Special nutritional support containing glutamine, arginine, and omega-3 fatty acids has therapeutic and immunomodulatory effects, and can significantly reduce the incidence of postoperative infectious complications and length of hospital stay in surgical patients. This review provides a clinical update regarding the concept and the use of pharmaconutrition and immunonutrition in patients undergoing gastrointestinal surgery.
Arginine ; therapeutic use ; Digestive System Surgical Procedures ; Enteral Nutrition ; Fatty Acids, Omega-3 ; therapeutic use ; Glutamine ; therapeutic use ; Humans

Animals ; Burns ; drug therapy ; metabolism ; Glutamine ; pharmacology ; therapeutic use ; Humans ; Wound Healing ; drug effects

Nutritional therapy is an important determinant of immune function in burn patients. However, common nutritional supplement given to patients with extensive deep burn is still therapeutically inefficient to block nutrients utilization due to metabolic disorder. Immunonutrition, a new nutrition therapeutic modality, has been used in severely burned patients for regulating cell function, improving metabolic state, and enhancing immune function. Glutamine (Gln) is often considered to be a prime immunonutrient in immunonutrition therapy for critically ill patients including those with serious burns. Our series of experimental and clinical studies have demonstrated that Gln administered in animals or patients could abate intestinal injury, accelerate repair of intestinal mucosa, improve nitrogen balance, abate immunosuppression, maintain immune homeostasis, ameliorate wound healing, and shorten hospital stay. Although the use of Gln for supportive care of severely burned patients is now well established, the science of its use is still in its infancy. There are some disputes in regard to its indication, dosage, and course of treatment, and the way of its supplementation, administration opportunity especially. These questions will be discussed in this paper, and we wish to propose the principle and method of administration of Gln in severely burned patients.
Burns ; metabolism ; therapy ; Glutamine ; therapeutic use ; Humans ; Nutritional Status ; Nutritional Support ; methods

Reprogramming of metabolism is a hallmark of tumors, which has been explored for therapeutic purposes. Prostate cancer (PCa), particularly advanced and therapy-resistant PCa, displays unique metabolic properties. Targeting metabolic vulnerabilities in PCa may benefit patients who have exhausted currently available treatment options and improve clinical outcomes. Among the many nutrients, glutamine has been shown to play a central role in the metabolic reprogramming of advanced PCa. In addition to amino acid metabolism, glutamine is also widely involved in the synthesis of other macromolecules and biomasses. Targeting glutamine metabolic network by maximally inhibiting glutamine utilization in tumor cells may significantly add to treatment options for many patients. This review summarizes the metabolic landscape of PCa, with a particular focus on recent studies of how glutamine metabolism alterations affect therapeutic resistance and disease progression of PCa, and suggests novel therapeutic strategies.
Male ; Humans ; Glutamine/therapeutic use* ; Prostatic Neoplasms, Castration-Resistant/drug therapy*

OBJECTIVETo determine the effect of dipeptide of glutamine and alanine on patients with severe traumatic brain injury.

METHODSA total of 46 patients (31 males and 15 females, aged 7-68 years, (47+/-9.6) years on average) with severe traumatic brain injury were randomized into two groups: Group G (n=23) and Group C (n=23). The patients in Group G received nutritional remedy with the dipeptide of glutamine and alanine, whereas the patients in Group C received routine nutritional therapy only. GCS changes, the length of stay in the neurosurgical intensive care unit (NICU), the mortality,the count of lymphocytes, related complications including lung infection and hemorrhage of alimentary tracts, etc, were examined and recorded.

RESULTSThe fatality rate and the length of stay in NICU in Group G was lower than these in Group C (P larger than 0.05), but no obvious difference was found in GCS changes of the patients between the two groups (P larger than 0.05). The patients with lung infection and alimentary tract hemorrhage in Group G were less than those in Group C (P larger than 0.05). The count of lymphocytes in Group G was more than that in Group C (P larger than 0.05), but no difference was found in other nutritional data.

CONCLUSIONSDipeptide of glutamine and alanine can increase the resisting stress and anti-infection ability of patients with severe traumatic brain injury, which can also lower the mortality and shorten the NICU stay.

Adolescent ; Adult ; Aged ; Alanine ; therapeutic use ; Brain Injuries ; drug therapy ; Child ; Dipeptides ; therapeutic use ; Female ; Glutamine ; therapeutic use ; Humans ; Male ; Middle Aged

