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L-Alanyl-L-Glutamine-Supplemented Parenteral Nutrition Decreases Infectious Morbidity Rate in Patients With Severe Acute Pancreatitis

From the ¹ Medical Research Unit in Clinical Epidemiology, Western Medical Center, Mexican Institute of Social Security;² Department of Nutritional Support at Civil Hospital "Fray Antonio Alcalde," University of Guadalajara; and³ Department of General Surgery and Nutritional Support, Specialties Hospital at Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico.

Address correspondence to: Alejandro González-Ojeda, MD, Calle José Enrique Rodo # 2558, Colonia Prados Providencia, 44657, Guadalajara, Jalisco, Mexico; e-mail: avygai15{at}yahoo.com.mx.

Background: The effect of parenteral GLN on recovery from severe acute pancreatitis has not been thoroughly investigated. The aims of this study were to determine whether parenteral GLN improves nutrition status and immune function, and to determine its ability to reduce morbidity and mortality in patients with this condition. Methods: In a randomized clinical trial, 44 patients with severe acute pancreatitis were randomly assigned to receive either standard PN (n = 22) or L-alanyl-L-glutamine-supplemented PN (n = 22) after hospital admission. Nitrogen balance, counts of leukocytes, total lymphocytes, and CD4 and CD8 subpopulations, and serum levels of immunoglobulin A, total protein, albumin, C-reactive protein, and serum interleukin (IL)-6 and IL-10 were measured on days 0, 5, and 10. Hospital stay, infectious morbidity, and mortality were also evaluated. Results: Demographics, laboratory characteristics, and pancreatitis etiology and severity at entry to the study were similar between groups. The study group exhibited significant increases in serum IL-10 levels, total lymphocyte and lymphocyte subpopulation counts, and albumin serum levels. Nitrogen balance also improved to positive levels in the study group and remained negative in the control group. Infectious morbidity was more frequent in the control group than in the study group. The duration of hospital stay was similar between groups, as was mortality. Conclusion: The results suggest that treatment of patients with GLN-supplemented PN may decrease infectious morbidity rate compared with those who treated with nonenriched PN.

Key Words: severe acute pancreatitis • GLN-supplemented PN • infectious morbidity

Journal of Parenteral and Enteral Nutrition, Vol. 32, No. 4, 403-411 (2008)
DOI: 10.1177/0148607108319797


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