A PROSPECTIVE RANDOMIZED STUDY OF GLUTAMINE-ENRICHED PARENTERAL COMPARED WITH ENTERAL FEEDING IN POSTOPERATIVE-PATIENTS

Plasma amino acids were measured in 17 postoperative subjects randomly assigned to receive for greater than or equal to 5 d tube feeding or total parenteral nutrition (TPN) that had identical energy, nitrogen, and glutamine contents. Subjects required gastric or pancreatic surger y for malignancy and were well-matched for age and body mass index. Tu be feeding or TPN began on postoperative day 1 and advanced in daily 2 5% 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 signifi cantly between feeding groups. Total indispensable amino acids, branch ed-chain amino acids, and glutamine declined 25% on postoperative day 1 compared with preoperative day 0. Indispensable and branched-chain a mino acid concentrations were restored with 5 d of either tube feeding or TPN. Glutamine concentrations did not differ significantly by feed ing group, though a trend suggested that glutamine recovered more slow ly in the tube-fed than in the TPN-fed subjects. Plasma amino acids ot herwise reflected formula composition with ratios of valine to leucine of 1.24 and 3.69 mu mol/L in subjects receiving 5 d of tube feeding o r TPN, respectively. These findings suggest that glutamine-enriched tu be feeding and TPN can result in similar profiles for most plasma amin o acids at carefully matched doses.