Modulation of postoperative immune and inflammatory response by immune-enhancing enteral diet in gastrointestinal cancer patients

摘要

AIM To evaluate if the administration of anenteral diet supplemented with glutamine,arginine and ω-3-fatty acids modulatesinflammatory and immune responses aftersurgery.METHODS A prospective randomized double-blind, clinical trial was performed. Forty-eightpatients with gastrointestinal cancer wererandomized into two groups, one group wasgiven an isocaloric and isonitrogenous standarddiet and the other was fed with the supplementeddiet with glutamine, arginine and ωo-3-fattyacids. Feedings were started within 48 hoursafter operation, and continued until day 8. Allvariables were measured before operation andon postoperative day 1 and 8. Immune responseswere determined by phagocytosis ability,respiratory burst of polymorphonuclear cells,total lymphocytes lymphocyte subsets, nitricoxide, cytokines concentration, andinflammatory responses by plasma levels of C-reactive protein, prostaglandin E2 level.RESULTS Tolerance of both formula diets wasexcellent. There were siagnificant differences inthe immunological and inflammatory responsesbetween the two groups. In supplementedgroup, phagocytosis and respiratory burst aftersurgery was higher and C-reactive protein levelwas lower (P<0.01) than in the standard group.The supplemented group had higher levels ofnitric oxide, total Iymphocytes, T lymphocytes,T-helper cells, and NK cells. Postoperativelevels of IL-6 and TNF-α were lower in thesupplemented group ( P < 0.05).CONCLUSION It was clearly established in thistrial that early postoperative enteral feeding issafe in patients who have undergone majoroperations for gastrointestinal cancer.Supplementation of enteral nutrition withglutamine, arginine, and ω-3 fatty acidspositively modulated postsurgicalimmunosuppressive and inflammatoryresponses.