Abstract
Perioperative nutritional therapy requires the consideration of metabolic changes, and it is desirable to reduce stress aiming at early metabolic normalization. Glutathione (GSH) is a tripeptide composed of glutamic acid, cysteine, and glycine. It is one of the strongest antioxidants in the body and important for adjusting immune function. Cystine and theanine (γ-glutamylethylamide) provide substrates of GSH, cysteine and glutamic acid, promoting the synthesis of GSH. It has been reported that the ingestion of cystine (700 mg) and theanine (280 mg) exhibits inhibitory effects against excess inflammation after strong exercise loads in athletes, based on which its application for invasive surgery has been tried. In patients undergoing gastrectomy, ingestion of cystine (700 mg) and theanine (280 mg) for 10 days from 5 days before surgery inhibited a postoperative increase in resting energy expenditure, promoted recovery from changes in interleukin-6, C-reactive protein, lymphocyte ratio, and granulocyte ratio and inhibited an increase in body temperature. In a mouse small intestine manipulation model, preoperative 5-day administration of cystine/theanine inhibited a postoperative decrease in GSH in the small intestine and promoted recovery from a decrease in behavior quantity. Based on the above, cystine/theanine reduces surgical stress, being useful for perioperative management as stress-reducing amino acids.
Highlights
Stress and Biological ReactionWhen stress, such as surgery, infection, and burn, is loaded, the body exhibits a defense reaction and induces metabolic, immune, and endocrine changes
The usefulness of early initiation of enteral nutrition in the perioperative period for nutrition management is widely recognized as described above, but similar stress-reducing effects of the orally ingested amino acids, cystine and theanine, which induce an increase in GSH, have been reported [19,20]
Shibakusa et al laparotomized mice under anesthesia and prepared a simple laparotomy group in which the abdomen was closed after laparotomy without manipulation, and a small intestine manipulation model in which the small intestine was pulled out of the wound and abrasion with a cotton swab was applied twice to the entire small intestine, and the wound was closed
Summary
When stress, such as surgery, infection, and burn, is loaded, the body exhibits a defense reaction and induces metabolic, immune, and endocrine changes. The changes in parameters monitored in routine clinical practice include fever, C-reactive protein (CRP) increase, peripheral blood leukocytosis, lymphocytopenia, and a decrease in urine volume. These inflammatory reactions become strong as stress increases and the time to recovery extends with it. Trogen balance is calculated fromnegative the nitrogen dose and nitrogen excretion, theAfter value nutrition management, including protein and amino acid administration, the balance subbecomes negative due to catabolic promotion under stress. Regarding nutrition including protein and amino acid administration, the balance subsequently turns positive management, protein anabolic are absorbed and as the course nutrients enters theadministered turning pointafter [8,9].the.
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