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Brazilian journal of veterinary medicine2026; 48; e005725; doi: 10.29374/2527-2179.bjvm005725

Effects of total parenteral nutrition and electrolyte solutions with or without glutamine on the hormonal profiles of horses subjected to exploratory laparotomy.

Abstract: Starvation and nutritional support clinically influence horses, particularly during the treatment of gastrointestinal diseases and post-surgical recovery. In this study, we aimed to evaluate the effects of different nutritional strategies on the endocrine response of horses subjected to exploratory laparotomy followed by food deprivation. Sixteen healthy adult horses were randomly allocated into four groups (n=4) based on treatments: enteral fluid therapy without (ENTFL) or with glutamine (ENTGL), and parenteral fluid therapy with glucose (PARFL) or total parenteral nutrition with glutamine (PARGL). Treatments were administered for 144 hours of starvation followed by 144 hours of refeeding. Blood samples were collected at five time points for hormonal (leptin, ghrelin, adiponectin, cortisol, insulin, free T3, and free T4) analyses. Serum insulin and glucose significantly varied across all groups, with the PARGL group exhibiting hyperinsulinemia and persistent hyperglycemia during starvation. No significant alterations in free T3 or T4 concentrations were observed, which is potentially attributed to elevated serum glucose levels maintaining thyroid hormone stability. Notably, cortisol levels increased in the ENTGL group 72 hours after the onset of starvation. Ghrelin significantly increased only in the PARGL group during starvation, and it decreased after refeeding. Adiponectin levels were enhanced in the PARFL group during deprivation, which dropped after refeeding. Starvation reduced leptin levels in the ENTGL and PARGL groups, which were increased after refeeding. Despite hormonal changes, enteral nutrition maintained glycemic control, indicating stable intestinal absorptive function. These findings highlight the influence of nutritional route and composition, especially glutamine and glucose, on endocrine adaptation during starvation and refeeding. However, limitations such as the small sample size and absence of an absolute fasting group constrain the interpretations. Future studies involving broader hormonal panels and longer follow-up can better clarify neuroendocrine regulation during nutritional stress in horses.
Publication Date: 2026-01-14 PubMed ID: 41550891PubMed Central: PMC12807115DOI: 10.29374/2527-2179.bjvm005725Google Scholar: Lookup
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  • Journal Article

Summary

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Researchers tested how giving fluids and nutrients by different routes (enteral vs parenteral) and compositions (with or without glutamine) affects hormones in horses after exploratory abdominal surgery during six days without feed and six days of refeeding. Total parenteral nutrition with glutamine drove high insulin and glucose and distinct appetite/adipose hormone shifts, whereas enteral support maintained better glycemic control.

What the study asked and why it matters

  • Question: How do route and composition of nutritional support during postoperative starvation and subsequent refeeding alter endocrine regulation (insulin, glucose, leptin, ghrelin, adiponectin, cortisol, thyroid hormones) in horses?
  • Clinical relevance: Horses with gastrointestinal disease often undergo periods of anorexia and receive enteral or parenteral support; understanding endocrine effects can guide safer nutrition plans that avoid hyperglycemia, dysregulated appetite, and impaired recovery.

How the study was done

  • Animals: Sixteen healthy adult horses after exploratory laparotomy.
  • Design: Randomized into four groups (n=4 each), starved 144 hours (6 days) with assigned support, then refed 144 hours.
  • Treatments:
    • ENTFL: Enteral electrolyte/fluid therapy without glutamine.
    • ENTGL: Enteral electrolyte/fluid therapy with glutamine.
    • PARFL: Parenteral fluid therapy with glucose (not full TPN).
    • PARGL: Total parenteral nutrition including glutamine.
  • Measures: Blood at five time points for leptin, ghrelin, adiponectin, cortisol, insulin, free T3 (fT3), free T4 (fT4), and glucose.
  • Phases: Starvation phase on assigned support, then refeeding phase to assess reversibility/overshoot of hormonal responses.

