SUPPLEMENTATION OF AN ELEMENTAL ENTERAL DIET WITH ALANYL-GLUTAMINE DECREASES BACTERIAL TRANSLOCATION IN BURNED MICE

Although there are many reports of the importance of early enteral fee ding in maintaining gastrointestinal integrity and preventing bacteria l translocation ( BT) following burn injury, no diet has been shown cl inically to protect the GI tract postburn. Several studies suggest tha t glutamine (GLN) may benefit gut integrity following injury, shock an d other stress. Unfortunately, the free amino acid GLN is unstable in solution. Alanyl-glutamine (ALA-GLN), a soluble form of GLN, maintains long-term stability in solution and could be supplemented to conventi onal liquid enteral diets. We studied the effects of ALA-GLN supplemen tation of the elemental diet Vivonex TEN on effecting BT in mice follo wing 32 per cent TBSA full skin thickness burns. Groups A-D were burne d. Group A (30 mice) was fed standard rodent chow, which contains extr emely high (clinically non-useable) levels of protein. Group B (51 mic e) was fasted 24 h, then fed chow 24 h. Group C (64 mice) was fed Vivo nex TEN, and Group D (65 mice) received Vivonex TEN plus ALA-GLN (GLN equivalent, 14 g/l). A control group (Group E) consisted of 22 normal mice (no burn injury, chow diet). Mice were assessed for BT by sterile harvesting and plating of mesenteric lymph node tissue, 48 h postburn . Plates were considered positive if any bacterial growth was noted. N on-burned mice exhibited no BT, while burn-fasted mice showed a 64.3 p er cent incidence of BT (P = NS). Burned mice fed Vivonex TEN showed a 55.9 per cent rate of BT. Maximal protection against BT was afforded by rodent chow (31.0 per cent BT, P = 0.0081). We also found a reduced incidence of BT after supplementation of Vivonex TEN with ALA-GLN com pared to burn-fasted animals (36.1 per cent vs 64.3 per cent BT, P = 0 .009), or compared to mice fed Vivonex TEN without supplemental ALA-GL N (36.1 per cent vs 55.9 per cent BT, P = 0.046).