摘要
AIM: To evaluate if the administration of an enteral diet supplemented with glutamine, arginine and omega-3-fatty acids modulates inflammatory and immune responses after surgery. METHODS: A prospective randomized double-blind, clinical trial was performed. Forty-eight patients with gastrointestinal cancer were randomized into two groups, one group was given an isocaloric and isonitrogenous standard diet and the other was fed with the supplemented diet with glutamine, arginine and omega-3-fatty acids. Feedings were started within 48 hours after operation, and continued until day 8. All variables were measured before operation and on postoperative day 1 and 8. Immune responses were determined by phagocytosis ability, respiratory burst of polymorphonuclear cells, total lymphocytes lymphocyte subsets, nitric oxide, cytokines concentration, and inflammatory responses by plasma levels of C-reactive protein, prostaglandin E2 level. RESULTS: Tolerance of both formula diets was excellent.There were significant differences in the immunological and inflammatory responses between the two groups. In supplemented group, phagocytosis and respiratory burst after surgery was higher and C-reactive protein level was lower (P【0.01) than in the standard group. The supplemented group had higher levels of nitric oxide, total lymphocytes, T lymphocytes, T-helper cells, and NK cells. Postoperative levels of IL-6 and TNF-alpha were lower in the supplemented group (P 【0.05). CONCLUSION: It was clearly established in this trial that early postoperative enteral feeding is safe in patients who have undergone major operations for gastrointestinal cancer. Supplementation of enteral nutrition with glutamine, arginine, and omega-3-fatty acids positively modulated postsurgical immunosuppressive and inflammatory responses.
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.