Key findings during starvation (0–144 hours)

  • Glucose and insulin:
    • All groups showed variability, but PARGL developed persistent hyperglycemia with hyperinsulinemia, indicating inadequate glycemic control on full TPN with glutamine.
    • Enteral groups maintained glycemic stability, suggesting intact intestinal absorptive function and better glucose homeostasis despite food deprivation.
  • Thyroid axis:
    • No significant changes in fT3 or fT4 in any group; authors suggest maintained serum glucose may have stabilized thyroid hormones despite starvation and surgery.
  • Cortisol:
    • Increased at 72 hours in ENTGL, implying a stress/HPA-axis signal temporally linked to enteral glutamine supplementation during fasting.
  • Ghrelin (orexigenic, fasting hormone):
    • Significantly rose only in PARGL during starvation, consistent with a strong central appetite signal when the gut is empty and nutrients are given intravenously, and potentially influenced by glutamine-containing TPN.
  • Adiponectin (insulin-sensitizing adipokine):
    • Increased in PARFL during deprivation, compatible with negative energy balance and relatively lower insulin/glucose exposure compared with PARGL.
  • Leptin (adiposity/satiety signal):
    • Decreased in ENTGL and PARGL during starvation, indicating an energy-deficit signal despite differing routes of support.

Key findings after refeeding (144–288 hours)

  • Ghrelin:
    • Declined after refeeding (notably in PARGL), consistent with nutrient availability and gastric/fuel signals suppressing appetite drive.
  • Adiponectin:
    • Dropped in PARFL with refeeding, aligning with increased insulin and positive energy balance.
  • Leptin:
    • Rebounded in ENTGL and PARGL, reflecting recovery from energy deficit and insulin-mediated adipocyte signaling during refeeding.
  • Glycemia:
    • Enteral groups continued to show better control, while prior hyperglycemia in PARGL underscores the need for careful transition strategies from TPN to oral intake.

Physiological interpretation and plausible mechanisms

  • Route matters:
    • Enteral delivery engages gut-derived signals (e.g., luminal nutrient sensing, motility, incretins) that aid glycemic control and may blunt fasting-driven hormone rises.
    • Parenteral delivery bypasses the gut, reducing incretin-mediated insulin modulation and altering appetite/adipose hormone dynamics.
  • Composition matters:
    • High glucose loads in TPN can exceed peripheral disposal, causing hyperglycemia and compensatory hyperinsulinemia, and potentially inducing insulin resistance during stress.
    • Glutamine may influence pancreatic insulin secretion and gut–brain hormones; in this study, the combination with TPN was associated with elevated insulin/glucose and a unique ghrelin rise.
  • Adipokines and energy status:
    • Adiponectin rose with relative energy deficit (PARFL) and fell with refeeding/insulinemia, a pattern consistent with its role in insulin sensitivity.
    • Leptin fell with starvation (ENTGL, PARGL) and increased after refeeding, signaling restoration of energy stores and insulin action.
  • Stress axis:
    • The transient cortisol increase in ENTGL may reflect postoperative stress modulated by enteral glutamine or timing of sampling; its specificity to one group suggests interactions beyond simple starvation.
  • Thyroid stability:
    • Unlike typical non-thyroidal illness patterns, fT3/fT4 remained stable; adequate glycemia and the controlled study population may have mitigated low-T3 responses seen in critical illness.

Clinical implications for postoperative and gastrointestinal cases in horses

  • Prefer enteral support when feasible:
    • Enteral fluid/electrolyte therapy (with or without glutamine) maintained glycemic control and avoided sustained hyperinsulinemia.
  • Use parenteral nutrition judiciously:
    • TPN with glutamine carried a risk of hyperglycemia and hyperinsulinemia; close glucose and insulin monitoring and rate adjustments are advisable.
  • Anticipate hormone-driven behavior and recovery:
    • Shifts in ghrelin and leptin may influence appetite return; managing route and composition could support earlier, safer refeeding.
  • Endocrine markers as guides:
    • Tracking glucose/insulin and select adipokines may help tailor nutritional strategies and minimize complications such as laminitis risk from hyperinsulinemia.

Strengths of the study

  • Randomized assignment to clearly defined nutrition strategies.
  • Controlled starvation and refeeding windows to observe dynamic endocrine responses.
  • Broad hormone panel covering metabolic, appetite, adipose, stress, and thyroid axes.

