Metabolic and clinical effects of parenteral L-alanine-L-glutamine in surgical oncology

Luca Gianotti, Marco Braga, Roberto Biffi, Federico Bozzetti, Luigi Mariani

Research output: Contribution to journalArticle


Objective: The aim of this study was to evaluate whether perioperative intravenous glutamine supplementation can affect metabolic parameters and outcome. Design: This was a prospective, randomized, phase III, multicenter clinical trial. Patients and methods: Well-nourished patients (n = 428) who were candidates for elective major gastrointestinal surgery for cancer were allocated to received either intravenous infusion of l-alanine-l-glutamine dipeptide (0.40 g/kg per day; equal to 0.25 g of free glutamine) (glutamine group, n = 212) or no supplementation (control group, n = 216). Glutamine infusion began the day before the operation and continued postoperatively for at least 5 days. No postoperative artificial nutrition was allowed unless patients could not adequately eat by day 7. At different time points, plasma or urine was obtained in 166 patients per group to measure standard biochemistry parameters and urinary nitrogen loss. Results: Both postoperative hyperglycemia and urine nitrogen loss were significantly reduced in the glutamine group compared with controls (minimum p = 0.03), while no significant differences between groups were observed for protein synthesis, liver function, and inflammation markers. Overall postoperative complication rate was 34.9% (74/212) in the glutamine group and 32.9% (71/216) in control group (p = 0.65). Infectious morbidity was 19.3% (41/212) in the glutamine group and 17.1% (37/216) in controls (p = 0.55). The rate of patients requiring postoperative artificial nutrition was 13.2% (28/212) in the glutamine group and 12.0% (26/216) in controls (p = 0.71). Conclusions: Despite selective metabolic advantages, perioperative glutamine does not seem to affect surgical outcome in well-nourished gastrointestinal cancer patients.

Original languageEnglish
Pages (from-to)77-85
Number of pages9
JournalNutritional Therapy and Metabolism
Issue number2
Publication statusPublished - Apr 2010


  • Cancer
  • Complications
  • Dipeptide
  • Glucose
  • Glutamine
  • Nitrogen
  • Surgery

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Nutrition and Dietetics

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