Enteral glutamine supplementation in surgical patients with head and neck malignancy: A randomized controlled trial

Azman, Mawaddah; Yunus, Mohd Razif Mohamad; Sulaiman, Suhaina; Nabil, Syed

doi:10.1002/hed.23839

Cited by 18 publications

(11 citation statements)

References 23 publications

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“…In the control patients a decline of plasma GLN was observed, while it was modestly increased in those having received 20 g GLN per day for 14 days. Finally, enteral GLN has also proven to improve body composition and in particular lean body mass in a group of 44 head and neck cancer patients randomized to receive a GLN supplement (30 g daily) for four weeks [217]. The authors observed a significant Improvement of fat-free mass, serum albumin, and quality of life scores postoperatively [217].…”

Section: Commentary To Recommendations 26 -28mentioning

confidence: 97%

ESPEN guideline on clinical nutrition in the intensive care unit

et al. 2019

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s u m m a r yFollowing the new ESPEN Standard Operating Procedures, the previous guidelines to provide best medical nutritional therapy to critically ill patients have been updated. These guidelines define who are the patients at risk, how to assess nutritional status of an ICU patient, how to define the amount of energy to provide, the route to choose and how to adapt according to various clinical conditions. When to start and how to progress in the administration of adequate provision of nutrients is also described. The best determination of amount and nature of carbohydrates, fat and protein are suggested. Special attention is given to glutamine and omega-3 fatty acids. Particular conditions frequently observed in intensive care such as patients with dysphagia, frail patients, multiple trauma patients, abdominal surgery, sepsis, and obesity are discussed to guide the practitioner toward the best evidence based therapy. Monitoring of this nutritional therapy is discussed in a separate document.

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Section: Commentary To Recommendations 26 -28mentioning

confidence: 97%

ESPEN guideline on clinical nutrition in the intensive care unit

et al. 2019

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“…Azman et al 27 states that their study is the first to show significant post-operative improvements in serum albumin (p < 0.001), fat free mass (p < 0.001), and patient QoL parameters (p < 0.05) after four weeks of enteral GLN supplementation at 0.3-0.4 g/kg/day. There was also a significant correlation (p < 0.05) between retention of lean body mass and improved QoL with GLN supplementation.…”

Section: 12mentioning

confidence: 95%

“…Adverse reactions (Table 5) of GLN, noted by Azman et al 27 included: abdominal discomfort; abdominal bloating; and diarrhoea. Other side effects of GLN include: chills; nausea; and vomiting, if the infusion rate is exceeds >0.1 g amino acid/kg body weight/hr.…”

Section: Side Effects and Contraindicationsmentioning

confidence: 96%

“…There was also a significant correlation (p < 0.05) between retention of lean body mass and improved QoL with GLN supplementation. 27 Studies conducted in paediatric oncology are limited. In children with solid tumours on chemotherapy, GLN supplementation showed significant improvements in pre-albumin, transferrin, lymphocyte counts, complement 3 and 4, 19,28 antibiotic necessity, 19 as well as reduced stomatitis severity.…”

Section: 12mentioning

confidence: 99%

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Glutamine and its use in selected oncology settings

Tydeman-Edwards

2017

South African Journal of Clinical Nutrition

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This review summarises the latest evidence for the use of glutamine (GLN) in oncology taking cognisance of current systematic reviews and available guidelines. Various studies in adults suggest that GLN supplementation suppresses tumour growth, by restoring the function of natural killer cells; improves protein metabolism; and, possibly enhances the effect of cancer therapy. There is insufficient data on whether GLN supplementation reduces the incidence of infection, although a trend exists towards such a reduction. GLN-supplemented enteral nutrition was superior in improving immune function, whilst oral GLN alone appeared to have no effect on: mortality; infections; time to neutrophil recovery; or, relapse. GLN significantly reduces the duration of diarrhoea, but had no effect on its prevention. Oral GLN may reduce the duration and severity of mucositis, with fewer days on opioid therapy. Oral GLN, but not intravenous GLN (IV-GLN), may decrease mucositis and graft-versus-host disease in adult bone marrow transplant patients. Currently, the evidence for reduction of severe mucositis or infection rate in children is not statistically significant, but GLN does significantly reduce parenteral nutrition use, reflecting a possible improvement in lower gut mucositis. Nevertheless, too few studies exist to either support or refute that GLN supplementation either reduces the duration of, or prevents the progression to, severe mucositis. In children, there is no significant evidence that IV-GLN supplementation reduces infection rates, hospital length of stay (LOS), graft-versus-host disease, or mortality. Children with solid tumours on chemotherapy receiving oral GLN supplementation showed significant improvements in some nutritional and immunological parameters, as well as the severity of stomatitis and need for antibiotic therapy. Caution is recommended when considering provision of IV-GLN to oncology patients who have hepatic or renal insufficiency or failure. Monitoring of hepatic and renal function is recommended. Further studies are needed specifically on the use of glutamine in an oncology setting. Larger, multicentre, randomised placebo-controlled studies are needed in both adult and paediatric oncology populations.

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“…Ó êîíòðîëüí³é ãðóï³ ïàö³ºíò³â ñïîñòåð³ãàëîñÿ çíèaeåííÿ ð³âíÿ ÃËÍ â ïëàçì³ êðîâ³, òîä³ ÿê ó ïàö³ºíò³â, ÿê³ îòðèìóâàëè 20 ã ÃËÍ íà äîáó ïðîòÿãîì 14 äí³â, â³í áóâ ïîì³ðíî ï³äâèùåíèì. Íà îñòàíîê, åíòàðàëüíå çàñòîñóâàííÿ ÃËÍ òàêîae ïðîäåìîíñòðóâàëî çäàòí³ñòü ïîë³ïøóâàòè òêàíèííèé ñêëàä ò³ëà ³, çîêðåìà, áåçaeèðîâó ìàñó ò³ëà â ãðóï³ 44 ïàö³ºíò³â ç ðàêîì ãîëîâè òà øè¿, ÿê³ áóëè ðàíäî-ì³çîâàí³ äëÿ îòðèìàííÿ äîáàâêè ÃËÍ (30 ã íà äîáó) ïðîòÿãîì 4 òèaeí³â [217]. Àâòîðè ñïîñòå-ð³ãàëè çíà÷íå ïîë³ïøåííÿ ïîêàçíèê³â áåçaeèðî-âî¿ ìàñè ò³ëà, ñèðîâàòêîâîãî àëüáóì³íó ³ ÿêîñò³ aeèòòÿ ï³ñëÿ îïåðàö³¿ [217].…”

Section: êîìåíòàð äî ðåêîìåíäàö³é 26-28unclassified