Cost containment through L-alanyl-L-glutamine supplemented total parenteral nutrition after major abdominal surgery: a prospective randomized double-blind controlled study

ackground & Aims: Glutamine is recognized as a conditionally essential amino acid. Recent studies indicate that glutamine-containing total parenteral nutrition improves nitrogen economy, enhances gastrointestinal and immune functions and shortens hospital stay. Methods: Thirty-seven patients (19 w and 18 m; age 61.4±10.4 years; BMI 23.7±2.8 kg/m2) following major abdominal surgery receiving an isonitrogenous isoenergetic TPN with or without alanyl-glutamine supplementation (0.5 g/kg BW/day), were evaluated in a double-blind, randomized, controlled trial over a five-day period by measuring nitrogen balance, selected biochemical parameters and length of hospital stay. Results: Supplemental alanyl-glutamine improved the overall mean (−3.5±1.6 vs. −5.5±1.4 g N;P<0.05) and cumulative nitrogen balance (−14.1±9.1 vs. −21.7±11.4 g N;P<0.05) compared with the isonitrogenous, isoenergetic standard regimen. Alanyl-glutamine normalized plasma glutamine concentration and reduced the length of hospital stay (12.8±2.6 vs. 17.5±6.4 days;P<0.05). Conclusions: The results of the study confirm that supplementation with synthetic alanyl-glutamine dipeptide is associated with cost containment due to shortened hospitalization and improved nitrogen economy.