Growth hormone together with glutamine-containing total parenteral nutrition maintains muscle glutamine levels and results in a less negative nitrogen balance after surgical trauma.
BACKGROUND
Muscle protein catabolism, reflected by a decrease in glutamine (GLN), a decrease in muscle protein synthesis, and a negative nitrogen balance can be reduced by either administration of GLN or growth hormone (GH). In this study, the effects of a combination of GH and GLH were studied.


METHODS
Patients (n = 16) undergoing abdominal operation were given total parenteral nutrition (TPN) containing either GLN alone or GLN together with GH (GH/GLN) during 3 postoperative days. The amino acid concentration and protein synthesis in muscle tissue and the nitrogen balance were measured.


RESULTS
GH/GLN reduced nitrogen losses compared with GLN alone (-5.8 +/- 1.4 g nitrogen versus -10.6 +/- 1.1 g nitrogen, P <.05). GH/GLN maintained muscle GLN at preoperative levels compared with a 47.5% +/- 6.3% decline in the GLN group. A similar decrease was seen in the fractional synthesis rate of muscle protein postoperatively in both groups.


CONCLUSIONS
GH has an additive effect given together with GLN on muscle amino acid metabolism, preventing the decrease in the GLN concentration in skeletal muscle and diminishing the loss of whole body nitrogen. However, the improvements in muscle amino acid concentrations and nitrogen loss were not associated with differences between the groups in muscle protein synthesis postoperatively.
Hammarqvist
F
F
Gastrocentrum, Huddinge University Hospital, Stockholm, Sweden.
Sandgren
A
A
Andersson
K
K
Essén
P
P
McNurlan
M A
MA
Garlick
P J
PJ
Wernerman
J
J
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D001806:Blood Urea Nitrogen; D005260:Female; D018698:Glutamic Acid / Q000097:blood; D005973:Glutamine / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D019382:Human Growth Hormone / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009124:Muscle Proteins / Q000096:biosynthesis / Q000378:metabolism; D018482:Muscle, Skeletal / Q000378:metabolism*; D009584:Nitrogen / Q000378:metabolism*; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control; D011446:Prospective Studies
D009124:Muscle Proteins; D005973:Glutamine; D019382:Human Growth Hormone; D018698:Glutamic Acid; D009584:Nitrogen