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Effect of glutamine enriched nutrition support on surgical patients with gastrointestinal tumor: a meta-analysis of randomized controlled trials.

Kang K, Shu XL, Zhang YS, Liu XL, Zhao J - Chin. Med. J. (2015)

Bottom Line: Thirteen RCTs, involving 1034 patients, were included in the meta-analysis.Meanwhile, it was more significant in decreasing the incidence of infectious complications (RR: 0.67; 95% CI: 0.50-0.90; P < 0.05) and shortening the length of hospital stay (MD: -1.72; 95% CI: -3.31--0.13; P < 0.05).Glutamine enriched nutrition support was superior in improving immune function, reducing the incidence of infectious complications and shortening the length of hospital stay, playing an important role in the rehabilitation of surgical GI cancer patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Nutrition, East Hospital, Tong Ji University School of Medicine, Shanghai 200120, China.

ABSTRACT

Background: Associations between glutamine (Gln) enriched nutrition support and surgical patients with gastrointestinal (GI) tumor remain controversy. The purpose of this meta-analysis was to assess the effect of Gln enriched nutrition support on surgical patients with GI tumor in term of relevant biochemical indices, immune indices, and clinical outcomes.

Methods: Six databases were systematically searched to find eligible randomized controlled trials (RCTs) from 1966 to May 2014. When estimated the analysis indexes, the relative risk (RR) was used as the effect size of the categorical variable, while the weighted mean difference (MD) was used as the effect size of a continuous variable. Meta-analysis was conducted with Rev Man 5.2.

Results: Thirteen RCTs, involving 1034 patients, were included in the meta-analysis. The analysis showed that Gln enriched nutrition support was more effective in increasing serum albumin (MD: 0.10; 95% confidence interval [CI]: 0.02-0.18; P < 0.05), serum prealbumin (MD: 1.98; 95% CI: 1.40-2.55; P < 0.05) and serum transferring (MD: 0.35; 95% CI: 0.12-0.57; P < 0.05), concentration of IgG (MD: 1.26; 95% CI: 0.90-1.63; P < 0.05), IgM (MD: 0.18; 95% CI: 0.11-0.25; P < 0.05), IgA (MD: 0.22; 95% CI: 0.10-0.33; P < 0.05), CD3 + (MD: 3.71; 95% CI: 2.57-4.85; P < 0.05) and CD4/CD8 ratio (MD: 0.27; 95% CI: 0.12-0.42; P < 0.05). Meanwhile, it was more significant in decreasing the incidence of infectious complications (RR: 0.67; 95% CI: 0.50-0.90; P < 0.05) and shortening the length of hospital stay (MD: -1.72; 95% CI: -3.31--0.13; P < 0.05).

Conclusions: Glutamine enriched nutrition support was superior in improving immune function, reducing the incidence of infectious complications and shortening the length of hospital stay, playing an important role in the rehabilitation of surgical GI cancer patients.

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Related in: MedlinePlus

Forest plot of relevant immune indices between glutamine and control group. (a) Change of CD3+ T-cell between glutamine and control group: Fixed-effects model. (b) Change of CD4+ T-cell between glutamine and control group: Random-effects model. (c) Change of CD8+ T-cell between glutamine and control group: Fixed-effects model. (d) Change of CD4/CD8 ratio between glutamine and control group: Random-effects model.
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Figure 5: Forest plot of relevant immune indices between glutamine and control group. (a) Change of CD3+ T-cell between glutamine and control group: Fixed-effects model. (b) Change of CD4+ T-cell between glutamine and control group: Random-effects model. (c) Change of CD8+ T-cell between glutamine and control group: Fixed-effects model. (d) Change of CD4/CD8 ratio between glutamine and control group: Random-effects model.

Mentions: There are five studies[2324252627] with 322 subjects that mentioned the change of CD3+, CD4+, CD8+ T-cell and CD4/CD8 ratio. The heterogeneity of CD3+ and CD8+ T-cell was acceptable, so the fixed-effects model was used [Figure 5a and c]. While the heterogeneity among CD4+ T-cell and CD4/CD8 ratio was significant, so the random-effects model was used [Figure 5b and d]. Analysis suggested Gln enriched nutrition support could effectively increase postoperative CD3+ T-cell (MD: 3.71; 95% CI: 2.57–4.85; P < 0.05) and CD4/CD8 ratio (MD: 0.27; 95% CI: 0.12–0.42; P < 0.05) of GI cancer patients. But changes between CD4+ (MD: 4.11; 95% CI: −0.82–9.04; P > 0.05) and CD8+ (MD: −0.37; 95% CI: −1.12–0.38; P > 0.05) T-cell were not statistically significant.


