Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters

AIM:To evaluate the effects of preoperative immunonutrition and other nutrition models on the cellular immunity parameters of patients with gastrointestinal tumors before surgical intervention.In addition,effects on postoperative complications were examined. METHODS:Patients with gastrointestinal tumors were randomized into 3 groups.The immunonutrition group received a combination of arginine,fatty acids and nucleotides.The second and third group received normal nutrition and standard enteral nutrition,respectively.Nutrition protocols were administered for 7 d prior to the operation.Nutritional parameters,in particular prealbumin levels and lymphocyte subpopulations(CD4+,CD8+,CD16+/56+,and CD69 cells)were evaluated before and after the nutrition protocols.Groups were compared in terms of postoperative complications and duration of hospital stay. RESULTS:Of the 42 patients who completed thestudy,16 received immunonutrition,13 received normal nutrition and 13 received standard enteral nutrition. prealbumin values were low in every group,but this parameter was improved after the nutritional protocol only in the immunonutrition group(13.64±8.83 vs 15.98±8.66,P=0.037).Groups were similar in terms of CD4+,CD16+/56,and CD69+prior to the nutritional protocol;whereas CD8+was higher in the standard nutrition group compared to the immunonutrition group.After nutritional protocols,none of the groups had an increase in their lymphocyte subpopulations.Also,groups did not differ in terms of postoperative complications and postoperative durations of hospital stay. CONCLUSION:Preoperative immunonutrition provided a significant increase in prealbumin levels,while it did not significantly alter T lymphocyte subpopulation counts,the rate of postoperative complications and the duration of hospital stay.

Effect of early enteral immunonutrition intervention on gastrointestinal hormones, stress hormones and immune response after pancreatic cancer surgery

Objective: To study the effect of early enteral immunonutrition intervention on gastrointestinal hormones, stress hormones and immune response after pancreatic cancer surgery. Methods:A total of 68 patients who received radical operation for pancreatic cancer in Chengdu Third People's Hospital between May 2015 and February 2017 were selected as the research subjects and randomly divided into TPF-T group and TP group who received early postoperative enteral immunonutrition intervention and conventional enteral nutrition intervention respectively. The levels of gastrointestinal hormones MTL, GAS, CGRP, Ghrelin and stress hormones ACTH, Cor,R, AT-II, ALD in serum as well as the levels of immune cells CD4+T, CD8+T, NKT, Treg, Breg, MDSC in peripheral blood were detected before surgery as well as 3 d and 7 d after surgery. Results: 3 d and 7 d after surgery, MTL, GAS, CGRP and Ghrelin levels in serum as well as CD4+T cell, CD8+T cell and NKT cell levels in peripheral blood of both groups of patients were significantly lower than those before surgery while ACTH, Cor, R, AT-II and ALD levels in serum as well as Treg, Breg and MDSC levels in peripheral blood were significantly higher than those before surgery, and MTL, GAS, CGRP and Ghrelin levels in serum as well as CD4+T cell, CD8+T cell and NKT cell levels in peripheral blood of TPF-T group were significantly higher than those of TP group while ACTH, Cor, R, AT-II and ALD levels in serum as well as Treg, Breg and MDSC levels in peripheral blood were significantly lower than those of TP group. Conclusion: Early postoperative enteral immunonutrition intervention can regulate the gastrointestinal hormone secretion, inhibit stress response and improve immune response.

Immunonutrition Intervention for Treatment of Postoperative Malnutrition in Testicular Cancer Patients:A Case Report

A young patient with testicular cancer appeared severe malnutrition and poor surgical incision healing,following an orchiectomy and post-abdominal lymphadenectomy.After treated with immunonutrition designed by the nutritional specialist of our department,the patient’s malnutrition was reversed,and the wound was healed.

Are we jumping the gun with pharmaconutrition(immunonutrition) in gastrointestinal onoclogical surgery?

Over the last 20 years there has been considerable research into the use of immunonutrition,also referred to as pharmaconutrition,in the management of patients undergoing and recovering from elective gastrointestinal surgery for malignancy.In this group of patients,the use of pharmaconutrition seems to confer superior outcomes to standard nutrition formulations with regards to postoperative infective complications and length of hospital stay.It is therefore frequently recommended for use in elective gastrointestinal oncological surgical populations.However,it remains unclear whether the data supporting these recommendation is robust.Studies reporting improved outcomes with pharmaconutrition frequently compare this intervention with non-equivalent control groups,do not report on the actual nutritional provision received by study participants,overlook the potential impact of industry funding on the conduct of research and do not adopt amulti-disciplinary approach to the research undertaken.For these reasons,an urgent critical re-appraisal of the use and recommendations of pharmaconutrition in this group of patients is warranted to resolve some of the above mentioned issues.