Dietary supplementation with nutrients enhancing immune function is beneficial in patients with surgical and critical illness. Malnutrition and immune dysfunction are common features in hospitalized patients. Specific nutrients with immunological and pharmacological effects, when consumed in amounts above the daily requirement, are referred to as immune-enhancing nutrients or immunonutrients. Supplementation of immunonutrients is important especially for patients with immunodeficiency, virus or overwhelming infections accompanied by a state of malnutrition. Representative immunonutrients are arginine, omega-3 fatty acids, glutamine, nucleotides, beta-carotene, and/or branched-chain amino acids. Glutamine is the most abundant amino acid and performs multiple roles in human body. However, glutamine is depleted from muscle stores during severe metabolic stress including sepsis and major surgery. Therefore it is considered conditionally essential under these conditions. This review discusses the physiological role of glutamine, mode and dose for glutamine administration, as well as improvement of certain disease state after glutamine supplementation. Even though immunonutrition has not been widely assimilated by clinicians other than nutritionists, immunonutrients including glutamine may exert beneficial influence on diverse patient populations.
Animals ; Critical Illness ; Glutamine/blood/metabolism/*therapeutic use ; Humans ; Immunity/drug effects ; Inflammation/drug therapy/metabolism ; Malnutrition

BACKGROUNDAssociations between glutamine (Gln) enriched nutrition support and surgical patients with gastrointestinal (GI) tumor remain controversy. The purpose of this meta-analysis was to assess the effect of Gln enriched nutrition support on surgical patients with GI tumor in term of relevant biochemical indices, immune indices, and clinical outcomes.

METHODSSix databases were systematically searched to find eligible randomized controlled trials (RCTs) from 1966 to May 2014. When estimated the analysis indexes, the relative risk (RR) was used as the effect size of the categorical variable, while the weighted mean difference (MD) was used as the effect size of a continuous variable. Meta-analysis was conducted with Rev Man 5.2.

RESULTSThirteen RCTs, involving 1034 patients, were included in the meta-analysis. The analysis showed that Gln enriched nutrition support was more effective in increasing serum albumin (MD: 0.10; 95% confidence interval [CI]: 0.02-0.18; P < 0.05), serum prealbumin (MD: 1.98; 95% CI: 1.40-2.55; P < 0.05) and serum transferring (MD: 0.35; 95% CI: 0.12-0.57; P < 0.05), concentration of IgG (MD: 1.26; 95% CI: 0.90-1.63; P < 0.05), IgM (MD: 0.18; 95% CI: 0.11-0.25; P < 0.05), IgA (MD: 0.22; 95% CI: 0.10-0.33; P < 0.05), CD3 + (MD: 3.71; 95% CI: 2.57-4.85; P < 0.05) and CD4/CD8 ratio (MD: 0.27; 95% CI: 0.12-0.42; P < 0.05). Meanwhile, it was more significant in decreasing the incidence of infectious complications (RR: 0.67; 95% CI: 0.50-0.90; P < 0.05) and shortening the length of hospital stay (MD: -1.72; 95% CI: -3.31--0.13; P < 0.05).

CONCLUSIONSGlutamine enriched nutrition support was superior in improving immune function, reducing the incidence of infectious complications and shortening the length of hospital stay, playing an important role in the rehabilitation of surgical GI cancer patients.

Enteral Nutrition ; Gastrointestinal Neoplasms ; surgery ; Glutamine ; therapeutic use ; Humans ; Parenteral Nutrition ; Postoperative Complications ; prevention & control ; Randomized Controlled Trials as Topic

OBJECTIVETo systematically evaluate the influence of glutamine-enhanced enteral nutrition on clinical prognosis and treatment cost of patients with critical illness.

METHODSRandomized controlled trials (RCTs) since 1976 were searched in 8 biomedical databases, such as MEDLINE, EMBASE, SCI, Cochran Library, and Chinese Biomedicine Database. Bibliography of retrieved papers and personal files were searched as well. RCTs were evaluated with inclusion criteria: (1) RCTs were enrolled, parallel control was set up; (2) Patients with critical illness, with their acute physiology and chronic health evaluation score over 10, or with total burn surface area over 30%TBSA; (3) The only difference between experimental and control groups was the addition of glutamine in enteral nutrition; (4) Clinical outcome index included mortality, nosocomial infection rate, length of hospital stay, organ dysfunction rate, and treatment cost. Methodological quality of the study was assessed based on Cochrane Reviewers' Handbook and Jadad's Score Scale. Statistical software RevMan 5.0 was used for Meta-analysis.

RESULTSAmong 224 related articles, 7 RCTs met all inclusion criteria. Mortality: death events among 545 patients were reported in 5 RCTs. There was no heterogeneity among the 5 RCTs (P = 0.46), relative risk (RR) = 0.94, 95% confidence interval (CI) 0.68 - 1.30, P = 0.70. No statistical difference was found between glutamine group and control group in respect of death risk (P > 0.05). Nosocomial infection rate:nosocomial infection events among 489 patients were reported in 3 RCTs. No heterogeneity was found among the 3 RCTs (P = 0.08). Fixed-effect model was applied. RR = 0.72, 95%CI 0.52 - 0.99, P = 0.04. Nosocomial infection rate of glutamine group was 28% lower than that of control group. Organ dysfunction rate: organ dysfunction events among 460 patients were reported in 3 RCTs. No heterogeneity was found among the 3 RCTs (P = 0.65). Fixed-effect model was applied. RR = 1.27, 95%CI 0.70 - 2.30, P = 0.43. No statistical difference was found between glutamine group and control group in respect of organ dysfunction rate (P > 0.05). Length of hospital stay:length of intensive care unit (ICU) stay of patients were reported in 4 RCTs, but 3 of them reported by median (interquartile ranges) and thus made Meta-analysis unavailable. No statistical difference was found between glutamine group and control group in respect of length of ICU stay. The other RCT reported length of ICU stay by mean standard deviation and showed no statistical difference between glutamine group and control group. Length of hospital stay was reported in 3 RCTs with severely burned patients. No heterogeneity was found among the 3 RCTs (P = 0.08). Fixed-effect model (Inverse Variance method) was applied, and it was shown that length of hospital stay of patients in glutamine group was 7.24 days fewer than that of control group by a mean difference of -7.24, 95%CI -13.28 to -1.19, P = 0.02.

