title: L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study.
abstract: OBJECTIVE
  Glutamine (Gln)-supplemented total parenteral nutrition (TPN) improves clinical outcome after planned surgery, but the benefits of Gln-TPN for critically ill (intensive care unit; ICU) patients are still debated.
  
  
  METHODS
  Prospective, double-blind, controlled, randomized trial.
  
  
  METHODS
  ICUs in 16 hospitals in France.
  
  
  METHODS
  One-hundred fourteen ICU patients admitted for multiple trauma (38), complicated surgery (65), or pancreatitis (11).
  
  
  METHODS
  Patients were randomized to receive isocaloric isonitrogenous TPN via a central venous catheter providing 37.5 kcal and 1.5 g amino acids.kg-1.day-1 supplemented with either L-alanyl-L-glutamine dipeptide (0.5 g.kg-1.day-1; Ala-Gln group, n=58) or L-alanine+L-proline (control group, n=56) over at least 5 days.
  
  
  RESULTS
  Complicated clinical outcome was defined a priori by the occurrence of infectious complications (according to the criteria of the Centers for Disease Control and Prevention), wound complication, or death. The two groups were compared by chi-square test on an intention-to-treat basis. The two groups did not differ at inclusion for type and severity of injury (mean simplified acute physiology score II, 30 vs. 30.5; mean injury severity score, 44.9 vs. 42.3). Similar volumes of TPN were administered in both groups. Ala-Gln-supplemented TPN was associated with a lower incidence of complicated outcome (41% vs. 61%; p<.05), which was mainly due to a reduced infection rate per patient (mean, 0.45 vs. 0.71; p<.05) and incidence of pneumonia (10 vs. 19; p<.05). Early death rate during treatment and 6-month survival were not different. Hyperglycemia was less frequent (20 vs. 30 patients; p<.05) and there were fewer insulin-requiring patients (14 vs. 22; p<.05) in the Ala-Gln group.
  
  
  CONCLUSIONS
  TPN supplemented with Ala-Gln dipeptide in ICU patients is associated with a reduced rate of infectious complications and better metabolic tolerance.
authors.affiliation: Nutrition Unit, Rouen University Hospital (PD), Rouen, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Déchelotte
authors.forename: Michel
authors.initials: M
authors.lastname: Hasselmann
authors.forename: Luc
authors.initials: L
authors.lastname: Cynober
authors.forename: Bernard
authors.initials: B
authors.lastname: Allaouchiche
authors.forename: Moïse
authors.initials: M
authors.lastname: Coëffier
authors.forename: Bernadette
authors.initials: B
authors.lastname: Hecketsweiler
authors.forename: Véronique
authors.initials: V
authors.lastname: Merle
authors.forename: Michel
authors.initials: M
authors.lastname: Mazerolles
authors.forename: Désiré
authors.initials: D
authors.lastname: Samba
authors.forename: Yves Marie
authors.initials: YM
authors.lastname: Guillou
authors.forename: Jean
authors.initials: J
authors.lastname: Petit
authors.forename: Odile
authors.initials: O
authors.lastname: Mansoor
authors.forename: Gabriel
authors.initials: G
authors.lastname: Colas
authors.forename: Robert
authors.initials: R
authors.lastname: Cohendy
authors.forename: Didier
authors.initials: D
authors.lastname: Barnoud
authors.forename: Pierre
authors.initials: P
authors.lastname: Czernichow
authors.forename: Gérard
authors.initials: G
authors.lastname: Bleichner
mesh_terms: D000704:Analysis of Variance; D003422:Critical Care; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D019587:Dietary Supplements; D004151:Dipeptides / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005602:France / Q000453:epidemiology; D018149:Glucose Intolerance / Q000209:etiology / Q000517:prevention & control*; D005973:Glutamine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D004151:Dipeptides; D005973:Glutamine; C054122:alanylglutamine