay: 49.6 days compared to 55.7 days in the control group (P < 0.05).
Authors’ Conclusions: Oral or tube-fed enteral glutamine supplements improve depressed immunological cell function following severe burns and associated wound healing, while reducing the length of hospital stay.