A double blind, randomised, controlled trial of glutamine supplementation in parenteral nutrition

Background and aims-To determine whether the inclusion of 20 g free glutami ne as part of the nitrogen source of parenteral feeds reduces length of hos pital stay or mortality. Methods-In a randomised, double blind, controlled trial in 168 patients cli nically accepted for parenteral nutrition, standard feeds were compared wit h feeds in which 3.8 g of the total nitrogen was replaced with the equivale nt 20 g glutamine. A minimum of 11 g nitrogen/day was used in all patients. Daily intakes of energy and nitrogen were determined using a validated com puter protocol and were similar for the two groups. All feeds included trac e elements, vitamins, electrolytes, and minerals. Results-A total of 85 patients received a median of eight (interquartile ra nge 5-13) daily feeds containing glutamine while 83 received a median of ei ght (5-15) standard feeds. No difference between groups was detected for in fective complications. Twenty control patients and 14 who had received glut amine died during their hospital stay (NS). Median length of stay was 32 (2 3-52) days on glutamine, which was not significantly different from the con trol value of 35 (25-55) days. Glutamine was associated with a significant (p<0.03) reduction in length of stay in surgical patients (45 days (range 2 9-81) versus 30 days (range 19-54)). Conclusion-The benefit from glutamine supplementation of parenteral feeds a s used in this trial has not been proved. Supplementation may have advantag es in surgical patients and in haematological malignancy. Further trials ar e required.