Glutamine-supplemented total parenteral nutrition reduces plasma interleukin-6 in surgical patients with lower disease severity Ming-Tsan Lin1, Sung-Ling Yeh2, Der-Yirng Hsieh3, Su-Hua Huang4, Lie-Jane Lin5, Po-Huang Lee1, Wei-Jao Chen1. 1 Department of Surgery, 3 Department of Nursing, 4 Department of Clinical Nutrition, 5 Department of Pharmacy, National Taiwan University Hospital, 2 School of Nutrition and Health Science, Taipei Medical University, Taipei, Taiwan To evaluate whether effect of glutamine (Gln) dipeptide-enriched total parenteral nutrition (TPN) on postoperative cytokine alteration were dependent on severity of diseases of patients undergoing surgery. Background: Surgery is know to impair immune response. The decrease in plasma Gln level following major surgery may contribute to state of immunosuppression. Gln supplementation improves depletion of body Gln pool, and may have indirect effect on reducing proinflammatory mediator release. Methods: Forty-eight patients with major abdominal surgery were allocated to two groups to receive isonitrogenous (0.228g nitrogen/kg/day) and isoenergetic (30kcal/kg/day) TPN for 6 days. Control group (Conv) received 1.5g amino acids/kg/day, whereas the test group received 0.972g amino acids/kg/day and 0.417g of L-alanyl-L-glutamine (Ala-Gln)/kg/day. Blood samples were collected on day 1 and day 6 postoperatively for plasma interleukin (IL)-2, IL-6, IL-8 and interferon-AE analysis. Cumulative nitrogen balance was calculated. Results: IL-2 and interferon-AE were not detectable. Plasma IL-6 concentrations were significantly lower on 6th postoperative day in Ala-Gln group than those in Conv group with APACHE II < 6, whereas no difference was noted in patients with APACHE II AE 6. There was no difference in IL-8 levels between 2 groups. Negative correlation was observed between plasma IL-6 levels and cumulative nitrogen balance on day 5 postoperatively in patients of test group. No such correlation was noted in control group. From "The 8th Congress of PENSA Programme & Abstracts" Kochi, Japan, November 5-7, 2002 : Page 51