The Impact of Glutamine Dipeptide–Supplemented Parenteral Nutrition on Outcomes of Surgical Patients

Wang, Yan; Zhu, Jiang; Nolan, Marie T.; Jiang, Hua; Han, Hae Ra; Yu, Kang; Li, Hai Long; Bin, Jie; Liang, Xiao Kun

doi:10.1177/0148607110362587

Cited by 81 publications

(40 citation statements)

References 56 publications

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“…Implications of such studies would extend beyond malnutrition to encompass other gastrointestinal diseases for which Ala-Gln supplementation has shown some benefit in metanalyses or small clinical studies. These include postsurgical infections (68), acquired immunodeficiency syndrome-associated diarrhea and wasting (7), and chemoradiotherapy mucositis (11).…”

Section: Discussionmentioning

confidence: 99%

Alanyl-glutamine promotes intestinal epithelial cell homeostasis in vitro and in a murine model of weanling undernutrition

Ueno

Oriá²,

Maier

et al. 2011

American Journal of Physiology-Gastrointestinal and Liver Physi

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Alanyl-glutamine (Ala-Gln) has recently been shown to enhance catch-up growth and gut integrity in undernourished children from Northeast Brazil. We hypothesized that the intestinal epithelial effects of Ala-Gln in malnourished weanling mice and mouse small intestinal epithelial (MSIE) cells would include modulation of barrier function, proliferation, and apoptosis. Dams of 10-day-old suckling C57BL/6 pups were randomized to a standard diet or an isocaloric Northeast Brazil "regional basic diet," moderately deficient in protein, fat, and minerals. Upon weaning to their dam's diet on day of life 21, pups were randomized to Ala-Gln solution or water. At 6 wk of age, mice were killed, and jejunal tissue was collected for morphology, immunohistochemistry, and Ussing chamber analysis of transmucosal resistance and permeability. Proliferation of MSIE cells in the presence or absence of Ala-Gln was measured by MTS and bromodeoxyuridine assays. MSIE apoptosis was assessed by annexin and 7-amino-actinomycin D staining. Pups of regional basic diet-fed dams exhibited failure to thrive. Jejunal specimens from undernourished weanlings showed decreased villous height and crypt depth, decreased transmucosal resistance, increased permeability to FITC-dextran, increased claudin-3 expression, and decreased epithelial proliferation and increased epithelial apoptosis (as measured by bromodeoxyuridine and cleaved caspase-3 staining, respectively). Undernourished weanlings supplemented with Ala-Gln showed improvements in weight velocity, villous height, crypt depth, transmucosal resistance, and epithelial proliferation/apoptosis compared with unsupplemented controls. Similarly, Ala-Gln increased proliferation and reduced apoptosis in MSIE cells. In summary, Ala-Gln promotes intestinal epithelial homeostasis in a mouse model of malnutrition-associated enteropathy, mimicking key features of the human disease.

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Section: Discussionmentioning

confidence: 99%

Alanyl-glutamine promotes intestinal epithelial cell homeostasis in vitro and in a murine model of weanling undernutrition

Ueno

Oriá²,

Maier

et al. 2011

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…If a critically ill or surgical patient does acquire an infectious complication, this will prolong that patient's length of stay in hospital and require more resources. Hospital acquired infections are expensive to treat, and it is estimated that hospital acquired infections can prolong a patient's length of stay by at least 4 days; this can have a significant financial impact on hospitalization cost (27). It has been observed that the additional cost of supplemented glutamine treatment is more than completely offset by cost savings in hospital care (37).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic benefits of glutamine: An umbrella review of meta-analyses

McRae

2017

Biomedical Reports

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Abstract. Glutamine may be an essential amino acid in patients with catabolic disease, as it has been demonstrated that circulating glutamine levels drop during critical illness and following major surgery; this may result in an increase in secondary infection risk, recovery time and mortality rates. However, there is much discrepancy in the literature with regards to randomized controlled studies, and therefore, the present study is an umbrella review of published meta-analyses, conducted to examine the effectiveness of glutamine's role as a therapeutic agent. A search using PubMed, Cochrane Library and CINAHL from January 1st, 1980 to December 31st, 2016 was conducted using the following strategy: 'Glutamine AND (meta-analysis OR systematic review)' and publications were retrieved, which provided quantitative statistical analysis of pooled treatment effects on the relative risks of infectious complications, mortality and length of stay in hospital. A total of 22 meta-analyses were entered into the current umbrella review. As displayed in Tables I, II and III, these analyses are split into three groups, based on different parameters. Of the 19 meta-analyses investigating the effects of infectious complications, 15 identified statistically significant reductions in complications, with relative risks ranging between 0.42 and 0.93. In addition, 12 of the 18 meta-analyses analyzing the length of hospital stays presented statistically significant reductions in the length of stay, with reductions ranging between 0.19 to 4.73 days. Only 4 of the 15 meta-analyses studying mortality effects identified statistically significant reductions in mortality with relative risks ranging between 0.64 and 1.28. Statistically significant heterogeneity was observed in 16 of 22 meta-analyses, and publication bias was observed in five of 11 meta-analyses. Glutamine supplementation for critically ill or surgical patients through parenteral or enteral routes appears to reduce the rate of hospital acquired infectious complications and shortening of the length of stay in hospital. Furthermore, glutamine supplementation appeared to reduce the rate of in-patient mortality, but the majority of meta-analyses did not reach statistical significance. However, researchers must appreciate the positive results with caution in light of the fact that there exists statistically significant heterogeneity for the majority of meta-analyses, and statistically significant publication bias in almost half.

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“…This is supported by a recent meta-analysis [32]. No data are available with regard to glutamine supplementation for combined enteral and parenteral nutrition.…”

Section: Immunonutritionmentioning

confidence: 97%

The Surgical/Trauma Patient

Weimann

2012

World Review of Nutrition and Dietetics

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In aiming for enhanced recovery and the reduction of postoperative morbidity, enhanced recovery after surgery concepts have introduced a new era in perioperative management. It is frequently not recognized that the enhanced recovery after surgery protocol does not overcome the necessity for appropriate perioperative nutritional and metabolic care, particularly with those in intensive care. Early detection and preoperative conditioning of patients at nutritional risk remains essential. In patients at risk where inadequate oral intake is anticipated for a longer period, nutritional support should be started early via the enteral route, possibly in combination with parenteral nutrition. For early enteral nutrition in the intensive care unit, a slow increase in the administration rate is recommended while observing the enteral tolerance by abdominal distension and gastric aspirate. While the length of time before combining enteral and parenteral nutrition with the appropriate supplementation is still under debate, immunomodulating substrates and diets have proven benefits in surgical high-risk patients.

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The Impact of Glutamine Dipeptide–Supplemented Parenteral Nutrition on Outcomes of Surgical Patients

Abstract: GLN-PN was beneficial to postoperative patients by shortening the length of hospital stay and reducing the morbidity of postoperative infectious complications.

Cited by 81 publications

References 56 publications

Alanyl-glutamine promotes intestinal epithelial cell homeostasis in vitro and in a murine model of weanling undernutrition

Alanyl-glutamine promotes intestinal epithelial cell homeostasis in vitro and in a murine model of weanling undernutrition

Therapeutic benefits of glutamine: An umbrella review of meta-analyses

The Surgical/Trauma Patient

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