Impact of Alanyl-Glutamine Dipeptide on Clinical Outcome for Gastric Cancer Patients with Nutritional Risk_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHENBo , XUA-man , HUKong-wang , HANWen-xiu , ZHANGJia-wei , LITing , WEIZhi-jian ,  XIONGMao-ming ,  MENGXiang-ling

Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, Anhui Province, China;

Corresponding author：

XIONGMao-ming, Email: anyixmm@163.com; MENGXiang-ling, Email: anyimxl@163.com

Keywords：

Nutritional risk screening; Malnutrition; Alanyl-glutamine; Gastric cancer; Clinical outcome

DOI：

10.7507/1007-9424.20160210

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the impact of using alanyl-glutamine dipeptide on clinical outcome for gastric cancer patients with nutritional risk after total gastrectomy. Methods This study was carried out in the period from March to August 2015. The nutritional risk was screened by continuous sampling method in the new hospitalized patients with gastric cancer who would undergo total gastrectomy. The patients were grouped randomly. Alanyl-glutamine was given to the experimental group patients. The clinical data of the two groups were analyzed, such as the laboratory parame-ters of nutritional status and hepatorenal function, complications of surgery, the nutrition-related hospitalization day, etc. Results The preoperative data were consistent in the two groups of the included 40 cases. The results showed, in the third and seventh days after surgery, the level of plasma albumin was higher in the experimental group than in the control group〔(33.9±5.6) g/L vs. (30.8±4.0) g/L and (36.6±3.9) g/L vs. (33.9±4.2) g/L, respectively). Also, the CD4⁺/CD8⁺ cells immune index was significantly improved in the experimental group after surgery (1.7±0.7 vs. 1.2±0.3, P < 0.05). The recovery time of intestinal function〔(65.7±5.3) h vs. (71.6±7.2)h, P < 0.01)〕and nutrition-related hospitalization day〔(10.1±1.8) d vs. (11.7±1.9)d, P < 0.01)〕in alanyl-glutamine dipeptide group were shorted than that in the control group. No serious adverse drug reactions were found in the patients during the treatment period. Conclusion Application alanyl-glutamine to the patients with nutritional risk after total gastrectomy could partly improve clinical outcome indicators.

Citation： CHENBo, XUA-man, HUKong-wang, HANWen-xiu, ZHANGJia-wei, LITing, WEIZhi-jian, XIONGMao-ming, MENGXiang-ling. Impact of Alanyl-Glutamine Dipeptide on Clinical Outcome for Gastric Cancer Patients with Nutritional Risk. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(7): 798-804. doi: 10.7507/1007-9424.20160210 Copy

