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AIM To investigate the individual and thecombined effects of glutamine, dietary fiber,and growth hormone on the structural adaptationof the remnant small bowel.METHODS Forty-two adult male Sprague-Dawley rats underwent 85% mid-small bowelresection and received total parenteral nutrition(TPN) support during the first threepostoperational days. From the 4thpostoperational day, animals were randomlyassigned to receive 7 different treatments for 8days: TPNcon group, receiving TPN and enteral20g·L~1 glycine perfusion; TPN + Gin group,receiving TPN and enteral 20 g·L~1 glutamineperfusion; ENcon group, receiving enteralnutrition (EN) fortified with 20 g·L~1 glycine; EN+ Gin group, enteral nutrition fortified with20g·L~1 glutamine; EN + Fib group, enteralnutrition and 2 g·d~1 oral soybean fiber; EN+GHgroup, enteral nutrition and subcutaneousgrowth hormone (GH) (0. 3IU) injection twicedaily; and ENint group, glutamine-enriched EN,oral soybean fiber, and subcutaneous GHinjection.RESULTS Enteral glutamine perfusion duringTPN increased the small intestinal villus height(jejunal villus height 250μm + 29μm in TPNcon vs 330μm±54μm in TPN+Gln, ileal villus height260μm±28μm in TPNcon vs 330μm±22μm inTPN + Gln, P<0.05) and mucosa thickness(jejunal mucosa thickness 360μm ± 32μm inTPNcon vs 460μm±65μm in TPN + Gln, ilealmucosa thickness 400μm ± 25μm in TPNcon vs490μm ± 11μm in TPN + Gin, P<0.05) incomparison with the TPNcon group. Either fibersupplementation or GH administration improvedbody mass gain (end body weight 270 g ± 3.6 g inEN+Fib, 265.7 g ± 3.3 g in EN+GH, vs 257g±3.3g in ENcon, P<0.05), elevated plasmainsulin-like growth factor (IGF-I) level(880μg·L~1±52μg.L~(-1) in EN+Fib, 1200μg·L(-1)+ 96μg·L~(-1) in EN + GH, vs 620μg·L~(-1) ±43μg·L~1 in ENcon, P<0.05), and increased thevillus height (jejunum 560μm ± 44μm in EN ± Fib,530μm ± 30μm in EN±GH, vs 450μm±44μm inENcon, ileum 400μm ± 30μm in EN + Fib, 380μm±49μm in EN ± GH, vs 320μm ± 16μm in ENcon,P<0.05) and the mucosa thickness (jejunum740μm ± 66μm in EN ± Fib, 705μm ± 27 μm in EN ±GH, vs 608μm ± 58μm in ENcon, ileum 570μm ±27μm in EN ± Fib, 560μm ± 56μm in EN ± GH, vs480μm ± 40μm in ENcon, P<0.05) in remnantjejunum and ileum. Glutamine-enriched ENproduced little effect in body mass, plasma IGF-I level, and remnant small bowel mucosalstructure. The ENint group had greater bodymass (280g ± 2.2 g), plasma IGF-1 level(1450μg.L~1 ± 137μg.L~1), and villus height(jejunum 620μm ± 56μm, ileum 450μm ± 31μm)and mucosal thickness (jejunum 800μm ± 52μm,ileum 633μm ± 33μm) than those in ENcon, EN +Gln (jejunum villus height and mucosa thickness450μm ± 47μm and 610μm ± 63μm, ileum villusheight and mucosa thickness 330μm ± 39μm and500μm±52μm), EN + GH groups (P<0.05), andthan those in EN + Fib group although nostatistical significance was attained.CONCLUSION Both dietary fiber and GH whenused separately can enhance the postresectionalsmall bowel structural adaptation. Simultaneoususe of these two gut-trophic factors can producesynergistic effects on small bowel structuraladaptation. Enteral glutamine perfusion isbeneficial in preserving small bowel mucosalstructure during TPN, but has little beneficialeffect during EN.
