Journal of Nutritional Sciences and Dietetics 2016. 2(2):.

Effects of Arginine and Citrulline supplementation on inflammatory markers in critically ill patients
Bahareh Barkhidarian, Shirin seyedhamzeh, Seyed Issac Hashemy, Mohsen Nematy, Ashraf Rahbari, Roya Ranjbar, Mohammad Safarian


Background/Objective: Citrulline is a nonessential amino acid that is a main precursor of Arginine and therefore could be a best alternative for arginine supplementation. The current study aimed to assess the effects of Arginine and Citrulline administration on inflammatory factors (C-reactive protein (CRP), interlukine-6 (IL-6)) in critically ill trauma patients.

Method: A total of 102 patients in 5 traumas intensive care units (ICU) were divided into three groups: Arginine, Citrulline and Control. Patients received 10 g/d Arginine powder (Arginine Group) or 10 g/d Citrulline powder (Citrulline Group) for 10 days. Serum level of CRP, IL-6 were determined in all patients before (day 0) and after intervention (day 11) and their correlation with APACHE II as an indicator of severity of disease were assessed.

Results: There were significant reduction in IL6 levels only in Citrulline group (P=0.009). Moreover, serum levels of CRP decreased in both experimental group but it was elevated during study period in Control group (mean changes in control group were 0.28 ±19.66, in Citrulline group -11.16 ± 22.72 and in arginine group it was -1.12 ± 28.30) which was only significant in Citrulline group (P= 0.025). Results showed that APACHE II score were decreased in all three groups but there were no significant differences between groups after 10 days intervention (P=0.44).  Changes in APACHE II score had significant correlation with IL6 level (r=0.29, P=0.02).

Conclusion: Citrulline supplementation could have modulatory effects on inflammatory biomarkers.


critically ill Patients; Arginine; Citrulline; Inflammatory factors; Nutritional markers; APACHE II


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