A prospective randomized study of glutamine-enriched parenteral compared with enteral feeding in postoperative patients

Abstract

Plasma amino acids were measured in 17 postoperative subjects randomly assigned to receive for > or = 5 d tube feeding or total parenteral nutrition (TPN) that had identical energy, nitrogen, and glutamine contents. Subjects required gastric or pancreatic surgery for malignancy and were well-matched for age and body mass index. Tube feeding or TPN began on postoperative day 1 and advanced in daily 25% increments to meet goals of 105 kJ . kg body wt-1 . d-1, 1.5 g protein . kg body wt-1 . d-1, and 0.3 g glutamine . kg body wt-1 . d-1. Delivered energy, nitrogen, and glutamine were closely matched on day 4. Nitrogen balance and plasma proteins did not differ significantly between feeding groups. Total indispensable amino acids, branched-chain amino acids, and glutamine declined 25% on postoperative day 1 compared with preoperative day 0. Indispensable and branched-chain amino acid concentrations were restored with 5 d of either tube feeding or TPN. Glutamine concentrations did not differ significantly by feeding group, though a trend suggested that glutamine recovered more slowly in the tube-fed than in the TPN-fed subjects. Plasma amino acids otherwise reflected formula composition with ratios of valine to leucine of 1.24 and 3.69 mumol/L in subjects receiving 5 d of tube feeding or TPN, respectively. These findings suggest that glutamine-enriched tube feeding and TPN can result in similar profiles for most plasma amino acids at carefully matched doses.

Effects of glutamine-enriched total parenteral nutrition on acute pancreatitis

“…Recent studies have shown that early enteral nutrition (EEN) provides better clinical course than TPN. Furthermore, some special nutritional substance like glutamine has potential benefits (Fish et al, 1997;Abou-Assi and O'Keefe, 2002) In many studies investigating the effects of glutamine, it was reported that complications were reduced by nutritional support (Ziegler et al, 1996(Ziegler et al, , 1997Morlion et al, 1998;Ockenga et al, 2002). In this study, complications developed in 10% of the patients in treatment group, whereas in 40% of the patients in control group.…”

Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: A pilot study

“…Little data are available comparing the metabolic effects of Gln when given by enteral versus parenteral routes (14,26). Also, metabolic results with enteral Gln administration have been inconsistent across studies (27,28).…”

New Developments in Glutamine Delivery

“…There is some evidence that the body glutamine pool is slower to recover when the same dose of glutamine is given enterally (orally) as opposed to parenterally (Fish et al 1997). The enteral route may be ideal when given early to the noninfected patient to improve gut-associated lymphoid tissue function and immune defense against infection, but for already severely stressed or infected ICU patients, enteral supplements alone may be inadequate, and parallel parenteral support is likely to be required.…”