Substrates with immune-modulating actions have been identifiedamong both macro and micronutrients.Currently,the modes of action of individual immune-modulating substrates,and their effects on clinical outcomes,are bei...Substrates with immune-modulating actions have been identifiedamong both macro and micronutrients.Currently,the modes of action of individual immune-modulating substrates,and their effects on clinical outcomes,are being examined.At present,some enteral formulas are available for the clinical setting which are enriched with selected immune-modulating nutritnts.The purpose of the present paper is to review the scientific rationale of enteral immunonutrition.The major aspects considered are mucosal barrier structure and function,cellular defence function and local or systemic inflammatory response.It is notable that in critical illness the mucosal barrier and cellular defence are impaired and a reinforcement iwht enteral immunonutrition is desirable,while local or systemic inflammatory response should be down regulated by nutritional interventions.The results available from clinical trials are conflicting.Meta-analyses of recent trials show improvements such as reduced risk of infeciton,fewer days on a ventilator,and reduced length of intensive care unit and hospital stay.Thus,a grade A recommendation was proclaimed for the clinical use of enteral immune-modulationg diets.Improvemtnet in outcome was only seen when critical amounts of the immune-modulating formula were tolerated in patients classified as being malnourished.However,in other patients with severe sepsis,shock and organ failure,no benefit or even disadvantages form immunonutrition were reported.In such severe conditions we hypothesize that systemic inflammation might be undesirably intensified by arginine and unsaturated fatty acids,directly affecting cellular defence and inflammatory response.We therefore recommed that in patients suffering from systemic inflammatory response syndrome great caution should be exercised when immune-enhancing substrates are involuvd which may aggravate systemic inflammation.展开更多
文摘Substrates with immune-modulating actions have been identifiedamong both macro and micronutrients.Currently,the modes of action of individual immune-modulating substrates,and their effects on clinical outcomes,are being examined.At present,some enteral formulas are available for the clinical setting which are enriched with selected immune-modulating nutritnts.The purpose of the present paper is to review the scientific rationale of enteral immunonutrition.The major aspects considered are mucosal barrier structure and function,cellular defence function and local or systemic inflammatory response.It is notable that in critical illness the mucosal barrier and cellular defence are impaired and a reinforcement iwht enteral immunonutrition is desirable,while local or systemic inflammatory response should be down regulated by nutritional interventions.The results available from clinical trials are conflicting.Meta-analyses of recent trials show improvements such as reduced risk of infeciton,fewer days on a ventilator,and reduced length of intensive care unit and hospital stay.Thus,a grade A recommendation was proclaimed for the clinical use of enteral immune-modulationg diets.Improvemtnet in outcome was only seen when critical amounts of the immune-modulating formula were tolerated in patients classified as being malnourished.However,in other patients with severe sepsis,shock and organ failure,no benefit or even disadvantages form immunonutrition were reported.In such severe conditions we hypothesize that systemic inflammation might be undesirably intensified by arginine and unsaturated fatty acids,directly affecting cellular defence and inflammatory response.We therefore recommed that in patients suffering from systemic inflammatory response syndrome great caution should be exercised when immune-enhancing substrates are involuvd which may aggravate systemic inflammation.