1.	Abunnaja S, Cuviello A, Sanchez JA. Enteral and parenteral nutrition in the perioperative period: state of the art. Nutrients, 2013, 5(2): 608-623.
2.	van Zanten AR. Glutamine and antioxidants: status of their use in critical illness. Curr Opin Clin Nutr Metab Care, 2015, 18(2): 179-186.
3.	Tegels JJ, De Maat MF, Hulsewé KW, et al. Improving the outcomes in gastric cancer surgery. World J Gastroenterol, 2014, 20(38): 13692-13704.
4.	Kirkland LL, Kashiwagi DT, Brantley S, et al. Nutrition in the hospitalized patient. J Hosp Med, 2013, 8(1): 52-58.
5.	Kondrup J. Nutritional-risk scoring systems in the intensive care unit. Curr Opin Clin Nutr Metab Care, 2014, 17(2): 177-182.
6.	Johansen N, Kondrup J, Plum LM, et al. Effect of nutritional support on clinical outcome in patients at nutritional risk. Clin Nutr, 2004, 23(4): 539-550.
7.	Villa Nova M, Gonçalves Mde C, Nogueira AC, et al. Formulation and characterization of ethylcellulose microparticles containing L-alanyl-L-glutamine peptide. Drug Dev Ind Pharm, 2014, 40(10): 1308-1317.
8.	Xie Y, Liang X, Wei M, et al. Optimization of glutamine peptide production from soybean meal and analysis of molecular weight distribution of hydrolysates. Int J Mol Sci, 2012, 13(6): 7483-7495.
9.	Rodas PC, Rooyackers O, Hebert C, et al. Glutamine and glutathione at ICU admission in relation to outcome. Clin Sci (Lond), 2012, 122(12): 591-597.
10.	Brianez LR, Caporossi C, de Moura YW, et al. Gastric residual volume by magnetic ressonance after intake of maltodextrin and glutamine: a randomized double-blind, crossover study. Arq Gastroenterol, 2014, 51(2): 123-127.
11.	Liu H, Ling W, Shen ZY, et al. Clinical application of immune-enhanced enteral nutrition in patients with advanced gastric cancer after total gastrectomy. J Dig Dis, 2012, 13(8): 401-406.
12.	Fan YP, Yu JC, Kang WM, et al. Effects of glutamine supplementa-tion on patients undergoing abdominal surgery. Chin Med Sci J, 2009, 24(1): 55-59.
13.	Yeh CN, Lee HL, Liu YY, et al. The role of parenteral glutamine supplement for surgical patient perioperatively: result of a single center, prospective and controlled study. Langenbecks Arch Surg, 2008, 393(6): 849-855.
14.	Oliveira GP, Dias CM, Pelosi P, et al. Understanding the mechanisms of glutamine action in critically ill patients. An Acad Bras Cienc, 2010, 82(2): 417-430.
15.	Pradelli L, Iannazzo S, Zaniolo O, et al. Effectiveness and cost-effec-tiveness of supplemental glutamine dipeptide in total parenteral nutrition therapy for critically ill patients: a discrete event simulation model based on Italian data. Int J Technol Assess Health Care, 2012, 28(1): 22-28.
16.	Estívariz CF, Griffith DP, Luo M, et al. Efficacy of parenteral nutri-tion supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients. JPEN J Parenter Enteral Nutr, 2008, 32(4): 389-402.
17.	Zádori D, Veres G, Szalárdy L, et al. Drug-induced movement disorders. Expert Opin Drug Saf, 2015, 14(6): 877-890.
18.	Zukiewicz-Sobczak W, Król R, Wróblewska P, et al. Huntington Disease-principles and practice of nutritional management. Neurol Neurochir Pol, 2014, 48(6): 442-448.
19.	Lodwick DL, Minneci PC, Deans KJ. Current surgical management of intestinal rotational abnormalities. Curr Opin Pediatr, 2015, 27(3): 383-388.
20.	Victorzon M. Single-anastomosis gastric bypass: better, faster, and safer? Scand J Surg, 2015, 104(1): 48-53.
21.	Ferreres AR, Asbun HJ. Technical aspects of cholecystectomy. Surg Clin North Am, 2014, 94(2): 427-454.
22.	Holst JJ. Enteroendocrine secretion of gut hormones in diabetes, obesity and after bariatric surgery. Curr Opin Pharmacol, 2013, 13(6): 983-988.
23.	Campos JM, Mello FS, Ferraz AA, et al. Endoscopic dilation of gastrojejunal anastomosis after gastric bypass. Arq Bras Cir Dig. 2012, 25(4): 283-289.
24.	Wang H, Zhang C, Wu G, et al. Glutamine enhances tight junction protein expression and modulates corticotropin-releasing factor signaling in the jejunum of weanling piglets. J Nutr, 2015, 145(1): 25-31.
25.	Jiang JW, Ren ZG, Chen LY, et al. Enteral supplementation with glycyl-glutamine improves intestinal barrier function after liver transplantation in rats. Hepatobiliary Pancreat Dis Int, 2011, 10(4): 380-385.