Limitations and potential confounders

  • Small sample size (n=4/group) limits power and precision; susceptible to Type I/II errors.
  • No absolute fasting/no-support control group to isolate the effects of fluids/nutrients versus starvation alone.
  • Route and composition were co-varied (e.g., TPN also included glutamine), making it hard to attribute effects to glutamine versus caloric load/route.
  • Limited time-point resolution (five samples) may miss peaks/troughs, especially for pulsatile hormones.
  • Lack of additional metabolic markers (e.g., GLP-1/GIP, glucagon, NEFA, ketones, IGF-1, acylated vs total ghrelin) and insulin sensitivity testing.
  • Outcomes were endocrine; clinical endpoints (ileus, wound healing, complications, appetite, time to full feeding) were not reported.

Priorities for future research

  • Include a true fasting control and match caloric/protein loads across routes to disentangle route from composition.
  • Expand endocrine and metabolic profiling: incretins, glucagon, catecholamines, NEFA, ketones, IGF-1, rT3, TSH, acylated ghrelin, inflammatory cytokines.
  • Assess insulin sensitivity directly (e.g., insulin tolerance or IVGTT) and energy expenditure.
  • Increase cohort size and extend follow-up beyond 6 days of refeeding to capture longer-term adaptations.
  • Link endocrine patterns to clinical outcomes (feed intake, gastrointestinal motility, postoperative complications, laminitis risk, length of hospitalization).
  • Test glutamine effects independently (enteral vs parenteral, with standardized non-glutamine macronutrient backgrounds).

Practical takeaways

  • When possible, prioritize enteral support after equine laparotomy to preserve glycemic stability.
  • If TPN is necessary, titrate glucose delivery and monitor glucose/insulin frequently to prevent hyperglycemia/hyperinsulinemia.
  • Expect leptin to fall and ghrelin to rise with deprivation; refeeding should normalize these signals—aberrant trends may flag nutritional mismatch or complications.
  • Stable fT3/fT4 in this context suggests routine thyroid adjustment may be unnecessary, but broader illness can still produce low-T3 patterns; interpret in clinical context.

Cite This Article

APA
Ferreira C, Palhares MS, de Melo UP, Leme FOP, Maranhão RPA, Garcia HC, Gheller VA. (2026). Effects of total parenteral nutrition and electrolyte solutions with or without glutamine on the hormonal profiles of horses subjected to exploratory laparotomy. Braz J Vet Med, 48, e005725. https://doi.org/10.29374/2527-2179.bjvm005725

Publication

ISSN: 2527-2179
NlmUniqueID: 9918435088106676
Country: Brazil
Language: English
Volume: 48
Pages: e005725
PII: e005725

Researcher Affiliations

Ferreira, Cintia
  • Centro Universitário Maurício de Nassau (Uninassau). Natal, RN, Brazil.
Palhares, Maristela Silveira
  • Programa de Pós-Graduação em Ciência Animal, Departamento Clínica e Cirurgia Veterinárias. Escola de Veterinária, Universidade Federal de Minas Gerais. Pampulha, MG. Brazil.
de Melo, Ubiratan Pereira
  • Centro Universitário Maurício de Nassau (Uninassau). Natal, RN, Brazil.
Leme, Fabíola de Oliveira Paes
  • Programa de Pós-Graduação em Ciência Animal, Departamento Clínica e Cirurgia Veterinárias. Escola de Veterinária, Universidade Federal de Minas Gerais. Pampulha, MG. Brazil.
Maranhão, Renata de Pino Albuquerque
  • Programa de Pós-Graduação em Ciência Animal, Departamento Clínica e Cirurgia Veterinárias. Escola de Veterinária, Universidade Federal de Minas Gerais. Pampulha, MG. Brazil.
Garcia, Hélio Chiarini
  • Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais. Pampulha, MG. Brazil.
Gheller, Valentim Arabicano
  • Programa de Pós-Graduação em Ciência Animal, Departamento Clínica e Cirurgia Veterinárias. Escola de Veterinária, Universidade Federal de Minas Gerais. Pampulha, MG. Brazil.

Conflict of Interest Statement

Conflict of interests: The authors declare no conflicts of interest in the preparation, execution, and dissemination of the results of this study.

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