Immunoenhanced enteral nutrition, effect on inflammatory markers in head and neck cancer patients

Abstract

The aim of our study was to evaluate the effect of enteral nutrition supplemented with arginine in inflammatory markers in surgical head and neck cancer patients. A population of 29 patients with oral and laryngeal cancer were enrolled in a randomized trial. At surgery patients were randomly allocated to two groups: (a) patients receiving an enteral diet supplements with arginine (group I, n ¼ 14); (b) patients receiving an isocaloric, isonitrogenous enteral formula (group II, n ¼ 15). The mean age was 61.1710.8 y (five females/24 males). Characteristics of the patients on enrollment were similar for the two groups. Prealbumin and transferrin improved in both groups. c-reactive protein (CRP) levels decreased in both groups, (group I: 134.5762.5 vs 75.3751 mg/dl:Po0.05) and (group II: 103.6762 vs 43.8734.4 mg/dl:Po0.05). Interleukin-6 (IL-6) improved in both groups (group I: 20.35711.2 vs 6.773.1 pg/ml:Po0.05) and (group II:22.8740 vs 9.9717.7 pg/ml:ns). Tumoral necrosis factor alpha and lymphocytes did not change. In conclusion, both formulas improved IL-6 and CRP levels. Further studies are needed to determine whether type of formula is the key in these patients or genetic background play a main role in inflammatory response.

Temporal nutritional and inflammatory changes in children with severe head injury fed a regular or an immune-enhancing diet: A randomized, controlled trial

“…This finding is in accordance to results of another study showing that IL-6 and IL-1RII were higher in the control group than in the IE group (31). In adult postsurgery patients, however, enhanced formula did not change IL6 and TNF-␣ levels (32). Similarly, low-fat feeding, with or without fish oil, did not change the early production of IL-6 after burn injury (33).…”

“…In a recent study, it was shown that an enteral formula containing glutamine and probiotics decreased the infection rate and shortened the stay in the intensive care unit of patients with brain injury (38). In another study, also in patients with severe trauma who were fed IE formula, no significant difference was found for mortality and hospital stay (32). The only two well-controlled trials (39,40) also had radically different outcomes, one positive and the other negative, for reductions in infectious complications.…”

Perioperative arginine-supplemented nutrition in malnourished patients with head and neck cancer improves long-term survival

“…Therefore, immunotherapy could be of great value to restrict this mechanism, which could be accomplished by arginase blocking therapy or arginine administration and thereby improve arginine balance (10,35). However, no significant difference in the inflammatory response (lymphocytes, tumor necrosis factor-a, interleukin-6, and C-reactive protein concentrations) was observed in patients with head and neck cancer between an arginine-supplemented group and a control group (36).…”

Perioperative Immunonutrition in Well-Nourished Patients Undergoing Surgery for Head and Neck Cancer: Evaluation of Inflammatory and Immunologic Outcomes

“…Post-surgery enteral nutrition enriched with arginine has been used in most studies [21,22,23,24,25,26] on the basis of its role in wound healing and immune function [27,28] and has been shown to confer beneficial immune effects when provided postoperatively to patients undergoing major surgery for cancer [29]. In head and neck surgery patients the potential beneficial effects of arginine administration on inflammatory and immune markers assessed from POD5 and beyond was not generally evident [21,22,23,24] except in one study [26] that showed improved lymphocyte counts and CD4/CD8 ratios on PODs 4 and 8 in the arginine group compared to control patients. Reduced wound complications [21,23] and postoperative length of stay [23] were reported with arginine administration.…”