1. Abunnaja S, Cuviello A, Sanchez JA. Enteral and parenteral nutrition in the perioperative period: state of the art. Nutrients, 2013, 5(2): 608-623.
2. van Zanten AR. Glutamine and antioxidants: status of their use in critical illness. Curr Opin Clin Nutr Metab Care, 2015, 18(2): 179-186.
3. Tegels JJ, De Maat MF, Hulsewé KW, et al. Improving the outcomes in gastric cancer surgery. World J Gastroenterol, 2014, 20(38): 13692-13704.
4. Kirkland LL, Kashiwagi DT, Brantley S, et al. Nutrition in the hospitalized patient. J Hosp Med, 2013, 8(1): 52-58.
5. Kondrup J. Nutritional-risk scoring systems in the intensive care unit. Curr Opin Clin Nutr Metab Care, 2014, 17(2): 177-182.
6. Johansen N, Kondrup J, Plum LM, et al. Effect of nutritional support on clinical outcome in patients at nutritional risk. Clin Nutr, 2004, 23(4): 539-550.
7. Villa Nova M, Gonçalves Mde C, Nogueira AC, et al. Formulation and characterization of ethylcellulose microparticles containing L-alanyl-L-glutamine peptide. Drug Dev Ind Pharm, 2014, 40(10): 1308-1317.
8. Xie Y, Liang X, Wei M, et al. Optimization of glutamine peptide production from soybean meal and analysis of molecular weight distribution of hydrolysates. Int J Mol Sci, 2012, 13(6): 7483-7495.
9. Rodas PC, Rooyackers O, Hebert C, et al. Glutamine and glutathione at ICU admission in relation to outcome. Clin Sci (Lond), 2012, 122(12): 591-597.
10. Brianez LR, Caporossi C, de Moura YW, et al. Gastric residual volume by magnetic ressonance after intake of maltodextrin and glutamine: a randomized double-blind, crossover study. Arq Gastroenterol, 2014, 51(2): 123-127.
11. Liu H, Ling W, Shen ZY, et al. Clinical application of immune-enhanced enteral nutrition in patients with advanced gastric cancer after total gastrectomy. J Dig Dis, 2012, 13(8): 401-406.
12. Fan YP, Yu JC, Kang WM, et al. Effects of glutamine supplementa-tion on patients undergoing abdominal surgery. Chin Med Sci J, 2009, 24(1): 55-59.
13. Yeh CN, Lee HL, Liu YY, et al. The role of parenteral glutamine supplement for surgical patient perioperatively: result of a single center, prospective and controlled study. Langenbecks Arch Surg, 2008, 393(6): 849-855.
14. Oliveira GP, Dias CM, Pelosi P, et al. Understanding the mechanisms of glutamine action in critically ill patients. An Acad Bras Cienc, 2010, 82(2): 417-430.
15. Pradelli L, Iannazzo S, Zaniolo O, et al. Effectiveness and cost-effec-tiveness of supplemental glutamine dipeptide in total parenteral nutrition therapy for critically ill patients: a discrete event simulation model based on Italian data. Int J Technol Assess Health Care, 2012, 28(1): 22-28.
16. Estívariz CF, Griffith DP, Luo M, et al. Efficacy of parenteral nutri-tion supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients. JPEN J Parenter Enteral Nutr, 2008, 32(4): 389-402.
17. Zádori D, Veres G, Szalárdy L, et al. Drug-induced movement disorders. Expert Opin Drug Saf, 2015, 14(6): 877-890.
18. Zukiewicz-Sobczak W, Król R, Wróblewska P, et al. Huntington Disease-principles and practice of nutritional management. Neurol Neurochir Pol, 2014, 48(6): 442-448.
19. Lodwick DL, Minneci PC, Deans KJ. Current surgical management of intestinal rotational abnormalities. Curr Opin Pediatr, 2015, 27(3): 383-388.
20. Victorzon M. Single-anastomosis gastric bypass: better, faster, and safer? Scand J Surg, 2015, 104(1): 48-53.
21. Ferreres AR, Asbun HJ. Technical aspects of cholecystectomy. Surg Clin North Am, 2014, 94(2): 427-454.
22. Holst JJ. Enteroendocrine secretion of gut hormones in diabetes, obesity and after bariatric surgery. Curr Opin Pharmacol, 2013, 13(6): 983-988.
23. Campos JM, Mello FS, Ferraz AA, et al. Endoscopic dilation of gastrojejunal anastomosis after gastric bypass. Arq Bras Cir Dig. 2012, 25(4): 283-289.
24. Wang H, Zhang C, Wu G, et al. Glutamine enhances tight junction protein expression and modulates corticotropin-releasing factor signaling in the jejunum of weanling piglets. J Nutr, 2015, 145(1): 25-31.
25. Jiang JW, Ren ZG, Chen LY, et al. Enteral supplementation with glycyl-glutamine improves intestinal barrier function after liver transplantation in rats. Hepatobiliary Pancreat Dis Int, 2011, 10(4): 380-385.

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Impact of Alanyl-Glutamine Dipeptide on Clinical Outcome for Gastric Cancer Patients with Nutritional Risk

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