To the Editor: We thank Drs. Manzanares and Hey-land (1) for their appreciation concerning our article published recently in Critical Care Medicine (2) concerning the effect of an arginine-supplemented diet on infectious complications in traumatized rats. However, we are puzzled by the claim of Manzanares and Heyland that "quite separate and distinct from the concept of immune enhancing diets (IEDs) is the concept of phamaconutrition where individual nutrients are studied by themselves" before going on to state that they "definitively disagree with our statement that adverse events attributed to arginine in severe sepsis are not supported by any clinical data." There is an obvious contradiction between their two claims because to support their view, Manzanares and Heyland cite three articles (3-5) studying the effects of a mixture of nutrients with pharmacological properties, including arginine (3-5), omage3 fatty acids (3-5), RNA (3) and antioxidants (5), but not arginine alone, which is the point of our study (as rightly mentioned by Manzanares and Heyland).
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机译：致编辑：感谢博士。曼萨纳雷斯（Manzanares）和海兰（Hey-land）（1）对我们最近发表在《重症医学》（Critical Care Medicine）（2）上的文章表示赞赏，该文章涉及补充精氨酸饮食对创伤大鼠感染并发症的影响。但是，我们对曼萨纳雷斯和海兰德的说法感到困惑，认为“与免疫增强饮食（IED）的概念截然不同且不同的是，营养素的概念是其中的营养素是由他们自己研究的”，然后继续声明它们“明确地不同意我们的说法，即任何临床数据均不支持在严重败血症中归因于精氨酸的不良事件。”他们的两个主张之间存在明显的矛盾，因为支持他们的观点，曼萨纳雷斯和海兰德引用了三篇文章（3-5）研究了具有药理学特性的营养物质混合物（包括精氨酸（3-5），omage3脂肪酸（ 3-5），RNA（3）和抗氧化剂（5），但不能单独使用精氨酸，这是我们研究的重点（Manzanares和Heyland正确提及）。
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