Effect of enteral immunonutrition after radical surgery for esophageal carcinoma on anti-tumor immune response and intestinal mucosal barrier function

Objective:To study the effect of enteral immunonutrition after radical surgery for esophageal carcinoma on anti-tumor immune response and intestinal mucosal barrier function.Methods:A total of102 patients who received radical surgery for esophageal carcinoma in our hospital between May 2013 and December 2016 were selected and randomly divided into observation group and control group who received postoperative enteral immunonutrition and routine enteral nutrition respectively. 1 d before operation as well as 1 d and 7 d after operation, peripheral blood immune cell marker expression and serum intestinal mucosal barrier injury marker levels were detected.Results:1 d after operation, peripheral blood T-bet, NKG2D, NKp30, NKp44 and NKp46 fluorescence intensity of both groups of patients were significantly lower than those 1d before operation while peripheral blood GATA-3 and Foxp3 fluorescence intensity as well as serum DAO, Occludin, ZO-1 and claudin-1 levels were significantly higher than those 1d before operation;peripheral blood T-bet, NKG2D, NKp30, NKp44 and NKp46 fluorescence intensity of observation group 7 d after operation were significantly higher than those 1 d after operation while peripheral blood GATA-3 and Foxp3 fluorescence intensity as well as serum DAO, Occludin, ZO-1 and claudin-1 levels were significantly lower than those 1 d after operation;peripheral blood T-bet, GATA-3, Foxp3, NKG2D, NKp30, NKp44 and NKp46 fluorescence intensity of control group 7 d after operation were not significant different from those 1 d after operation, and serum DAO, Occludin, ZO-1 and claudin-1 levels were significantly lower than those 1d after operation.Conclusion: Enteral immunonutrition after radical surgery for esophageal carcinoma can enhance the anti-tumor immune response and improve the intestinal mucosal barrier function.

Advancements in nutritional diagnosis and support strategies during the perioperative period for patients with liver cancer

Liver cancer represents a grave hepatic condition and constitutes a significant global health concern.Surgical resection remains the principal therapeutic modality for liver cancer.Nevertheless,perioperative malnutrition exerts a notable impact on patients with liver cancer,emerging as an independent risk factor for disease mortality and adverse outcomes.Hence,precise nutritional diagnosis and timely nutritional support hold the potential to enhance therapeutic efficacy and quality of life for liver cancer patients.This study represents a meticulous foray into the literature,extracting data from PubMed,Web of Science,and EMBASE databases,with a focus on the past 5 years.It scrutinizes the impact of malnutrition on patients undergoing liver cancer surgery,the etiological underpinnings of malnutrition within this patient cohort,the critical assessment of perioperative nutritional status,and the strategic approaches to nutritional support.Utilizing rigorous inclusion and exclusion criteria,the amassed scholarly works are meticulously synthesized,methodically organized,and categorically elaborated upon.Ultimately,the authors propose the incorporation of a multidisciplinary nutrition management team during the perioperative period,comprising nutritionists,pharmacists,physicians,nurses,psychologists,and rehabilitation therapists,among other specialized professionals.Together,they collaborate to devise and implement personalized nutritional support plans,monitor patients’nutritional status,and make necessary adjustments as required.Through comprehensive management and intervention,improvements in the nutritional status of liver cancer patients can be achieved,thereby enhancing surgical success rates and facilitating postoperative recovery.It is believed that this manuscript will offer valuable insights to advance the nutritional management during the perioperative phase of liver cancer,aiding in ameliorating patients'nutritional status and treatment outcomes.

