Evaluation of Combined Glutamine and Lactobacillus reuteri Supplementation in Patients with Colorectal Cancer: A Parallel-Group Clinical Trial
Keywords:
colorectal neoplasia; antineoplastic treatment; diarrhea.Abstract
Introduction: In Mexico, 74,685 cancer deaths were reported in 2010, 5.4% from colon cancer, and the number of deaths from malignant tumors rose to 89,574 in 2022. Chemotherapy is a systemic treatment that often presents adverse gastrointestinal effects, dependent on the medication, dose, and nutritional status of the patient. Glutamine is a conditionally essential amino acid for intestinal and immune health, and, in conjunction with the administration of Limosilactobacillus reuteri, it has been shown to be effective in reducing diarrhea.
Objective: To evaluate the effect of glutamine and Limosilactobacillus reuteri supplementation on albumin and lymphocyte levels, and the presence of diarrhea in patients with colorectal cancer undergoing chemotherapy.
Methods: A pilot clinical study was conducted. Patients diagnosed with colon cancer undergoing treatment with capecitabine (n = 50) were randomly assigned to two groups: a) an intervention group (n = 21), supplemented with 30 g of glutamine and 300 million units of Limosilactobacillus reuteri, and b) a control group (n = 29) without supplementation. The effect on albumin and lymphocyte levels and the presence of diarrhea was analyzed after 4 weeks.
Results: When analyzing the presence of diarrhea, there were no differences between the two groups at baseline, and after the intervention, the supplemented group showed significant improvement (p < 0.05).
Conclusions: Treatment with glutamine and Limosilactobacillus reuteri reduces the incidence of diarrhea, thus helping the patient continue antineoplastic treatment.
Downloads
References
1. Zuno SE, Karam D, Sandoval F, Madrazo M. Guía de Práctica Clínica Detección Oportuna y Diagnóstico de Cáncer de Colon y Recto no Hereditario en Adultos en Primero, Segundo y Tercer Nivel de Atención. Instituto Mexicano del Seguro Social 2010.
2. Aldaco-Sarvide F, Pérez-Pérez P, Cervantes-Sánchez G, Torrecillas-Torres L, Erazo-V AE. Mortalidad por cáncer en México 2000-2010: el recuento de los daños. GAMO. 2012 [acceso 12/06/2024];11:371-9. Disponible en: https://biblat.unam.mx/hevila/Gacetamexicanadeoncologia/2012/vol11/no6/5.pdf
3. Kuipers EJ, Grady WM, Lieberman D, Seufferlein T, Sung JJ, Boelens PG, et al. COLORECTAL CANCER. Nat Rev Dis Primers. 2015;1:15065. DOI: https://doi.org/10.1038/nrdp.2015.65.
4. Kasprzak A. The Role of Tumor Microenvironment Cells in Colorectal Cancer (CRC) Cachexia. Int J Mol Sci. 2021;22:1565. DOI: https://doi.org/10.3390/ijms22041565
5. Candela CG, Peña GM, Cos Blanco AI, Iglesias Rosado C, Castillo Rabaneda R. Evaluación del estado nutricional en el paciente oncológico. Sociedad Española de Oncología Médica. España. p.14. [acceso 12/06/2024].
Disponible en: https://www.seom.org/seomcms/images/stories/recursos/infopublico/publicaciones/soporteNutricional/pdf/cap_04.pdf
6. Calzas Rodríguez J, De La Nogal Fernández B, Arrieta Garmendia JM, Lastra Aras E, García Castaño A, Barrio Gil-Fournier A, et al. Capecitabina: un quimioterápico oral en la lucha contra el cáncer de mama y colorrectal metastásico. Farm Hosp. 2003 [acceso 12/06/2024];27:171-8. Disponible en: https://www.revistafarmaciahospitalaria.es//es-capecitabina-un-quimioterapico-oral-lucha-articulo-13118786
7. Kim JH. Chemotherapy for colorectal cancer in the elderly. World J Gastroenterol. 2015;21:5158-66. DOI: https://doi.org/10.3748/wjg.v21.i17.5158
8. Zheng J, Wittouck S, Salvetti E, Franz CMAP, Harris HMB, Mattarelli P, et al. A taxonomic note on the genus Lactobacillus: Description of 23 novel genera, emended description of the genus Lactobacillus Beijerinck 1901, and union of Lactobacillaceae and Leuconostocaceae. International Journal of Systematic and Evolutionary Microbiology. 2020;70:2782-858. DOI: https://doi.org/10.1099/ijsem.0.004107
9. Kim H. Glutamine as an Immunonutrient. Yonsei Med J. 2011;52:892-7. DOI: https://doi.org/10.3349/ymj.2011.52.6.892
10. Alonso Pérez L, Fernández Vázquez A, Valero Zanuy MA, Gomis Muñoz P, León Sanz M, Herreros de Tejada A. Parenteral nutrition supplemented with glutamine in patients undergoing bone marrow transplantation. Nutr Hosp 2010 [acceso 12/06/2024];25(1):49-52. Disponible en: https://pubmed.ncbi.nlm.nih.gov/20204255/
11. Cruzat V, Macedo Rogero M, Noel Keane K, Curi R, Newsholme P. Glutamine: Metabolism and Immune Function, Supplementation and Clinical Translation. Nutrients. 2018;10:1564. DOI: https://doi.org/10.3390/nu10111564
12. Fox AD, Kripke SA, De Paula J, Berman JM, Settle RG, Rombeau JL. Effect of a glutamine-supplemented enteral diet on methotrexate-induced enterocolitis. JPEN J Parenter Enteral Nutr. 1988;12:325-31. DOI: https://doi.org/10.1177/0148607188012004325
