The clinical effects of early administration of a modular formula containing glutamine trophic dosing in cachectic hospitalized patients

Aims: The study evaluated the safety and efficacy of early administration of a modular formula containing glutamine trophic dosing in hospital settings for up to 28 days, or until death or unexpected discharge. The objective is to quantify efficacy and safety feasibility outcomes, selecting appropriate cachectic patients and making pragmatic choices regarding nutrition formulation and study course.

Methods: A retrospective study was conducted at the King Hussein Medical Center in Amman, Jordan, focusing on a mixed population with malnutrition, including aliptia, cachexia, and loss of muscle mass/sarcopenia due to bed-rest and/or underlying chronic disease. Patients aged 50 years and above were chosen for the study, as age-related differences in complication risks can be observed in both surgical intervention and malnutrition recovery. Participants were informed about the study and asked to consume the same formula in powder form, mixed in 150ml of water, twice a day, between breakfast and lunch, and between lunch and supper for at least two weeks. The study administered modules in the form of liquid shakes, following the manufacturer's recommendation for "trophic" dosing: 5 doses/day, 50 ml/dose for five consecutive days. The intervention involved the early administration of a modular formula with glutamine trophic dosing within 72 hours after admission in the hospital for hospitalized patients. The rationale for using trophic dosed modular formula containing glutamine in this clinical situation is that early addition of glutamine to enteral feeding in critically ill patients is beneficial for gut and patient as a whole.

Results: The study aimed to investigate the effectiveness of early administration of a modular formula containing glutamine trophic dosing in cachectic hospitalised patients. 82 patients with involuntary weight loss within the past six months and at least two criteria of cachexia-syndrome were grouped into the intervention group (n=12, cumulative intake of 18g of the ready-to-use formula rich in proteins, polyunsaturated fatty acids, balanced among omega-3/omega-6, zinc, and antioxidant vitamins) versus 11 patients receiving standard hospitality care. Supplements were administered within the first 48 hours after admission. After 1 week of admission, the intervention group showed a small gain in weight and muscle-mass quantity, but body weight and muscle mass deteriorated significantly after 4 weeks. The intervention group also had a lower number of blood transfusions, indicating a positive effect on nutritional parameters in hospitalised patients with clinically imminent cachexia.

Conclusion: Research shows that trophic feeding and arginine supplements improve gastrointestinal motility, but no significant changes in morphine administration rates. A specialized formula enriched with glutamine can improve clinical outcomes and alleviate cachexia in patients with acute and chronic stress, including cancer patients.