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Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: a pilot study.
Clin Nutr. 2008 Apr; 27(2):297-306.CN

Abstract

BACKGROUND

Glutamine (Gln) may become conditionally indispensable during critical illness. The short-term metabolic effects of enteral versus parenteral Gln supplementation are unknown in this clinical setting.

OBJECTIVES

We studied metabolic effects of intravenous (i.v.) alanyl-Gln dipeptide (AG) supplementation and enteral (e.n.) AG supplementation on plasma Gln concentration, antioxidant status, plasma lymphocyte subset number, gut permeability and nitrogen balance in adult critically ill patients requiring tube feeding compared to a control group not receiving Gln supplementation.

METHODS

In a double-blind, pilot clinical trial, 44 medical and surgical ICU patients received identical Gln-free tube feedings 24 h/day and were randomized to either isonitrogenous control (n=15), e.n. AG (n=15) or i.v. AG (n=14) groups (AG). Twelve patients were discontinued from the study. The goal AG dose was 0.5 g/kg/day. Biochemical and metabolic endpoints were measured at baseline and on day 9 (plasma Gln, antioxidant indices, lymphocyte subsets; serum IGF-1 and IGF-binding protein-3; intestinal permeability). Nitrogen balance was determined between study days 6 and 8.

RESULTS

Illness severity indices, clinical demographics, enteral energy and nitrogen intake and major biochemical indices were similar between groups during study. Plasma Gln was higher in the i.v. AG (565+/-119 microM, mean+/-SEM) vs the e.n. AG (411+/-27 microM) group by day 9 (p=0.039); however, subjects in the i.v. AG group received a higher dose of AG (i.v. AG 0.50 versus e.n. AG 0.32+/-0.02 g/kg/day; p<0.001). E.n. AG subjects showed a significant increase in plasma alpha-tocopherol levels over time and maintained plasma gamma-tocopherol concentrations. There were no differences between groups for plasma concentrations of vitamin C, glutathione, malondialdehyde (MDA), T-lymphocyte subsets, intestinal permeability or nitrogen balance.

CONCLUSIONS

This study showed that alanyl-Gln administration by enteral or parenteral routes did not appear to affect antioxidant capacity or oxidative stress markers, T-lymphocyte subset (CD-3, CD-4, CD-8) number, gut barrier function or whole-body protein metabolism compared to unsupplemented ICU patients requiring enteral tube feeding. Enteral Gln appeared to maintain plasma tocopherol levels in this pilot metabolic study.

Authors+Show Affiliations

Department of Medicine, Emory University, 1364 Clifton Road, Atlanta, GA 30322, United States.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

18258342

Citation

Luo, Menghua, et al. "Metabolic Effects of Enteral Versus Parenteral Alanyl-glutamine Dipeptide Administration in Critically Ill Patients Receiving Enteral Feeding: a Pilot Study." Clinical Nutrition (Edinburgh, Scotland), vol. 27, no. 2, 2008, pp. 297-306.
Luo M, Bazargan N, Griffith DP, et al. Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: a pilot study. Clin Nutr. 2008;27(2):297-306.
Luo, M., Bazargan, N., Griffith, D. P., Estívariz, C. F., Leader, L. M., Easley, K. A., Daignault, N. M., Hao, L., Meddings, J. B., Galloway, J. R., Blumberg, J. B., Jones, D. P., & Ziegler, T. R. (2008). Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: a pilot study. Clinical Nutrition (Edinburgh, Scotland), 27(2), 297-306. https://doi.org/10.1016/j.clnu.2007.12.003
Luo M, et al. Metabolic Effects of Enteral Versus Parenteral Alanyl-glutamine Dipeptide Administration in Critically Ill Patients Receiving Enteral Feeding: a Pilot Study. Clin Nutr. 2008;27(2):297-306. PubMed PMID: 18258342.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: a pilot study. AU - Luo,Menghua, AU - Bazargan,Niloofar, AU - Griffith,Daniel P, AU - Estívariz,Concepción F, AU - Leader,Lorraine M, AU - Easley,Kirk A, AU - Daignault,Nicole M, AU - Hao,Li, AU - Meddings,Jon B, AU - Galloway,John R, AU - Blumberg,Jeffrey B, AU - Jones,Dean P, AU - Ziegler,Thomas R, Y1 - 2008/02/07/ PY - 2007/05/31/received PY - 2007/11/01/revised PY - 2007/12/05/accepted PY - 2008/2/9/pubmed PY - 2008/5/31/medline PY - 2008/2/9/entrez SP - 297 EP - 306 JF - Clinical nutrition (Edinburgh, Scotland) JO - Clin Nutr VL - 27 IS - 2 N2 - BACKGROUND: Glutamine (Gln) may become conditionally indispensable during critical illness. The short-term metabolic effects of enteral versus parenteral Gln supplementation are unknown in this clinical setting. OBJECTIVES: We studied metabolic effects of intravenous (i.v.) alanyl-Gln dipeptide (AG) supplementation and enteral (e.n.) AG supplementation on plasma Gln concentration, antioxidant status, plasma lymphocyte subset number, gut permeability and nitrogen balance in adult critically ill patients requiring tube feeding compared to a control group not receiving Gln supplementation. METHODS: In a double-blind, pilot clinical trial, 44 medical and surgical ICU patients received identical Gln-free tube feedings 24 h/day and were randomized to either isonitrogenous control (n=15), e.n. AG (n=15) or i.v. AG (n=14) groups (AG). Twelve patients were discontinued from the study. The goal AG dose was 0.5 g/kg/day. Biochemical and metabolic endpoints were measured at baseline and on day 9 (plasma Gln, antioxidant indices, lymphocyte subsets; serum IGF-1 and IGF-binding protein-3; intestinal permeability). Nitrogen balance was determined between study days 6 and 8. RESULTS: Illness severity indices, clinical demographics, enteral energy and nitrogen intake and major biochemical indices were similar between groups during study. Plasma Gln was higher in the i.v. AG (565+/-119 microM, mean+/-SEM) vs the e.n. AG (411+/-27 microM) group by day 9 (p=0.039); however, subjects in the i.v. AG group received a higher dose of AG (i.v. AG 0.50 versus e.n. AG 0.32+/-0.02 g/kg/day; p<0.001). E.n. AG subjects showed a significant increase in plasma alpha-tocopherol levels over time and maintained plasma gamma-tocopherol concentrations. There were no differences between groups for plasma concentrations of vitamin C, glutathione, malondialdehyde (MDA), T-lymphocyte subsets, intestinal permeability or nitrogen balance. CONCLUSIONS: This study showed that alanyl-Gln administration by enteral or parenteral routes did not appear to affect antioxidant capacity or oxidative stress markers, T-lymphocyte subset (CD-3, CD-4, CD-8) number, gut barrier function or whole-body protein metabolism compared to unsupplemented ICU patients requiring enteral tube feeding. Enteral Gln appeared to maintain plasma tocopherol levels in this pilot metabolic study. SN - 1532-1983 UR - https://www.unboundmedicine.com/medline/citation/18258342/Metabolic_effects_of_enteral_versus_parenteral_alanyl_glutamine_dipeptide_administration_in_critically_ill_patients_receiving_enteral_feeding:_a_pilot_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0261-5614(07)00209-9 DB - PRIME DP - Unbound Medicine ER -