13. Anderson PM, Lalla RV. Glutamine for Amelioration of Radiation and Chemotherapy Associated Mucositis during Cancer Therapy. Nutrients. 2020;12:1675. DOI: https://doi.org/10.3390/nu12061675
14. Elad S, Cheng KKF, Lalla RV, Yarom N, Hong C, Logan RM, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126:4423-31. DOI: https://doi.org/10.1002/cncr.33100
15. Jolfaie NR, Mirzaie S, Ghiasvand R, Askari G, Miraghajani M. The effect of glutamine intake on complications of colorectal and colon cancer treatment: A systematic review. J Res Med Sci. 2015;20:910-8. DOI: https://doi.org/10.4103/1735-1995.170634
16. Urbańska M, Gieruszczak-Białek D, Szajewska H. Systematic review with meta-analysis: Lactobacillus reuteri DSM 17938 for diarrhoeal diseases in children. Alimentary Pharmacology & Therapeutics. 2016;43:1025-34. DOI: https://doi.org/10.1111/apt.13590
17. Dinleyici EC, Dalgic N, Guven S, Metin O, Yasa O, Kurugol Z, et al. Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting. Jornal de Pediatria. 2015;91:392-6. DOI: https://doi.org/10.1016/j.jped.2014.10.009
18. Gutierrez-Castrellon P, Lopez-Velazquez G, Diaz-Garcia L, Jimenez-Gutierrez C, Mancilla-Ramirez J, Estevez-Jimenez J, et al. Diarrhea in Preschool Children and Lactobacillus reuteri: A Randomized Controlled Trial. Pediatrics. 2014;133:e904-9. DOI: https://doi.org/10.1542/peds.2013-0652
19. Cimperman L, Bayless G, Best K, Diligente A, Mordarski B, Oster M, et al. A Randomized, Double-blind, Placebo-controlled Pilot Study of Lactobacillus reuteri ATCC 55730 for the Prevention of Antibiotic-associated Diarrhea in Hospitalized Adults. Journal of Clinical Gastroenterology. 2011;45:785. DOI: https://doi.org/10.1097/MCG.0b013e3182166a42
20. Yu T, Guo F, Yu Y, Sun T, Ma D, Han J, et al. Fusobacterium nucleatum Promotes Chemoresistance to Colorectal Cancer by Modulating Autophagy. Cell 2017;170:548-563.e16. DOI: https://doi.org/10.1016/j.cell.2017.07.008
21. World Medical Assocition Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310(20):1-95. DOI: https://doi.org/10.1001/jama.2013.281053
22. Savarese D, Al-Zoubi A, Boucher J. Glutamine for Irinotecan Diarrhea. JCO 2000;18:450. DOI: https://doi.org/10.1200/JCO.2000.18.2.450
23. Thomsen M, Vitetta L. Adjunctive Treatments for the Prevention of Chemotherapy- and Radiotherapy-Induced Mucositis. Integrative Cancer Therapies. 2018 [acceso 12/06/2024];17(4):1027-47. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC6247548/
24. Yoshida S, Matsui M, Shirouzu Y, Fujita H, Yamana H, Shirouzu K. Effects of glutamine supplements and radiochemotherapy on systemic immune and gut barrier function in patients with advanced esophageal cancer. Annals of Surgery. 1998;227:485. DOI: https://doi.org/10.1097/00000658-199804000-00006
25. Lamichhane P, Maiolini M, Alnafoosi O, Hussein S, Alnafoosi H, Umbela S, et al. Colorectal Cancer and Probiotics: Are Bugs Really Drugs? Cancers. 2020;12. DOI: https://doi.org/10.3390/cancers12051162
26. Peng Y, Ma Y, Luo Z, Jiang Y, Xu Z, Yu R. Lactobacillus reuteri in digestive system diseases: focus on clinical trials and mechanisms. Frontiers in Cellular and Infection Microbiology. 2023;13. DOI: https://doi.org/10.3389/fcimb.2023.1254198
27. Yu A-Q, Li L. The Potential Role of Probiotics in Cancer Prevention and Treatment. Nutrition and Cancer. 2016;68:535-44. DOI: https://doi.org/10.1080/01635581.2016.1158300
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Diana Yolanda Reyes Barretero, Emigdio Jaimes Alpízar, Yazmin Lizeth Beltrán Chaides, Imelda García Argueta, Carmen Juárez González, Paola Mariana Medina Cárdenas, Arturo González Santana
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The Cuban Journal of Medicine protects the author's patrimonial rights. However, it is licensed under a Creative Commons Licensehttps://creativecommons.org/licenses/by-nc/4.0/deed.es_ES which permits unrestricted non-commercial use, distribution and reproduction in any medium, provided that the primary source of publication is duly cited. The author always retains his moral rights.
You are free to:
- Share - copy and redistribute the material in any medium or format.
- Adapt - remix, transform and build upon the material
- The license cannot revoke these freedoms as long as you follow the terms of the license.
Under the following terms:
- Attribution - You must give proper credit, provide a link to the license, and indicate if changes have been made. You may do so in any reasonable manner, but not in such a way as to suggest that you or your use is supported by the licensor.
- Non-Commercial Purpose- You may not make use of the material for commercial purposes.
- No Additional Restrictions - You may not apply legal terms or technological measures that legally restrict others from making any use permitted by the license.
