Effect of Glutamine Enriched Nutrition Support on Surgical Patients with Gastrointestinal Tumor

Abstract

Background:Associations between glutamine (Gln) enriched nutrition support and surgical patients with gastrointestinal (GI) tumor remain controversy. The purpose of this meta-analysis was to assess the effect of Gln enriched nutrition support on surgical patients with GI tumor in term of relevant biochemical indices, immune indices, and clinical outcomes.Methods:Six databases were systematically searched to find eligible randomized controlled trials (RCTs) from 1966 to May 2014. When estimated the analysis indexes, the relative risk (RR) was used as the effect size of the categorical variable, while the weighted mean difference (MD) was used as the effect size of a continuous variable. Meta-analysis was conducted with Rev Man 5.2.Results:Thirteen RCTs, involving 1034 patients, were included in the meta-analysis. The analysis showed that Gln enriched nutrition support was more effective in increasing serum albumin (MD: 0.10; 95% confidence interval [CI]: 0.02–0.18; P < 0.05), serum prealbumin (MD: 1.98; 95% CI: 1.40–2.55; P < 0.05) and serum transferring (MD: 0.35; 95% CI: 0.12–0.57; P < 0.05), concentration of IgG (MD: 1.26; 95% CI: 0.90–1.63; P < 0.05), IgM (MD: 0.18; 95% CI: 0.11–0.25; P < 0.05), IgA (MD: 0.22; 95% CI: 0.10–0.33; P < 0.05), CD3+ (MD: 3.71; 95% CI: 2.57–4.85; P < 0.05) and CD4/CD8 ratio (MD: 0.27; 95% CI: 0.12–0.42; P < 0.05). Meanwhile, it was more significant in decreasing the incidence of infectious complications (RR: 0.67; 95% CI: 0.50–0.90; P < 0.05) and shortening the length of hospital stay (MD: −1.72; 95% CI: −3.31–−0.13; P < 0.05).Conclusions:Glutamine enriched nutrition support was superior in improving immune function, reducing the incidence of infectious complications and shortening the length of hospital stay, playing an important role in the rehabilitation of surgical GI cancer patients.

<p>The Effect of Glutamine Supplementation on Oxidative Stress and Matrix Metalloproteinase 2 and 9 After Exhaustive Exercise</p>

“…Increased serum levels of hs-CRP observed after exhaustive exercise in our study is in line with findings of the study by Vincent et al43 Inflammatory reaction in intensive exercise has been reported as one of the reasons for sport injury 44. Glutamine may play a role in improving and controlling inflammatory processes 45. Thus, in this study, the reduction of the inflammatory process as a result of glutamine supplementation is considered a very important finding because it can prevent sport damage associated with increased inflammation in sport and glutamine consumption can be beneficial for young healthy males performing intense physical activities.…”

ESPEN guideline: Clinical nutrition in surgery

“…In addition, an improvement of immune parameters has been emphasized in a recent meta-analysis by Kang et al on 13 RCTs including 1034 surgical patients with gastrointestinal tumour. In three of the studies glutamine was administered via the enteral route [275] (1þ). Another meta-analysis included 19 RCTs with 1243 patients.…”

A randomized, controlled study to evaluate the effect of parenteral glutamine on the reduction of infection related morbidity in burn patients in ICU

“…12, 19-20 Some authors reported that supplementation of enteral or parenteral glutamine showed improved immune function, reduced infections, and shortened the length of ICU stay. [29][30][31] Day 1 SOFA score is an indicator of the severity of illness. The decrease in SOFA score was statistically significant in the two groups.…”