Nutritional effects have traditionally focused on outcomes, such as nitrogen balance, wound healing, or muscle strength. Little emphasis has been placed on how biochemical or physical improvements ...translate into functional changes as perceived by the patient. Because glutamine (GLN)-supplemented nutrition promotes protein synthesis and improves nitrogen balance, we assessed the mood of individuals participating in a randomized controlled blinded trial receiving GLN solutions. Patients (n = 23) undergoing marrow transplantation were randomized by the research pharmacist to receive either standard total parenteral nutrition (TPN) (control) or GLN-containing TPN (40 g of glutamine total). The solutions were isocaloric and isonitrogenous and were administered until the patient was eating 50% of estimated requirements. Before TPN and on admission to the hospital, the patient completed the Profile of Mood States questionnaire, a standardized test quantifying the degree of tension, depression, anger, vigor, fatigue, and confusion. The patient completed the questionnaire again at the end of TPN near discharge. The tests were scored and the change from baseline for each mood for both groups of patients was calculated at the completion of TPN. The scores for vigor in the control group (Δ scores) decreased over the course of hospitalization as would be expected with a serious illness. The group receiving glutamine TPN, however, essentially showed little change in vigor from baseline and the Δ score was significantly different from the control group (Δ vigor score -0.85 ± 2.1 in the glutamine group vs -5.90 ± 1.7 in the control group; p = .07). The control group exhibited little change in feelings of anger over the course of hospitalization; however, the glutamine TPN group felt significantly less angry at the completion of TPN than the control group (Δ anger score -6.2 ± 1.6 in the glutamine group vs -0.5 ± 2.5 in the control group; p = .052). There was a trend for the total mood score (all six moods evaluated together) to exhibit improvement (p = 1). The GLN group also was discharged from the hospital sooner and had fewer infectious episodes. This is one of the first studies to illustrate an improvement in patients' psychosocial status associated with a nutrition intervention. GLN may influence patients' feelings of well-being either directly by affecting central nervous system neurotransmitters or through its effects on the protein status of patients. Psychosocial testing may prove useful in evaluating the functional status of patients receiving nutrition support. (Journal of Parenteral and Enteral Nutrition
17:422-427, 1993)
Subcutaneous (sq) administration of recombinant human growth hormone (r-hgh) has an anabolic effect and increases systemic insulin-like growth factor (IGF-I) in surgical patients. IGF-I is a mediator ...of growth hormone (gh) anabolic effects. To determine the effect of intravenous (iv) administration of r-hgh on systemic IGF-I, 11 patients were given 14 1-week courses of daily 8-hr infusions of r-hgh (10 mg in 500 ml D5W). Serum gh and IGF-I levels were measured. To compare routes of administration, iv r-hgh patients were matched to comparable sq r-hgh patients and IGF-I responses were examined. Illness severity effect on IGF-I response to r-hgh was assessed by dividing 16 burn patients who received either iv or sq r-hgh into two groups on the basis of severity scores. Analysis of the data showed that IGF-I levels increased significantly after iv r-hgh, IGF-I response to iv r-hgh (1.14 +/- 0.18 U/ml to 4.12 +/- 0.65 U/ml) was not different from IGF-I response to sq r-hgh (1.04 +/- 0.36 U/ml to 4.96 +/- 1.09 U/ml). Increasing illness severity attenuated the IGF-I response in the more severely injured group (0.91 +/- 17 U/ml to 2.40 +/- 0.38 U/ml) relative to the less severely injured group (1.37 +/- 0.22 U/ml to 5.53 +/- 0.78 U/ml) despite a significant increase in IGF-I after gh in both groups. In summary, IGF-I increased significantly after iv r-hgh and the increases were similar to those seen after sq r-hgh in comparable patients.
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