Glutamine-enriched enteral feeding in trauma patients: Reduced infectious morbidity is not related to changes in endocrine and metabolic responses

Background: Recently we have shown that glutamine-enriched enteral nutritio n in trauma patients reduced the occurrence of pneumonia, bacteremia, and s epsis. In that study, no clear explanation for these results was found exce pt for lower tumor necrosis factor (TNF)-soluble receptors, suggesting immu nomodulation. Here we present data on the course of endocrine and metabolic plasma mediators that; were analyzed to provide more insight into the work ing mechanism of glutamine. Methods: Endocrine and metabolic mediators were measured in plasma samples taken on admission (day 0) and on days 1, 2, 3, 7, and 10. Glucose, prealbumin, albumin, alanine, C-reactive protein, or,a lpha(1)-antitrypsin, complement; factors, cortisol, glucagon, insu lin, and growth hormone were assessed by standard techniques. Results: The rate of feeding, demography, and injury severity did not differ between the glutami ne and control group. There was a sustained hyperglycemic response in both groups. Insulin levels rose in the second phase of the period of observatio n. A moderate cortisol and glucagon response was seen in both groups. There was no alteration in growth hormone levels in either group. C-reactive pro tein, alpha(1)-antitrypsin, and complement factors showed similar increases in both levels groups but levels remained in the normal range. The course of alanine, albumin, and prealbumin also showed no difference between the g roups. Conclusion: Glutamine-enriched enteral nutrition had no influence on the endocrine and metabolic response in trauma patients. Therefore, the re duction in infectious morbidity seen in glutamine-supplemented trauma patie nts is most likely not explained by a modulation of the humoral stress resp onse and its metabloic consequences.