Critical Appraisal Paper

Critical Appraisal of a research article is considered as a basic tool for the evidence based practice in the nursing profession. This assignment is intended to appraise a quantitative research article published in a peer reviewed, indexed journal. The article is entitled with “Oral supplementation with L-glutamine alters gut microbiota of obese and overweight adults: A pilot study” Authored by Alessandra Zanin Zambom de Souza M.A et al published in the journal Nutrition in the year of 2015 (Zambom de Souza, A. Z., Zambom, 2015). The study was aimed to determine whether oral supplementation with L-glutamine (GLN) modifies the gut microbiota composition in overweight and obese adults. Obesity is a serious public concern that affects millions
of individuals’ worldwide (Raoult D, 2008). Obesity alters the gut bacterial flora and affects the utilization of nutrients due to the altered absorption. This article is focused on how the oral supplementation of L- glutamine can alter the microbiota of gut and exert a favorable effect among obese population. The problem identified here is very important because many of the young population in United States are suffering from obesity and the management is a difficult task. Hence the supplementation of GLN provide any favorable output, the data can be used for further studies.
Appraisal of Methodology
The study was aimed to determine whether oral supplementation with L-glutamine (GLN) modifies the gut microbiota composition in overweight and obese adults.
The study was conducted at the State Hospital of Sumare, in Sumare city, Sao Paulo state, Brazil. It was a randomized, double blind clinical trial, and the samples were selected from the employees of the hospital. Around 31 obese patients were recruited in the study, they were divided in to two groups, group1 was control, received Alanine and group 2 was test population, received L- Glutamine. The age group of patients were between 20 – 60 years and all had BMI> 25 kg/ m2. The blood samples were collected on day1 and 14; the body weight and height were measured on respective days. Blood sugar, BMI and 24 hour food record was documented. Institutional review board approved the
study.
Appraisal of results
After 14 days of supplementation, in GLN group exhibited statistically significant differences in the Firmicutes and Actinobacteria phyla compared with those in the ALA group.
This ratio is a good marker for obesity, decreased in the GLN group from 0.85 to 0.57, whereas it increased from 0.91 to 1.12 in the ALA group. The data was analyzed by using SAS software and continues variables were expressed as mean and SD. The sample size was not sufficient to draw a conclusion, and a study with higher number of samples needs to be conducted.
Clinical Implications
The study was conducted to answer the EBP question “Whether the supplementation of L- Glutamine can provide any change in gut bacterial flora compare to Alanine supplementation, could it be helpful to reduce the body weight?”. Though the methodology and procedures were at par with the international standard and the result is statistically significant, it is not sufficient to change the practice based on this outcome. The sample size is too small to conclude the outcome; it is only a pilot study.

References
Zambom de Souza, A. Z., Zambom, A. Z., Abboud, K. Y., Reis, S. K., Tannihão, F., Guadagnini, D., … Prada, P. O. (2015). Oral supplementation with l-glutamine alters gut microbiota of obese and overweight adults: A pilot study. Nutrition, 31(6), 884–889.
http://doi.org/10.1016/j.nut.2015.01.004
Raoult D. Obesity pandemics and the modification of digestive bacterialflora. Eur J Clin Microbiol Infect Dis 2008;27:631–4.