ORIGINAL ARTICLE
Glutamine dipeptide-supplemented parenteral nutrition in patients with colorectal cancer

https://doi.org/10.1016/j.clnu.2004.07.010Get rights and content

Summary

Objectve: To study the impact of glutamine-supplemented parenteral nutrition on immune-function and protein metabolism in postoperative patients with colorectal cancer.

Methods: Forty colorectal cancer patients were randomized into two groups and were administered isonitrogenous and isocaloric parenteral nutrition with (ala-gln group) or without (TPN group) glutamine dipeptide (0.3–0.4 g/ kg–1 d–1) for 7 days postoperatively. Immune function and nitrogen balance were assessed peri-operatively.

Results: Compared to a matched group of patients with gastrointestinal benign diseases (control group) colorectal cancer patients showed immune suppression preoperatively. Postoperatively, from the fourth day onwards CD4, NK cell counts, CD4/CD8 ratio and IL-2R expression were higher (P<0.05) in the ala-gln group as compared with the TPN group. Nitrogen balance became positive from postoperative day 4 onwards in the ala-gln group, whereas it remained negative in the TPN group for the study period.

Conclusions: Glutamine dipeptide supplementation improved immune-function and nitrogen balance in patients with colorectal cancer postoperatively.

Introduction

Immune suppression and hypercatabolism are frequent associates of malignancy, and surgery may deteriorate the immunity and augment stress. Impairments of both humoral and cellular immune function is signaled by decreased levels of immuno globulins and reduction in the number of mature T lymphocytes, Th cells, natural killer (NK) cells, interleukin-2 receptor (IL-2R) and an unbalanced ratio of Th:Ts. In these patients, standard parenteral nutrition may not be sufficient to maintain the immune system and stabilize nitrogen metabolism. Therefore, we prospectively evaluated the effect of postoperative glutamine-dipeptide-(ala-gln)-supplemented parenteral nutrition on the immune function and protein metabolism in patients with colorectal cancer.

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Patients

Forty consecutive adult patients (26 male and 14 female) with colorectal cancer were included in this study. The average age of the patients was 56 years (range 28–80). There were 24 patients with rectal cancer, five patients with ascending colonic cancer, four patients with sigmoid colonic cancer, four patients with descending colonic cancer and three patients with transverse colonic cancer. The surgeries performed were: right hemicolectomy (n=6); transverse colectomy (n=3); left hemicolectomy

Comparison of cellular immune function between colorectal cancer patients and control group before operation

CD3, CD4 and CD25 counts of the 40 colorectal cancer patients were lower than controls (P<0.05). The ratio of CD4:CD8 was higher in the control group, yet the difference did not approach significance (Table 1).

Comparison of humoral immune function between colorectal cancer patients and control group before operation

Plasma or serum IgA, IgG, IgM, C3, C4 and CH50 levels of the 40 colorectal cancer patients were lower than controls, the differences of C4 and CH50 levels were significant (P<0.05) (Table 2).

Changes of cellular immune function in patients with colorectal cancer

The two groups (TPN and ala-gln) revealed no significant differences preoperatively. Indices of

Discussion

Among all amino acids glutamine is the most abundant in plasma and cells.1 It has recently been recognized as a conditionally essential amino acid, supplementation of which can maintain the glutamine levels of skeletal muscle tissue and plasma, stimulate protein anabolism and inhibit protein breakdown, increase the level of certain post-traumatic anti-inflammatory mediators and down regulate pro-inflammatory factors.2 Furthermore, glutamine exerts impact on glucose homeostasis, affecting

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Copyright © 2004 Published by Elsevier Ltd.