The Indian Journal of Nutrition and Dietetics

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Enteral/Oral Glutamine Supplementation in Patients Following Abdominal Surgery


Affiliations
1 Sri Ramachandra University, Chennai, India
2 TNMC & BYL Nair Hospital, Mumbai, India
3 DNB Clinical Pharmacy, Mumbai, India
     

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The objective of this investigation was to study the effect of enteral/oral glutamine supplementation in patients following abdominal surgery on plasma glutamine levels, rate of infection and Length Of Hospitalization (LOS). A randomized control trial was used and the patients were randomly divided into two groups namely experimental and control with 15 participants each. Glutamine supplement (0.5g/kg) was administered (oral and enteral) to the experimental group for a period of 5 days postsurgery immediately after the feeding began. In both the feeding groups the plasma glutamine levels were analyzed spectrophotometrically using a glutamine determination kit on day 1 following surgery and day 6 (post 5 days of feeding). For statistical analysis t test and Chi square test were used. The study was carried out in Topiwala National Medical College and BYL Nair Hospital, Mumbai, India. There was a significant difference in the baseline plasma glutamine levels in both the groups (p<0.05). And on day 6 the plasma glutamine analysis revealed significant higher levels in the experimental group as compared to the control group. The incidence of infection in the control group was found to be almost twice that in the experimental group considering the role of glutamine in combating infection. Also the length of hospitalization was found to be slightly higher in the control group as compared to the experimental group. The present study has provided evidence that the supplementation of enteral glutamine in post-operative patients decreases the incidence of post-surgical infection, shortening of hospital stay and reduction in the overall hospital costs.

Keywords

Glutamine Supplementation, Post-Operative Patients, Oral and Enteral Feed.
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  • Hiram, S.O. Percentage of weight loss basic indicator of surgical risk in patients with chronic peptic ulcer. J. Am. Med. Asso., 1936, 106, 458-460.

  • MacFie, J.O., Boyle, C., Mitchell, C.J., Buckley, P.M., Johnstone, D. and Sudworth, P. Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora and septic morbidity. Gut, 1999, 45, 223-228.

  • Hulst, V.D., Rene. R.W. and Meynefeldt, V. Gut permeability, intestinal morphology and nutritional depletion, Nutrition, 1988, 14, 1-16.

  • Beattie, A.H., Prach, A.T., Baxter, J.P. and Pennington, C.R., A randomized controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients. Gut, 2000, 46, 813-818.

  • Caroline Kratzing, Pre-operative nutrition and carbohydrate loading. Proceedings of the Nutrition Society, 2011, 70, 311-315.

  • Beier-Holgersen, R. and Boesby, S. Influence of postoperative enteral nutrition on postsurgical infections. Gut, 1996, 39, 833-835.

  • Sodergren, M.H., Jethwa, P., Kumar, S., Duncan, H.D., John, T. and Pearce, C.B. Immuno nutrition in patients undergoing major upper gastrointestinal surgery: a prospective doubleblind randomized controlled study. Scandi. J.Surgery, 2010, 99, 153-161.

  • Furst, P. and Stehle, P. Glutamine supplemented nutrition in clinical practice and use of glutamine-containing dipeptides. Infusionsther Transfusions Med., 1995, 22, 317-324.

  • Morlion, B.J., Stehle, P. and Wachtler, P. Total parenteral nutrition with glutamine dipeptide after major abdominal surgery: a randomized, double-blind, controlled study. Ann. Surgery, 1998, 227, 302-308.

  • Lin, M.T., Kung, S.P., Yeh, S.L., Liaw, K.Y., Wang, M.Y., Kuo, M.L., Lee, P.H. and Chen, W.J. Glutamine-supplemented total parenteral nutrition attenuates plasma interleukin-6 in surgical patients with lower disease severity. World J. Gastroenterol., 2005, 11, 6197-6201.

  • Nicola Ward, Nutrition support to patients undergoing gastrointestinal surgery. Nutr. J., 2003, 2, 18.

  • Jian, Z.M., Cao, J.D., Zhu, X.G., Zhao, W.X., Yu, J.C., Ma, E.L., Wang, X.R., Zhu, M.W., Shu, H. and Liu, Y.W. The impact of alanyl-glutamine on clinical safety, nitrogen balance, intestinal permeability, and clinical outcome in postoperative patients: a randomized, double-blind, controlled study of 120 patients. J. Parenter. Enteral Nutr., 1999, 23 (5 Suppl), S62-S66.

  • Fan, Y.P., Yu, J.C., Kang, W.M., Zhang, Q., Effects of glutamine supplementation on patients undergoing abdominal surgery. Chin. Med. Sci. J., 2009, 24, 55-9.

  • Kim, H. Glutamine as an immune nutrient. Yonsei Med. J., 2011, 52, 892-897.

  • Jan Wernerman, Glutamine supplementation, Ann.Intensive Care, 2011, 1- 25.

  • Singer, P.1., Berger, M.M., Van den Berghe, G., Biolo, G., Calder, P., Forbes, A., Griffiths, R., Kreyman, G., Leverve, X. and Pichard, C. ESPEN Guidelines on parenteral nutrition: intensive care. Clin. Nutr., 2009, 28, 387-400.

