Impact of Glutamine Supplemented Total Parenteral Nutrition in

Abstract

BACKGROUND: The importance of the metabolic role of glutamine has been demonstrated in several laboratory and clinical studies. A number of publications have addressed issues relevant to the benefits of the parenteral use of glutamine in patients with a variety of conditions. OBJECTIVE: To review published evidence of the relationship between glutamine supplemented total parenteral nutrition (TPN) and infection rates, length of hospital stay, nitrogen balance, total lymphocyte count and mortality in patients undergoing elective surgery. MATERIAL AND METHODS: 146 titles, abstracts, and articles were reviewed. Those primary studies were included that were randomized trials of surgical patients requiring TPN. The effect of glutamine enriched TPN (Gln-enriched TPN) regimen vs. standard TPN regimen on clinical and biological outcomes was evaluated. RESULTS: Eight randomized trials were found. When the results of these trials were analyzed with respect to infection, Gln-enriched TPN was associated with a relative risk ratio (RR) of 0.368 (95% CI, 0.162-0.832, p=0.016). Gln-enriched TPN was also associated with reduced length of hospital stay (1.191 days less; 95% CI 0.395- 1.986, p=0.004), better cumulative nitrogen balance (2.568gr; 95% CI 1.274-3.863, p=0.000), an increase in total lymphocyte count (2.246 /?¬L; 95% CI 0.416-4.076, p=0.017), and a reduction in mortality rate (RR 0.723; 95% CI 0.174-3.012, p=0.656). No side-effects were reported. CONCLUSION: There is strong evidence that a benefit from Gln-enriched TPN may exist for surgical patients in terms of length of hospital stay, infection rate, total lymphocyte count and cumulative nitrogen balance. The benefit from glutamine-enriched TPN on mortality was not found to be statistically significant.