title: The effect of L-alanyl-L-glutamine dipeptide supplemented total parenteral nutrition on infectious morbidity and insulin sensitivity in critically ill patients.
abstract: OBJECTIVE
  The aim of this study was to assess the clinical efficacy of alanine-glutamine dipeptide-supplemented total parenteral nutrition defined by the occurrence of nosocomial infections. Secondary parameters included Sequential Organ Failure Assessment score, hyperglycemia and insulin needs, intensive care unit and hospital length of stay, and 6-month mortality.
  
  
  METHODS
  Multicenter, prospective, double-blind, randomized trial.
  
  
  METHODS
  Twelve intensive care units at Spanish hospitals.
  
  
  METHODS
  One hundred twenty-seven patients with Acute Physiology and Chronic Health Evaluation II score >12 and requiring parenteral nutrition for 5-9 days.
  
  
  METHODS
  Patients were randomized to receive an isonitrogenous and isocaloric total parenteral nutrition or alanine-glutamine dipeptide-supplemented total parenteral nutrition. Nutritional needs were calculated: 0.25 g N/kg(-1)/d(-1) and 25 kcal/kg(-1)/d(-1). The study group received 0.5 g/kg(-1)/d(-1) of glutamine dipeptide and the control total parenteral nutrition group a similar amount of amino acids. Hyperglycemia was controlled applying an intensive insulin protocol with a target glycemia of 140 mg/dL.
  
  
  RESULTS
  The two groups did not differ at inclusion for the type and severity of injury or the presence of sepsis or septic shock. Caloric intake was similar in both groups. Preprotocol analysis showed that treated patients with alanine-glutamine dipeptide-supplemented total parenteral nutrition had lesser nosocomial pneumonia, 8.04 vs. 29.25 episodes-‰ days of mechanical ventilation (p = .02), and urinary tract infections, 2.5 vs. 16.7 episodes-‰ days of urinary catheter (p = .04). Intensive care unit, hospital, and 6-month survival were not different. Mean plasmatic glycemia was 149 ± 46 mg/dL in the alanine-glutamine dipeptide-supplemented total parenteral nutrition group and 155 ± 51 mg/dL in the control total parenteral nutrition group (p < .04), and mean hourly insulin dose was 4.3 ± 3.3 IU in the alanine-glutamine dipeptide-supplemented total parenteral nutrition group and 4.7 ± 3.7 IU in control total parenteral nutrition group (p < .001). Multivariate analysis showed a 54% reduction of the amount of insulin for the same levels of glycemia in the alanine-glutamine dipeptide-supplemented total parenteral nutrition group.
  
  
  CONCLUSIONS
  Total parenteral nutrition supplemented with alanine-glutamine in intensive care unit patients is associated with a reduced rate of infectious complications and better glycemic control.
authors.affiliation: Hospital Universitario Doce de Octubre, Madrid, Spain. tgrau.hdoc@salud.madrid.org
authors.forename: Teodoro
authors.initials: T
authors.lastname: Grau
authors.forename: Alfonso
authors.initials: A
authors.lastname: Bonet
authors.forename: Eduardo
authors.initials: E
authors.lastname: Miñambres
authors.forename: Laura
authors.initials: L
authors.lastname: Piñeiro
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Irles
authors.forename: Angel
authors.initials: A
authors.lastname: Robles
authors.forename: José
authors.initials: J
authors.lastname: Acosta
authors.forename: Ignacio
authors.initials: I
authors.lastname: Herrero
authors.forename: Venancio
authors.initials: V
authors.lastname: Palacios
authors.forename: Jorge
authors.initials: J
authors.lastname: Lopez
authors.forename: Antonio
authors.initials: A
authors.lastname: Blesa
authors.forename: Pilar
authors.initials: P
authors.lastname: Martínez
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D003428:Cross Infection / Q000517:prevention & control*; D004151:Dipeptides / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007333:Insulin Resistance; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total
chemical_list: D004151:Dipeptides; C054122:alanylglutamine