Early postoperative enteral nutrition with arginine-omega-3 fatty acids and ribonucleic acid-supplemented diet versus placebo in cancer patients: an immunologic evaluation of Impact
Kemen M, Senkal M, Homann HH, Mumme A, Dauphin AK, Baier J, Windeler J, Neumann H, Zumtobel V
Critical care medicine · 132 citas
Etiquetas de revisión
Financiación no declaradaSolo mecanismosDatos neutrales que nuestra revisión registró sobre cómo se hizo este estudio. Describen el método, nunca si nos gusta el resultado.
Cómo se estudió
- Diseño
- Ensayo controlado aleatorizado (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Solo mecanismos
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 1995-04-01 · Crit Care Med · vol. 23 · número 4 · págs. 652–659
- Editorial
- Lippincott Williams & Wilkins
- Citado
- 211 citas · más que el 100% de estudios similares · 16.5× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 22 trabajos
- Acceso
- De pago
- Áreas de investigación
- Clinical Nutrition and Gastroenterology · Enhanced Recovery After Surgery · Infant Nutrition and Health
- Palabras clave
- early postoperative enteral nutrition, L-arginine, omega-3 fatty acids, T cell subsets, interferon-gamma, immunoglobulins, B cells, surgical trauma, jejunostomy, dietary supplementation, immunonutrition, surgical intensive care unit, postoperative complications, weight gain
- MeSH
- lymphocyte subsets, humans, gastrointestinal neoplasms, fatty acids, omega-3, arginine, immunoglobulin g, immunoglobulin m, rna, hla-dr antigens, lymphocyte count, enteral nutrition, postoperative care, prospective studies, double-blind method, lymphocyte activation, food, formulated, aged, intensive care units, female, male, interferon-gamma
9 autores
- Matthias Kemen🇩🇪St. Josef-Hospital; Ruhr University Bochum
- M. Senkal🇩🇪St. Josef-Hospital; Ruhr University Bochum
- Heinz Herbert Homann🇩🇪St. Josef-Hospital; Ruhr University Bochum
- Achim Mumme🇩🇪St. Josef-Hospital; Ruhr University Bochum
- Anne-Kathrin Dauphin🇩🇪St. Josef-Hospital; Ruhr University Bochum
- J. Baier🇩🇪St. Josef-Hospital; Ruhr University Bochum
- Jürgen Windeler🇩🇪St. Josef-Hospital; Ruhr University Bochum
- Herbert Neumann🇩🇪St. Josef-Hospital; Ruhr University Bochum
- Volker Zumtobel🇩🇪St. Josef-Hospital; Ruhr University Bochum
Resumen
El texto original del estudio, en el idioma en que se publicó.
Objective
To evaluate the effect of early postoperative feeding with a nutritionally complete enteral diet supplemented with the nutrients arginine, ribonucleic acid (RNA), and omega-3 fatty acids on the immune function in patients undergoing surgery for upper gastrointestinal (GI) malignancies.
Design
Prospective, randomized, placebo-controlled, double-blind study.
Setting
Surgical intensive care unit (ICU) in a German university hospital.
Patients
Forty-two consecutive patients receiving an enteral diet via needle catheter jejunostomy after GI surgery for cancer.
Interventions
Patients were randomized to receive either the arginine, RNA, and omega-3 fatty acids supplemented diet or an isocaloric and isonitrogenous placebo diet. Early enteral nutrition was started on postoperative day 1 in the surgical ICU with 20 mL/hr and progressed to the optimal goal of 80 mL/hr by postoperative day 5.
Measurements and main results
Clinical examination and adverse GI symptoms were recorded on a daily basis. Body weight was determined twice weekly. Immunoglobulin concentrations were determined by laser nephelometry. Interferon-gamma concentrations were measured with a modified enzyme-linked immunosorbent assay method. Fluorescence-activated cell scan flow cytometry was performed to analyze B cells, T lymphocytes and their subsets. Clinical patient characteristics and mean caloric intake were similar between the two groups and both formulas were well tolerated. The number of T lymphocytes and their subsets, helper T cells (CD4) and activated T cells (CD3, HLA-DR), were significantly higher in the supplemented diet group on postoperative days 10 and 16 (p < .05). Mean interferon-gamma concentration after phytohemagglutinin stimulation was higher in the supplemented diet group on postoperative day 16. In the supplemented diet group, mean immunoglobulin M concentrations were significantly higher on postoperative day 10 and mean immunoglobulin G concentrations were higher on postoperative day 16 (p < .05) compared with the results in the placebo group. B-lymphocyte indices were significantly higher in the supplemented vs. the placebo diet group on postoperative days 7 and 10 (p < .05).
Conclusions
Supplementation of enteral diet with arginine, RNA, and omega-3 fatty acids in the early postoperative time period improves postoperative immunologic responses and helps to overcome more rapidly the immunologic depression after surgical trauma.
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