A double-blind, placebo-controlled, glutamine-supplementation trial in growth-faltering Gambian infants.

Double-blind, placebo-controlled randomized trial in growth-faltering, malnourished Gambian infants aged 4 to 11 months from six villages in West Kiang, The Gambia. Forty-six infants were randomized to the glutamine arm and 47 to placebo, with enrollment during two consecutive rainy seasons.

Oral glutamine powder was given to the active arm twice daily for 5 to 6 months during the rainy season, mixed with expressed breast milk or distilled water. The source packet reports the dose as 0.25 mg/kg body weight twice daily in the abstract, while the Methods describe 0.5 g/kg/day in two daily doses; the comparator was an isonitrogenous, isoenergetic placebo amino acid mix.

Glutamine did not improve growth, intestinal permeability, plasma immune markers, or morbidity versus placebo, and the authors concluded that mass supplementation is unlikely to improve growth or health in this setting. Weight gain was 60 Ȁ 19 g/mo in the glutamine group versus 69 Ȁ 20 g/mo with placebo, and length gain was 1.01 Ȁ 0.05 cm/mo versus 0.95 Ȁ 0.03 cm/mo. Intestinal permeability and inflammatory markers were also similar overall; the lactulose-mannitol ratio at end of treatment was 0.29 (0.23, 0.35) versus 0.26 (0.21, 0.32), and CRP was 1.70 (1.01, 2.85) versus 2.16 (1.33, 2.85). Some analyses suggested marginally higher mucosal permeability in the glutamine arm (P=0.05; corrected P=0.035), but this was not consistent across measures.

Small single-region infant sample and a setting-specific rainy-season cohort limit generalizability. Dietary intake, baseline nutritional status, and physical activity were not well characterized, and the trial had limited power for modest effects. Some outcomes showed borderline findings and the supplement dose is reported inconsistently across sections of the source packet.