title: A prospective randomized study of glutamine-enriched parenteral compared with enteral feeding in postoperative patients.
abstract: Plasma amino acids were measured in 17 postoperative subjects randomly assigned to receive for > or = 5 d tube feeding or total parenteral nutrition (TPN) that had identical energy, nitrogen, and glutamine contents. Subjects required gastric or pancreatic surgery for malignancy and were well-matched for age and body mass index. Tube feeding or TPN began on postoperative day 1 and advanced in daily 25% increments to meet goals of 105 kJ . kg body wt-1 . d-1, 1.5 g protein . kg body wt-1 . d-1, and 0.3 g glutamine . kg body wt-1 . d-1. Delivered energy, nitrogen, and glutamine were closely matched on day 4. Nitrogen balance and plasma proteins did not differ significantly between feeding groups. Total indispensable amino acids, branched-chain amino acids, and glutamine declined 25% on postoperative day 1 compared with preoperative day 0. Indispensable and branched-chain amino acid concentrations were restored with 5 d of either tube feeding or TPN. Glutamine concentrations did not differ significantly by feeding group, though a trend suggested that glutamine recovered more slowly in the tube-fed than in the TPN-fed subjects. Plasma amino acids otherwise reflected formula composition with ratios of valine to leucine of 1.24 and 3.69 mumol/L in subjects receiving 5 d of tube feeding or TPN, respectively. These findings suggest that glutamine-enriched tube feeding and TPN can result in similar profiles for most plasma amino acids at carefully matched doses.
authors.affiliation: Department of Gastroenterology, Geisinger Medical Center, Danville, PA 17822, USA.
authors.forename: J
authors.initials: J
authors.lastname: Fish
authors.forename: G
authors.initials: G
authors.lastname: Sporay
authors.forename: K
authors.initials: K
authors.lastname: Beyer
authors.forename: J
authors.initials: J
authors.lastname: Jones
authors.forename: T
authors.initials: T
authors.lastname: Kihara
authors.forename: A
authors.initials: A
authors.lastname: Kennedy
authors.forename: C
authors.initials: C
authors.lastname: Apovian
authors.forename: G L
authors.initials: GL
authors.lastname: Jensen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000097:blood*; D004750:Enteral Nutrition / Q000592:standards*; D005260:Female; D005526:Food, Formulated / Q000032:analysis / Q000592:standards*; D005973:Glutamine / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology; D010179:Pancreas / Q000601:surgery; D010288:Parenteral Nutrition / Q000592:standards*; D011182:Postoperative Care / Q000379:methods*; D013270:Stomach / Q000601:surgery
chemical_list: D000596:Amino Acids; D005973:Glutamine; D009584:Nitrogen