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L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis.
Clin Nutr. 2004 Feb; 23(1):13-21.CN

Abstract

BACKGROUND & AIMS

A growing number of randomized clinical trials suggest that glutamine (Gln) supplementation may be beneficial in a selected group of patients and conditions. However, the effects of Gln-enriched total parenteral nutrition (TPN) on recovery from acute intra-abdominal infection have not been thoroughly investigated. Therefore, the aim of this study was to investigate whether the provision of Gln-enriched TPN after surgical and medical treatment of secondary peritonitis improves infectious morbidity.

METHODS

Thirty-three patients with secondary peritonitis were randomly assigned to receive either standard (n=16) TPN or L-alanyl-L-glutamine-supplemented (n=17) TPN, after medical and surgical treatment of the infectious focus. The two TPN formulae were isonitrogenous and isocaloric, which commenced the morning after surgery and ran continuously for 10 consecutive days. The control group received standard TPN, while the treatment group was given L-alanyl-L-glutamine, 0.40 g/kg/d (Dipeptiven, Fresenius Kabi, Bad Homburg, Germany). Infectious morbidity, nitrogen balance, leukocytes, lymphocytes, subpopulations CD(4) and CD(8), Immunoglobulin A (IgA), total proteins, albumin, hospital and intensive care unit (ICU) stays, and mortality were evaluated. Statistical analysis included one-way ANOVA, the unpaired Student's t-test, the Mann-Whitney U-test, chi(2) test, or Fisher's exact test.

RESULTS

Patients in both groups were comparable prior to the operation. Nitrogen balance and the levels of albumin and IgA were significantly better than those in the control group. Also, a significant reduction in the infectious morbidity was found in the Gln-treated group. Lymphocyte counts as well as subpopulations CD(4) and CD(8), and proteins showed a propensity to improvement and a tendency to reduced rates of mortality were observed when comparing the groups. Hospital and ICU stays were similar.

CONCLUSION

L-alanyl-L-glutamine-supplemented TPN improved the infectious morbidity of patients with secondary peritonitis. Gln supplementation to parenteral nutrition may be an alternative for enhancing host defenses and improving infectious morbidity.

Authors+Show Affiliations

Medical Research Unit in Clinical Epidemiology at Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14757388

Citation

Fuentes-Orozco, Clotilde, et al. "L-alanyl-L-glutamine-supplemented Parenteral Nutrition Improves Infectious Morbidity in Secondary Peritonitis." Clinical Nutrition (Edinburgh, Scotland), vol. 23, no. 1, 2004, pp. 13-21.
Fuentes-Orozco C, Anaya-Prado R, González-Ojeda A, et al. L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis. Clin Nutr. 2004;23(1):13-21.
Fuentes-Orozco, C., Anaya-Prado, R., González-Ojeda, A., Arenas-Márquez, H., Cabrera-Pivaral, C., Cervantes-Guevara, G., & Barrera-Zepeda, L. M. (2004). L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis. Clinical Nutrition (Edinburgh, Scotland), 23(1), 13-21.
Fuentes-Orozco C, et al. L-alanyl-L-glutamine-supplemented Parenteral Nutrition Improves Infectious Morbidity in Secondary Peritonitis. Clin Nutr. 2004;23(1):13-21. PubMed PMID: 14757388.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis. AU - Fuentes-Orozco,Clotilde, AU - Anaya-Prado,Roberto, AU - González-Ojeda,Alejandro, AU - Arenas-Márquez,Humberto, AU - Cabrera-Pivaral,Carlos, AU - Cervantes-Guevara,Gabino, AU - Barrera-Zepeda,Luis M, PY - 2004/2/6/pubmed PY - 2004/6/18/medline PY - 2004/2/6/entrez SP - 13 EP - 21 JF - Clinical nutrition (Edinburgh, Scotland) JO - Clin Nutr VL - 23 IS - 1 N2 - BACKGROUND & AIMS: A growing number of randomized clinical trials suggest that glutamine (Gln) supplementation may be beneficial in a selected group of patients and conditions. However, the effects of Gln-enriched total parenteral nutrition (TPN) on recovery from acute intra-abdominal infection have not been thoroughly investigated. Therefore, the aim of this study was to investigate whether the provision of Gln-enriched TPN after surgical and medical treatment of secondary peritonitis improves infectious morbidity. METHODS: Thirty-three patients with secondary peritonitis were randomly assigned to receive either standard (n=16) TPN or L-alanyl-L-glutamine-supplemented (n=17) TPN, after medical and surgical treatment of the infectious focus. The two TPN formulae were isonitrogenous and isocaloric, which commenced the morning after surgery and ran continuously for 10 consecutive days. The control group received standard TPN, while the treatment group was given L-alanyl-L-glutamine, 0.40 g/kg/d (Dipeptiven, Fresenius Kabi, Bad Homburg, Germany). Infectious morbidity, nitrogen balance, leukocytes, lymphocytes, subpopulations CD(4) and CD(8), Immunoglobulin A (IgA), total proteins, albumin, hospital and intensive care unit (ICU) stays, and mortality were evaluated. Statistical analysis included one-way ANOVA, the unpaired Student's t-test, the Mann-Whitney U-test, chi(2) test, or Fisher's exact test. RESULTS: Patients in both groups were comparable prior to the operation. Nitrogen balance and the levels of albumin and IgA were significantly better than those in the control group. Also, a significant reduction in the infectious morbidity was found in the Gln-treated group. Lymphocyte counts as well as subpopulations CD(4) and CD(8), and proteins showed a propensity to improvement and a tendency to reduced rates of mortality were observed when comparing the groups. Hospital and ICU stays were similar. CONCLUSION: L-alanyl-L-glutamine-supplemented TPN improved the infectious morbidity of patients with secondary peritonitis. Gln supplementation to parenteral nutrition may be an alternative for enhancing host defenses and improving infectious morbidity. SN - 0261-5614 UR - https://www.unboundmedicine.com/medline/citation/14757388/L_alanyl_L_glutamine_supplemented_parenteral_nutrition_improves_infectious_morbidity_in_secondary_peritonitis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0261561403000554 DB - PRIME DP - Unbound Medicine ER -