Nucleotides

Nucleotides form part of the normal diet but are absent from standard enteral feeds. They can be synthesized from glutamine, but considerable upregulation of this pathway is needed if the body's needs are to be satisfied in the absence of dietary intake. In vitro experiments show that human enterocyte growth is stimulated by purines or pyrimidines, but only when the supply of glutamine is limited. Similar effects have been shown in lymphocytes. Experimental studies have demonstrated a link between dietary nucleotide restriction and mortality from infection. In humans, the bacteria dying in the bowel lumen would normally provide larger amounts of nucleotide than the content of 'nucleotide-supplemented' enteral feeds, and improved patient outcome has not yet been shown.

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