L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis

Background & aims: A growing. number of randomized clinical trials suggest that glutamine (Gin) supplementation May be beneficial in a selected group of patients and conditions. However, the effects of Gln-enriched total parenteral nutrition (TPN) on recovery from acute intra-abdominal infection have not been thoroughly investigated. Therefore, the Aim of this study was to investigate whether the provision of Gln-enriched TON After surgical and medical treatment of secondary peritonitis improves infectious morbidity. Methods: TKirty-three patients with secondary peritonitis were randomly assigned to receive either standard (n = 16) TPN or L-alanyl-L-glutamine-supplemented (n = 17) TPN, after medical and surgical treatment of the infectious focus. The two TPN formulae were isonitrogenous and isocaloric, which commenced the morning after surgery and ran continuously for 10 consecutive days. The control group received standard TPN, white the treatment group was given L-alanyl-L-glutamine, 0.40 g/kg/d (Dipeptiven, (R) Fresenius Kabi, Bad Homburg, Germany). Infectious morbidity, nitrogen balance, leukocytes, Lymphocytes, subpopulations CD4 and CD8, Immunoglobulin A (IgA), total. proteins, albumin, hospital and intensive care unit (ICU) stays, and mortality were evaluated. Statistical analysis included one-way ANOVA, the unpaired Student's t-test, the Mann-Whitney U-test, chi(2) test, or Fisher's exact test. Results: Patients in both groups were comparable prior to the operation. Nitrogen balance and the levels of albumin and IgA were significantly better than those in the control group. Also, a significant reduction in the infectious morbidity was found in the Gln-treated group. Lymphocyte counts as well as subpopulations CD4 and CD8, and proteins showed a, propensity, to improvement and a tendency to reduced rates of mortality were observed when comparing the groups. Hospital and ICU stays were similar. Conclusion: L-alanyl-L-glutamine-supplemented TPN improved the infectious morbidity of patients with secondary peritonitis. Gin supplementation to parenteral nutrition may be an alternative for enhancing host defenses and improving infectious morbidity. (C) 2003 Elsevier Ltd. All rights reserved.