The role of parenteral glutamine supplement for surgical patient perioperatively

Background: We conducted a prospective and case-controlled study to evaluate the impact of supplement of alanyl-glutamine dipeptide (Gln) in parenteral nutrition on perioperative immune and nutritional changes and clinical outcomes for patients undergoing gastrointestinal (GI) operations. Materials and methods: During 2006, 70 patients undergoing GI surgeries were allocated equally into two groups. One group received regular parenteral nutrition and the other received the same formulation and supplemented with the Gln; the two groups were isonitrogenous. The infusion was started from 1 day before operation to the sixth day after operation for 7 days. Blood samples were collected on the morning of the day before the operation and on the morning 6 days after the operation and analyzed for immune and nutrition parameters. Results: There were no differences between the two groups in terms of clinical characteristics, operative procedures, biochemistry, nutritional status, and immune status preoperatively. After GI surgery, significant reduction in nutritional and immune parameters were observed in both groups, demonstrated by significant difference of albumin, C-reactive protein (CRP), lymphocyte count, T cell, and CD8 cell. The length of hospital stay is slightly longer in the control group patients, but not to statistical significance (16.3±21.3 versus 12.2±6.8 days, p=0.299). In terms of morbidity, there was no difference between the two groups, but two patients in the control group had wound infection; none was noted in the Gln group (p=1.0). No surgical mortality was noted in this study. Conclusions: Perioperative parenteral nutrition supplemented with Gln is beneficial for patients undergoing GI surgery. Gln supplementation significantly attenuated postoperative inflammation and ameliorated postoperative immunodepression as well as nutritional depression in GI surgery.