Pre-operative glutamine supplementation: effect on the first week post-op period

PhilSPEN Online Journal of Parenteral and Enteral Nutrition

Published in International Journal of Nutrition (Nutrition 2009: 25: 920-925)

http://www.ncbi.nlm.nih.gov/pubmed/19647623

Parenteral glutamine dipeptide supplementation during the pre-operative phase alone: effect on immune indices in malnourished abdominal surgery patients in the first week post-operative period.

Submitted: March 7, 2008 | Posted: March 6, 2009

AUTHORS:

Jonathan M. Asprer, M.D. (1), Luisito O. Llido, M.D.* (2), Reynaldo Sinamban, M.D. (2), Ewald Schlotzer, M.D. (3), and Hrishikesh Kulkarni, M.D., Ph.D (3).

*Corresponding author; Email: llido2001@gmail.com

INSTITUTION WHERE RESEARCH WAS CONDUCTED:

Department of Surgery, Jose Reyes Memorial Medical Center, Sta. Cruz, Metro-Manila, Philippines

St. Luke’s Medical Center, Clinical Nutrition, Obesity, and Weight Management Center, Philippines

Fresenius-Kabi, Bad Homburg, Germany

ABSTRACT: | Back

OBJECTIVE: To determine if parenteral glutamine dipeptide supplementation given only in the pre-operative period of malnourished gastrointestinal surgery patients, would sustain its effects into the first post-operative week, as shown by immune indices

RESEARCH METHODS AND PROCEDURES: A prospective randomized study on malnourished adult patients for abdominal surgery was done where one group (n = 17) received pre-operative glutamine supplementation (0.4 gm/kg/day) for 5 days, and the other (n = 17) had none. Both received isocaloric (30 kcal/kg/day) and isonitrogenous (1.5 gm/kg/day) nutrition. Outcomes were a) immune indices on admission (Day 1), day before surgery (Day 2), and 7th post-op day (Day 3) and b) clinical outcome were infection, wound complication, ICU days, and mortality. Statistical tests were repeated samples ANOVA, Friedman test, Wilcoxon and t-test for individual comparison.

RESULTS: Glutamine supplemented group showed increase in total WBC (Day 1: 8,700 to Day 2:11,080, p = 0.026), granulocytes (Day 1: 6,177 to Day 2: 8,568, p = 0.039), and lymphocytes (Day 1: 1,516 to Day 2: 1,747, p = 0.049). Significant drop in glutamine supplemented group values from Day 2 to Day 3 occurred in: granulocytes, lymphocytes, CD8, CD22, and CD19 cells. Clinical outcome was similar in both groups. Intake was adequate in both groups (preop: 85% vs. postop: 82% of computed) and mean glutamine delivered was 18 gm/day.

CONCLUSION: Parenteral glutamine supplementation in the pre-operative phase resulted to increased WBC, granulocyte, and lymphocyte counts, which did not sustain in the first week post-operative period when supplementation was discontinued before surgery.

KEYWORDS: pre-operative glutamine, abdominal surgery, immune status

PD_021_01to05_POJ_0014.pdf

INTRODUCTION | Back