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Healthou_Clinical and Metabolic Efficacy of Glutamine-supplemented Parenteral Nutrition after Bone Marrow Transplantation: A Randomized, Double-Blind, Controlled Study
Thomas R. Ziegler, MD; Lorraine S. Young, RD, MS; Kathleen Benfell, RPh; Marc Scheltinga, MD; Kari Hortos, DO; Rancy Bye, RD, MS; Frank D. Morrow, PhD; Danny O. Jacobs, MD; Robert J. Smith, MD; Joseph H. Antin, MD; and Douglas W. Wilmore, MD
Ann Intern Med. 1992;116(10):821-828. doi:10.7326/0003-4819-116-10-821
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Grant Support: In part by National Institutes of Health Trauma Center grant #5P50 GM36428, by grant CA 39542, and by the M. Larry Lawrence Foundation. Dr. Jacobs is a recipient of the Robert Wood Johnson Foundation grant 14462.

Requests for Reprints: Douglas W. Wilmore, MD, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Current Author Addresses: Drs. Ziegler and Smith: Department of Medicine, Division of Diabetes and Metabolism, Brigham and Women's Hospital and Joslin Diabetes Center, One Joslin Place, Boston, MA 02215.

Drs. Jacobs and Wilmore: Department of Surgery and Laboratory for Surgical Metabolism and Nutrition, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Dr. Antin: Department of Medicine, Division of Hematology and Oncology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Ms. Young, Benfell, and Bye: Laboratory for Surgical Metabolism and Nutrition, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Dr. Scheltinga: Department of Surgery, Vrije Universeiteit, De Boelelann 1118, 1081 HV Amsterdam, The Netherlands.

Dr. Hortos: Department of Medicine, Mt. Clemens General Hospital, 1000 Harrington Boulevard, Mt. Clemens, MI 48062.

Dr. Morrow: USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111.

 

 Objective: To determine whether glutamine-supplemented parenteral nutrition improves nitrogen retention and reduces hospital morbidity compared with standard parenteral nutrition after bone marrow transplantation.

 Design: Double-blind, randomized, controlled clinical trial.

 Setting: University teaching hospital.

 Patients: Forty-five adults receiving allogeneic bone marrow transplants for hematologic malignancies.

 Intervention: Parenteral nutrition was initiated the day after bone marrow transplantation (day 1). The experimental solution was supplemented with L-glutamine (0.57 g/kg body weight per day) and provided estimated requirements for energy and protein. The control solution was a standard, glutamine-free, isonitrogenous, isocaloric formula.

 Measurements: Nitrogen balance was determined between days 4 and 11 in the initial 23 patients. The incidence of clinical infection and microbial colonization, time until bone marrow engraftment, indices of clinical care, and other data related to hospital morbidity were recorded for all patients.

 Results: The glutamine-supplemented patients (n = 24) were clinically similar to the controls (n = 21) at entry. Nutrient intake was similar in both groups; however, nitrogen balance was improved in the glutamine-supplemented patients relative to the controls (- 1.4 ± 0.5 g/d compared with - 4.2 ± 1.2; P = 0.002). Fewer experimental patients developed clinical infection (three compared with nine in the control group; P = 0.041), and the incidence of microbial colonization was also significantly reduced. Hospital stay was shortened in patients receiving glutamine supplementation (29 ± 1 d compared with 36 ± 2 d; P = 0.017).

 Conclusion: Patients receiving glutamine-supplemented parenteral nutrition after bone marrow transplantation had improved nitrogen balance, a diminished incidence of clinical infection, lower rates of microbial colonization, and shortened hospital stay compared with patients receiving standard parenteral nutrition. These effects occurred despite no differences between groups in the incidence of fever, antibiotic requirements, or time to neutrophil engraftment.


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