TOTAL PARENTERAL-NUTRITION WITH GLUTAMINE DIPEPTIDE AFTER MAJOR ABDOMINAL-SURGERY - A RANDOMIZED, DOUBLE-BLIND, CONTROLLED-STUDY

Objective To assess the efficacy of glutamine (Gin) dipeptide-enriched total parenteral nutrition (TPN) on selected metabolic, immunologic, and clinical variables in surgical patients. Summary Background Data D epletion of Gin stores might lead to severe clinical complications. Re cent studies indicate that the parenteral provision of Gin or Gin-cont aining dipeptides improves nitrogen balance, maintains the intracellul ar Gin pool, preserves intestinal permeability and absorption, and sho rtens hospital stay. Methods Twenty-eight patients (age range, 42-85 y ears, mean 68 years) undergoing elective abdominal surgery were alloca ted, after randomization, to two groups to receive isonitrogenous (0.2 4 g nitrogen kg(-1) day(-1)) and isoenergetic (29 kcal/122 kJ kg(-1) d ay(-1)) TPN over 5 days. Controls received 1.5 g of amino acids kg(-1) day(-1), and the test group received 1.2 g of amino acids and 0.3 g of L-alanyl-L-glutamine (Ala-Gln) kg(-1)day(-1). Venous heparinized bloo d samples were obtained before surgery and on days 1, 3, and 8 after s urgery for routine clinical chemistry and for the measurement of plasm a free amino acids. Lymphocytes were counted and the generation of cys teinyl-leukotrienes from polymorphonuclear neutrophil granulocytes was analyzed before surgery and on days 1 and 6 after surgery. Nitrogen b alances were calculated postoperatively on days 2, 3, 4, and 5. Result s No side effects or complaints were noted. Patients receiving Gin dip eptide revealed improved nitrogen balances (cumulative balance over 5 days: -7.9 +/- 3.6 vs. -23.0 +/- 2.6 g nitrogen), improved lymphocyte recovery on day 6 (2.41 +/- 0.27 vs. 1.52 +/- 0.17 lymphocytes/nL) and improved generation of cysteinyl-leukotrienes from polymorphonuclear neutrophil granulocytes (25.7 +/- 4.89 vs. 5.03 +/- 3.11 ng/mL). Posto perative hospital stay was 6.2 days shorter in the dipeptide-supplemen ted group. Conclusion We confirm the beneficial effects of Gin dipepti de-supplemented TPN on nitrogen economy, maintenance of plasma Gin con centration, lymphocyte recovery, cysteinyl-leukotriene generation, and shortened hospital stay in surgical patients.