Effect of glutamine enriched nutrition support on surgical patients with gastrointestinal tumor: a meta-analysis of randomized controlled trials.

Kang K, Shu XL, Zhang YS, Liu XL, Zhao J - Chin. Med. J. (2015)

Forest plot of relevant immune indices between glutamine and control group. (a) Change of CD3+ T-cell between glutamine and control group: Fixed-effects model. (b) Change of CD4+ T-cell between glutamine and control group: Random-effects model. (c) Change of CD8+ T-cell between glutamine and control group: Fixed-effects model. (d) Change of CD4/CD8 ratio between glutamine and control group: Random-effects model.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4837846&req=5

Figure 5: Forest plot of relevant immune indices between glutamine and control group. (a) Change of CD3+ T-cell between glutamine and control group: Fixed-effects model. (b) Change of CD4+ T-cell between glutamine and control group: Random-effects model. (c) Change of CD8+ T-cell between glutamine and control group: Fixed-effects model. (d) Change of CD4/CD8 ratio between glutamine and control group: Random-effects model.
Mentions: There are five studies[2324252627] with 322 subjects that mentioned the change of CD3+, CD4+, CD8+ T-cell and CD4/CD8 ratio. The heterogeneity of CD3+ and CD8+ T-cell was acceptable, so the fixed-effects model was used [Figure 5a and c]. While the heterogeneity among CD4+ T-cell and CD4/CD8 ratio was significant, so the random-effects model was used [Figure 5b and d]. Analysis suggested Gln enriched nutrition support could effectively increase postoperative CD3+ T-cell (MD: 3.71; 95% CI: 2.57–4.85; P < 0.05) and CD4/CD8 ratio (MD: 0.27; 95% CI: 0.12–0.42; P < 0.05) of GI cancer patients. But changes between CD4+ (MD: 4.11; 95% CI: −0.82–9.04; P > 0.05) and CD8+ (MD: −0.37; 95% CI: −1.12–0.38; P > 0.05) T-cell were not statistically significant.

Bottom Line: Thirteen RCTs, involving 1034 patients, were included in the meta-analysis.Meanwhile, it was more significant in decreasing the incidence of infectious complications (RR: 0.67; 95% CI: 0.50-0.90; P < 0.05) and shortening the length of hospital stay (MD: -1.72; 95% CI: -3.31--0.13; P < 0.05).Glutamine enriched nutrition support was superior in improving immune function, reducing the incidence of infectious complications and shortening the length of hospital stay, playing an important role in the rehabilitation of surgical GI cancer patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Nutrition, East Hospital, Tong Ji University School of Medicine, Shanghai 200120, China.

ABSTRACT

Background: Associations between glutamine (Gln) enriched nutrition support and surgical patients with gastrointestinal (GI) tumor remain controversy. The purpose of this meta-analysis was to assess the effect of Gln enriched nutrition support on surgical patients with GI tumor in term of relevant biochemical indices, immune indices, and clinical outcomes.

Methods: Six databases were systematically searched to find eligible randomized controlled trials (RCTs) from 1966 to May 2014. When estimated the analysis indexes, the relative risk (RR) was used as the effect size of the categorical variable, while the weighted mean difference (MD) was used as the effect size of a continuous variable. Meta-analysis was conducted with Rev Man 5.2.

Results: Thirteen RCTs, involving 1034 patients, were included in the meta-analysis. The analysis showed that Gln enriched nutrition support was more effective in increasing serum albumin (MD: 0.10; 95% confidence interval [CI]: 0.02-0.18; P < 0.05), serum prealbumin (MD: 1.98; 95% CI: 1.40-2.55; P < 0.05) and serum transferring (MD: 0.35; 95% CI: 0.12-0.57; P < 0.05), concentration of IgG (MD: 1.26; 95% CI: 0.90-1.63; P < 0.05), IgM (MD: 0.18; 95% CI: 0.11-0.25; P < 0.05), IgA (MD: 0.22; 95% CI: 0.10-0.33; P < 0.05), CD3 + (MD: 3.71; 95% CI: 2.57-4.85; P < 0.05) and CD4/CD8 ratio (MD: 0.27; 95% CI: 0.12-0.42; P < 0.05). Meanwhile, it was more significant in decreasing the incidence of infectious complications (RR: 0.67; 95% CI: 0.50-0.90; P < 0.05) and shortening the length of hospital stay (MD: -1.72; 95% CI: -3.31--0.13; P < 0.05).

Conclusions: Glutamine enriched nutrition support was superior in improving immune function, reducing the incidence of infectious complications and shortening the length of hospital stay, playing an important role in the rehabilitation of surgical GI cancer patients.

Show MeSH
Related in: MedlinePlus