CONCLUSIONSAdministration of Glutamine-enhanced enteral nutrition in patients with critical illness may reduce nosocomial infection rate, and shorten length of hospital stay. Studies with a large sample are needed to verify the efficiency of glutamine-enhanced enteral nutrition on lowering mortality of patients with critical illness and its cost-effectiveness.

Critical Illness ; Enteral Nutrition ; Glutamine ; therapeutic use ; Humans ; Meta-Analysis as Topic ; Randomized Controlled Trials as Topic ; Treatment Outcome

OBJECTIVETo observe the therapeutic effect and safety of retention enema with compound glutamine entero-soluble Capsule (CGC) on active ulcerative colitis (UC).

METHODSOne hundred and sixty-eight patients with active UC were randomly assigned to the treatment group (86 patients) and the control group (82 patients). Besides the basic treatment of oral taking salicylazosulfapyridine or mesalazine, they were treated by retention enema with predisolone plus metronidazole injection. In addition, the patients in the treatment group were treated by retention enima with GGC and orally took CGC, 0.8 g each time, thrice a day. The efficacy of treatment and the changes in the principal symptoms 2 months after treatment were evaluated.

RESULTSThe total effective rate in the treatment group was 94.2% (81/86 cases), and that in the control group was 82.9% (68/82 cases), the difference between the two groups was significant (P <0. 05). The symptoms of hemafecia and abdominal pain were improved, the disease active index (DAI) was lowered after treatment in both groups (P <0.01), but the improvement of hemafecia, time of disappearance of mucous bloody stool and decrease of DAI in the treatment group were superior to those in the control group (P <0.05 or P <0.01). No adverse reaction was found in all patients.

CONCLUSIONThe retention enema with glucocorticoid plus metronidazole combined with CGC shows an immediate effect obviously superior to that treated with glucocorticoids and metronidazole alone, and with no adverse reaction.

Adolescent ; Adult ; Aged ; Capsules ; Colitis, Ulcerative ; drug therapy ; Drug Therapy, Combination ; Enema ; Female ; Glucocorticoids ; therapeutic use ; Glutamine ; therapeutic use ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the influence of combined supplementation of glutamine (Gln) and recombinant human growth hormone (rhGH) on the protein metabolism in severely burned patients.

METHODSSixty severely burned patients were enrolled in the study and were randomly divided into control (C, n = 20) and Gln with rhGH (Gln + rhGH, n = 20) groups. The patients in C group received glycine as the placebo, while those in Gln group took Gln orally in dose of 0.5 g kg(-1) d(-1) during 1-14 postburn days (PBDs). For the patients in Gln + rhGH group rhGH was administered subcutaneously in dose of 0.2 U kg(-1) d(-1) in addition to glutamine in same dosage beginning on the 7 PBD for 7 days. The plasma Gln concentration in the 3 groups of patients was determined on the 1st, 7th and 14th PBD and the plasma albumin level was determined on 14th and 21st PBD. The wound healing rate of the patients within 30 PBSs and the total hospital stay days were recorded.

RESULTSThe plasma Gln concentration in Gln + rhGH group of patients was evidently higher than that in C group after 7 PBD[(452.28 +/- 21.72) micromol/L vs(325.12 +/- 25.34) micromol/L, P < 0.05]. The plasma albumin level in Gln + rhGH group was obviously higher than that in C and Gln groups on the 21st PBD (P < 0.05). The wound healing rate in Gln + rhGH group was evidently higher than that in Gln and C groups on the 30th PBD (P < 0.05). The total hospital stay days in Gln + rhGH group were obviously less than that in C and Gln groups (P < 0.05 or 0.01).

CONCLUSIONCombined administration of Gln and rhGH could be beneficial to the elevation of plasma Gln level in severely burned patients and the systemic protein synthesis was therefore enhanced and the wound healing rate was improved.

Adult ; Aged ; Burns ; metabolism ; therapy ; Female ; Glutamine ; administration & dosage ; blood ; therapeutic use ; Human Growth Hormone ; administration & dosage ; therapeutic use ; Humans ; Male ; Middle Aged ; Recombinant Proteins ; administration & dosage ; therapeutic use ; Treatment Outcome ; Wound Healing ; drug effects ; Young Adult