Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters

Günerhan, Yusuf; Köksal, Neşet; Sahin, Umit Yasar; Uzun, Mehmet; Ekşioğlu-Demiralp, Emel

doi:10.3748/wjg.15.467

Cited by 66 publications

(83 citation statements)

References 28 publications

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“…to bring about a decrease in T-lymphocytes and natural killer cells (2) . The result of this suppression is an increased risk of infection.…”

Section: Proceedings Of the Nutrition Societymentioning

confidence: 99%

Pre-operative nutrition and carbohydrate loading

Kratzing

2011

Proc. Nutr. Soc.

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An optimal nutritional state is an important consideration in providing successful operative outcomes. Unfortunately, many aspects of surgery are not constructive to providing this. In addition, the metabolic and immune response to injury induces a catabolic state and insulin resistance, a known risk factor of post-operative complications. Aggressive insulin therapy post-operatively has been shown to reduce morbidity and mortality but similar results can be achieved when insulin resistance is lessened by the use of pre-operative carbohydrate loading. Consuming carbohydrate-containing drinks up to 2 h before surgery has been found to be an effective way to attenuate insulin resistance, minimise protein losses, reduce hospital stays and improve patient comfort without adversely affecting gastric emptying. Enhanced recovery programmes have employed carbohydrate loading as one of several strategies aimed at reducing post-operative stress and improving the recovery process. Studies examining the benefits of these programmes have demonstrated significantly shorter post-operative hospital stays, faster return to normal functions and lower occurrences of surgical complications. As a consequence of the favourable evidence they are now being implemented in many surgical units. Further benefit to post-operative recovery may be found with the use of immune-enhancing diets, i.e. supplementation with n-3 fatty acids, arginine, glutamine and/or nucleotides. These have the potential to boost the immune system, improve wound healing and reduce inflammatory markers. Research exploring the benefits of immunonutrition and solidifying the use of carbohydrate loading is ongoing; however, there is strong evidence to link good pre-operative nutrition and improved surgical outcomes.Pre-operative nutrition: Carbohydrate loading: Immunonutrition

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“…to bring about a decrease in T-lymphocytes and natural killer cells (2) . The result of this suppression is an increased risk of infection.…”

Section: Proceedings Of the Nutrition Societymentioning

confidence: 99%

Pre-operative nutrition and carbohydrate loading

Kratzing

2011

Proc. Nutr. Soc.

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“…13,[21][22][23][24][25][26][27][28][29] In the present study, we enrolled all patients at nutritional risk who were identified by using the NRS, and no restriction on the type of operation was made, as this patient group is likely to benefit most from nutritional interventions. [6][7][8] So far, no randomized trial on IN has used the NRS before.…”

Section: Discussionmentioning

confidence: 99%

Preoperative immunonutrition in patients at nutritional risk: results of a double-blinded randomized clinical trial

et al. 2012

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BACKGROUND/OBJECTIVES:To evaluate the impact of preoperative immunonutrition (IN) on postoperative morbidity in patients at risk of malnutrition undergoing major gastrointestinal (GI) surgery. SUBJECTS/METHODS: The combination of malnutrition and major GI surgery entails high morbidity. The Nutritional Risk Score (NRS) reliably identifies patients who need preoperative nutrition; the optimal nutritional formula for these patients still needs to be defined. In all, 152 patients with a NRSX3 and undergoing elective major GI surgery were randomized between IN or isocaloricisonitrogenous nutrition (ICN) given for 5 days preoperatively. Patients and caregivers were blinded for the allocated intervention. Thirty days complication rate was the primary endpoint. Infections, length of hospital stay and compliance were considered as secondary outcomes. RESULTS: Overall, 145 patients were available for analysis; the 73 patients in the IN group matched well with the 72 ICN patients with regards to patient's and surgical characteristics. In all, 39 IN and 33 ICN patients experienced a total of 48 and 50 postoperative complications, respectively (P ¼ 0.723). Both groups did not differ significantly concerning infectious (13 vs 9) complications. Independent risk factors for overall complications were malignant disease (odds ratio (OR) ¼ 4.304; confidence interval (CI) 1.317-14.002) and operative time (OR ¼ 1.004; CI 1.000-1.008). CONCLUSION: In patients at nutritional risk, complications, infections and hospital stay after major GI surgery were comparable regardless of preoperative supplementation with IN or ICN.

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“…Deficiency of protein greater than 20% due to a negative impact on the structure and function of the respiratory muscles and lung parenchyma leads to a reduction in weight and respiratory muscle strength, reduces neuronal respiratory drive, and causes abnormal ventilation, prolonged respiratory therapy and increased risk of infection. Malnutrition through a range of mechanisms leads to weakening of the immune defense of the body: it causes atrophy of lymph nodes, inhibits the maturation and differentiation of lymphocytes, reduces the secretion of IgA, and suppresses the cellular response [13]. Very important is the local effect of nutrition in the gastrointestinal tract and its impact on the body's defense mechanisms.…”

Section: Malnutritionmentioning

confidence: 99%

“…Loss of 10% of ideal body weight within 3-4 months leads to changes in function of the immune system. It is described that among patients with diagnosed cancer of the gastrointestinal tract 90% were malnourished [13,15]. Energy requirement is estimated based on anthropometric data: age, sex, weight, height, and markers of the metabolic consumption of O 2 and generation of CO 2 .…”

Section: Malnutritionmentioning

confidence: 99%

“…Assessment of the impact of such nutritional therapy for differentiation of immune cells revealed reduced incidence of complications, which was associated with increased differentiation, maturation and restoration of particular lymphocyte subsets: Th1, Th2, Th17 [36]. Sorensen and colleagues have studied the effects of perioperative nutritional immunotherapy in the course of head and neck cancer and reported favorable changes: inhibition of immunosuppression, the count of lymphocyte subpopulations, markers of inflammation and nutritional status -concentrations of C-reactive protein, albumin, prealbumin and postoperative course [13,35]. Słotwiński et al found that enteral nutrition mixtures enriched with immunoactive components limited severity of traumatic stress, stimulated anti-inflammatory cytokine synthesis and by affecting interleukin-1 receptor antagonist (IL-1RA) reduced the biological activity of IL-1.…”

Section: Use Of Immunonutritionmentioning

confidence: 99%

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