Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation

A randomized, double-blind, controlled study

Thomas R. Ziegler, Lorraine S. Young, Kathleen Benfell, Marc Scheltinga, Kari Hortos, Rancy Bye, Frank D. Morrow, Danny Jacobs, Robert J. Smith, Joseph H. Antin, Douglas W. Wilmore

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)821-828
Number of pages8
JournalAnnals of internal medicine
Volume116
Issue number10
DOIs
StatePublished - Jan 1 1992
Externally publishedYes

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Parenteral Nutrition
Glutamine
Bone Marrow Transplantation
Double-Blind Method
Nitrogen
Incidence
Length of Stay
Infection
Bone Marrow
Morbidity
Hematologic Neoplasms
Teaching Hospitals
Neutrophils
Fever
Randomized Controlled Trials
Body Weight
Anti-Bacterial Agents
Transplants
Food
Control Groups

ASJC Scopus subject areas

  • Internal Medicine

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Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation : A randomized, double-blind, controlled study. / Ziegler, Thomas R.; Young, Lorraine S.; Benfell, Kathleen; Scheltinga, Marc; Hortos, Kari; Bye, Rancy; Morrow, Frank D.; Jacobs, Danny; Smith, Robert J.; Antin, Joseph H.; Wilmore, Douglas W.

In: Annals of internal medicine, Vol. 116, No. 10, 01.01.1992, p. 821-828.

Research output: Contribution to journalArticle

Ziegler, TR, Young, LS, Benfell, K, Scheltinga, M, Hortos, K, Bye, R, Morrow, FD, Jacobs, D, Smith, RJ, Antin, JH & Wilmore, DW 1992, 'Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation: A randomized, double-blind, controlled study', Annals of internal medicine, vol. 116, no. 10, pp. 821-828. https://doi.org/10.7326/0003-4819-116-10-821
Ziegler, Thomas R. ; Young, Lorraine S. ; Benfell, Kathleen ; Scheltinga, Marc ; Hortos, Kari ; Bye, Rancy ; Morrow, Frank D. ; Jacobs, Danny ; Smith, Robert J. ; Antin, Joseph H. ; Wilmore, Douglas W. / Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation : A randomized, double-blind, controlled study. In: Annals of internal medicine. 1992 ; Vol. 116, No. 10. pp. 821-828.
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abstract = "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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AU - Young, Lorraine S.

AU - Benfell, Kathleen

AU - Scheltinga, Marc

AU - Hortos, Kari

AU - Bye, Rancy

AU - Morrow, Frank D.

AU - Jacobs, Danny

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AU - Antin, Joseph H.

AU - Wilmore, Douglas W.

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