Impact of a low-to-middle dosage of glutamine-supplemented total parenteral nutrition on inflammatory markers in patients with inflammatory bowel disease

Objective To evaluate the impact of total parenteral nutrition (TPN) on nutrition status and inflammatory markers in hospitalized fasted patients with inflammatory bowel disease (IBD). Methods A retrospective study was performed and 82 hospitalized fasted IBD patients [male/female=58/24, (39.4±14.5) years] who received TPN entered the study. Among them, 38 patients had ulcerative colitis (UC) and 44 patients suffered from Crohn's disease (CD). Clinical data (gender, age, duration of disease, history of disease, prednisone, immuno-suppressor, and antibiotics) were obtained from medical records. Nutritional parameters, C-creative protein (CRP), and erythrocyte sedimentation rate (ESR) before and after TPN were also obtained. Average caloric supplementation by TPN was (4 437.3±1 199.1) kJ/d and the nitrogen amount was (9.9±1.7)g/d. Median PN length was 15 days (7-54 days). 67 IBD patients received a TPN formula with glutamine (≥14 d, 25 patients vs. 0-14 d, 42 patients) and 15 IBD subjects received TPN without glutamine. Malnutrition was diagnosed by body mass index (BMI) and serum albumin level. Results The prevalence of undernutrition was 90.2% (74/82) in the study population. CD patients had a significantly longer history of disease [84(3-288)months vs. 24(1-324)months, P<0.001] and a significantly lower BMI [(15.6±1.8)kg/m2vs. (19.1±3.5)kg/m2, P<0.001] compared with those in UC patients. TPN improved nutritional parameters [serum albumin: (28.7±6.6)g/L before TPN vs. (31.7±5.8)g/L after TPN, P<0.001; pre-albumin: (174.1±85.5)mg/L before TPN vs. (227.2±82.8)mg/L after TPN, P<0.001]. Conclusions TPN improves nutritional status in hospitalized fasted IBD patients. However, prospective randomized controlled trials are required to estimate the role of low-to-middle dosage of glutamine in IBD patients. Key words: Inflammatory bowel disease; Crohn's disease; Ulcerative colitis; Glutamine; Total parenteral nutrition