AIM To investigate the individual and the combined effects of glutamine, dietary fiber, and growth hormone on the structural adaptation of the remnant small bowel. METHODS Forty-two adult male Sprague-Dawley rats underwent 85% mid-small bowel rection and received total parenteral nutrition From the 4th posttoperational day, animals were randomly assigned to receive 7 different treatments for 8 days: TPNcon group, receiving TPN and enteral 20g · L ~ 1 glycine perfusion; TPN + Gin group, receiving TPN and enteral 20 g · En ~ l glutamine infusion; ENcon group, receiving enteralnutrition (EN) fortified with 20 g · L ~ 1 glycine; EN + Gin group, enteral nutrition fortified with 20g · L ~ 1 glutamine; EN + Fib group, enteralnutrition and 2 g · d ~ 1 oral soybean fiber; EN + GHgroup, enteral nutrition and subcutaneousgrowth hormone (GH) (0.3IU) injection twicedaily; and ENint group, glutamine-enriched EN, oral soybean fiber, and subcutaneous GHjectionjection .RESULTS Ent eral glutamine perfusion duringTPN increased the small intestinal villus height (jejunal villus height 250 μm + 29 μm in TPNcon vs 330 μm ± 54 μm in TPN + Gln, ileal villus height 260 μm ± 28 μm in TPNcon vs 330 μm ± 22 μm inTPN + GIn, mucosa thickness (jejunal mucosa thickness 360 μm ± 32 μm in TPNcon versus 460 μm ± 65 μm in TPN + Gln, ileal mucosa thickness 400 μm ± 25 μm in TPNcon vs 490 μm ± 11 μm in TPN + Gin, P <0.05) compared with the TPNcon group. Either fibersupplementation or GH administration improvedbody mass gain (body weight 270 g ± 3.6 g inEN + Fib, 265.7 g ± 3.3 g in EN + GH, 257 g ± 3.3 g in ENcon, P <0.05), elevated plasmainsulin-like growth factor (IGF- · L ~ 1 ± 52μg.L -1 in EN + Fib, 1200μg · L -1 + 96μg · L -1 in + GH + vs 620μg · L -1 ± 43μg ENJFG, 530μm ± 30μm in EN ± GH, vs 450μm ± 44μm inENcon, ileum 400μm ± 30μm in EN + Fib, 380μm ± 49μm in EN GH, vs 320μm ± 16μm in ENcon, P <0.05) and the mucosa thickneEN (jejunum 740 μm ± 66 μm in EN ± Fib, 705 μm ± 27 μm in EN ± GH, vs 608 μm ± 58 μm in ENcon, Ileum 570 μm ± 27 μm in EN ± Fib, <0.05) in remnantjejunum and ileum. Glutamine-enriched ENproduced little effect in body mass, plasma IGF-I level, and remnant small bowel mucosalstructure. The ENint group had greater bodymass (280g ± 2.2g), plasma IGF- .L ~ 1 ± 137 μg.L ~ 1), and villus height (jejunum 620 μm ± 56 μm, ileum 450 μm ± 31 μm) and mucosal thickness (jejunum 800 μm ± 52 μm, ileum 633 μm ± 33 μm) than those in ENcon, EN + Gln villus height and mucosa thickness 450 μm ± 47 μm and 610 μm ± 63 μm, ileum villusheight and mucosa thickness 330 μm ± 39 μm and 500 μm ± 52 μm), EN + GH groups (P <0.05), and those in EN + Fib group both nostatistical significance was attained. dietary fiber and GH when used separately can enhance the postresectionalsmall bowel structural adaptation. Sim ultaneoususe of these two gut-trophic factors can produce beneficial effects on small bowel structuraladaptation. Enteral glutamine perfusion is beneficial in preserving small bowel mucosalstructure during TPN, but has little beneficialeffect during EN.