  • Tjader, I., Rooyackers, O., Forsberg, A.M., Vesali, R.F., Garlick, P.J. and Wernerman, J. Effects on skeletal muscle of intravenous glutamine supplementation to ICU patients. Intensive Care Med., 2004, 30, 266-275.

  • Berg, A., Rooyackers, O., Norberg, A. and Wernerman, J., Elimination kinetics of l-alanyl-l-glutamine in ICU patients. Amino Acid, 2005, 29, 221-228.

  • Sorensen, L.T., Risk factors for tissue and wound complications in gastrointestinal surgery. Ann.Surg., 2005, 241, 654-658.

  • Hammarqvist, F., Wernerman, J., Ali, R., Von der Decken, A., Vinnars, E., Addition of glutamine to total parenteral nutrition after elective abdominal surgery spares free glutamine in muscle, counteracts the fall in muscle protein synthesis, and improves nitrogen balance. Ann. Surg., 1989, 209, 455-461.

  • Zheng, Y. M., Li, F., Zhang, M.M. and Wu, X.T. Glutamine dipeptide for parenteral nutrition in abdominal surgery; a meta-analysis of randomized controlled trials, World J. Gastroenterol., 2006, 12, 7537-7541.

  • Estivariz, C.F., Griffith, D.P., Luo, M., Szeszycki, E.E., Bazagan, N. and Dave, N. Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients. J. Parent. Enteral. Nutr., 2008, 32, 389-402.

  • Oguz, M., Kerem, M., Bedirli, A., Mentes, B.B., Sakrak, O. and Salman, B. l-alanyl-l-glutamine supplementation improves the outcome after colorectal surgery for cancer. Colorectal Dis., 2007, 9, 515-520.

  • Kumar, S., Kumar, R., Sharma, S.B. and Jain, B.K. Effect of oral glutamine administration on oxidative stress, morbidity and mortality in critically ill surgical patients. Ind. J. Gastroenterol., 2007, 26, 70-73.

  • Dechelotte, P., Darmaun, D., Rongier, M., Hecketsweiler, B., Rigal, O. and Desjeux, J.F. Absorption and metabolic effects of enterally administered glutamine in humans. Am. J. Physiol., 1991, 260, G677-G682.

  • Wernerman, J. Clinical use of glutamine supplementation. J. Nutr., 2008, 138, 2040-2044.

  • Vanek, V.W., Matarese, L.E., Robinson, M., Sacks, G.S., Young, L.S. and Kochevar, M. A.S.P.E.N. Position paper: Parenteral nutrition glutamine supplementation. Nutr.Clin. Pract., 2011, 26, 479-494.

  • Wilmore, D.W. The effect of glutamine supplementation in patients following elective surgery and accidental injury. J. Nutr., 2001, 131, 2543-2549.

  • Peng, X., Yan, H., You, Z., Wang, P. and Wang, S. Effects of enteral supplementation with glutamine granules on intestinal mucosal barrier function in severe burned patients. Burns, 2004, 2, 135-139.


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  • Enteral/Oral Glutamine Supplementation in Patients Following Abdominal Surgery

Abstract Views: 336  |  PDF Views: 2

Authors

Hima Ann Isaac
Sri Ramachandra University, Chennai, India
Salome Benjamin
TNMC & BYL Nair Hospital, Mumbai, India
M. K. Sanjana
TNMC & BYL Nair Hospital, Mumbai, India
Renuka Munshi
DNB Clinical Pharmacy, Mumbai, India
Deepika Furtado
DNB Clinical Pharmacy, Mumbai, India

Abstract


The objective of this investigation was to study the effect of enteral/oral glutamine supplementation in patients following abdominal surgery on plasma glutamine levels, rate of infection and Length Of Hospitalization (LOS). A randomized control trial was used and the patients were randomly divided into two groups namely experimental and control with 15 participants each. Glutamine supplement (0.5g/kg) was administered (oral and enteral) to the experimental group for a period of 5 days postsurgery immediately after the feeding began. In both the feeding groups the plasma glutamine levels were analyzed spectrophotometrically using a glutamine determination kit on day 1 following surgery and day 6 (post 5 days of feeding). For statistical analysis t test and Chi square test were used. The study was carried out in Topiwala National Medical College and BYL Nair Hospital, Mumbai, India. There was a significant difference in the baseline plasma glutamine levels in both the groups (p<0.05). And on day 6 the plasma glutamine analysis revealed significant higher levels in the experimental group as compared to the control group. The incidence of infection in the control group was found to be almost twice that in the experimental group considering the role of glutamine in combating infection. Also the length of hospitalization was found to be slightly higher in the control group as compared to the experimental group. The present study has provided evidence that the supplementation of enteral glutamine in post-operative patients decreases the incidence of post-surgical infection, shortening of hospital stay and reduction in the overall hospital costs.

Keywords


Glutamine Supplementation, Post-Operative Patients, Oral and Enteral Feed.

References