Arginine metabolism and its functions in growth, nutrient utilization, and immunonutrition of fish

Fish have limited ability in endogenous biosynthesis of arginine.Arginine is an indispensable amino acid for fish,and the arginine requirement varies with fish species and fish size.Recent studies on fish have demonstrated that arginine influences nutrient metabolism,stimulates insulin release,is involved in nonspecific immune responses and antioxidant responses,and elevates disease resistance.Specifically,arginine can regulate energy homeostasis via modulating the adenosine 5'-monophosphate(AMP)-activated protein kinase(AMPK)pathway,and also regulate protein synthesis via activating the target of rapamycin(TOR)signaling pathway.The present article reviews pertinent knowledge of arginine in fish,including dietary quantitative requirements,endogenous anabolism and catabolism,regulation of the endocrine and metabolic systems,and immune-regulatory functions under pathogenic challenge.Our findings showed that further data about the distribution of arginine after intake into specific cells,its sub-cellular sensor to initiate downstream signaling pathways,and its effects on fish mucosal immunity,especially the adaptive immune response against pathogenic infection in different species,are urgently needed.

Should perioperative immunonutrition for elective surgery be the current standard of care?

Postoperative infectious complications are independently associated with increased hospital length of stay(LOS)and cost and contribute to significant inpatient morbidity.Many strategies such as avoidance of long periods of preoperative fasting,re-establishment of oral feeding as early as possible after surgery,metabolic control and early mobilization have been used to either prevent or reduce the incidence of postoperative infections.Despite these efforts,it remains a big challenge to our current healthcare system to mitigate the cost of postoperative morbidity.Furthermore,preoperative nutritional status has also been implicated as an independent risk factor for postoperative morbidity.Perioperative nutritional support using enteral and parenteral routes has been shown to decrease postoperative morbidity,especially in high-risk patients.Recently,the role of immunonutrition(IMN)in postoperative infectious complications has been studied extensively.These substrates have been found to positively modulate postsurgical immunosuppression and inflammatory responses.They have also been shown to be cost-effective by decreasing both tpostoperative infectious complications and hospital LOS.In this review,we discuss the postoperative positive outcomes associated with the use of perioperative IMN,their cost-effectiveness,current guidelines and future clinical implications.

Enteral nutrition in acute pancreatitis:A review of the current evidence

The use of enteral feeding as part of the management of acute pancreatitis dates back almost two decades.This review describes the indications for and limitations of enteral feeding for the treatment of acute pancreatitis using up-to-date evidence-based data.A systematic review was carried out to analyse current data on the use of enteral nutrition in the management of acute pancreatitis.Relevant literature was analysed from the viewpoints of enteral vs parenteral feeding,early vs delayed enteral nutrition,nasogastric vs nasojejunal feeding,and early oral diet and immunonutrition,particularly glutamine and probiotic supplementation.Finally,current applicable guidelines and the effects of these guidelines on clinical practice are discussed.The latest meta-analyses suggest that enteral nutrition significantly reduces the mortality rate of severe acute pancreatitis compared to parenteral feeding.To maintain gut barrier function and prevent early bacterial translocation,enteral feeding should be commenced within the first 24 h of hospital admission.Also,the safety of nasogastric feeding,which eases the administration of enteral nutrients in the clinical setting,is likely equal to nasojejunal feeding.Furthermore,an earlylow-fat oral diet is potentially beneficial in patients with mild pancreatitis.Despite the initial encouraging results,the current evidence does not support the use of immunoenhanced nutrients or probiotics in patients with acute pancreatitis.

Embracing cancer immunotherapy with vital micronutrients

Immunotherapy is now commonly prescribed to cancer patients,but autoimmune-related adverse events are considerable.For severe,life-threatening side effects,cessation of therapy seems unavoidable,let alone intensive medical care required for patching up the adverse events.Even without serious adverse events,the response rates are too low and various combinatory regimens have been tried.However,toxicities are also added on,unless the adjuvant agents have remarkably few side effects.Actually,micronutrients are usually taken by a majority of cancer patients as nutritional support or to boost the immune function,let alone hoping to counteract treatment side effects.Recent studies have shown that combinations of micronutrients exert pleiotropic effects in controlling tumor growth and metastasis by modulating the tumor microenvironment,enhancing gut microbiota immune functions,and providing adjunct nutritional support to micronutrient deficient cancer patients.A higher than recommended dietary allowance micronutrient dose is proposed to reduce the toxic free radicals generated as a result of immunotherapy and tumor metabolism.This is not only helpful for managing treatment side effects but also enhancing treatment efficacy.As micronutrient supplementation is also useful to improve patients’quality of life,prolong survival,and sustain compliance to immunotherapy,further investigations are mandatory.

Pyruvate-Dependent Changes in Neutrophil Amino- and Alpha-Keto Acid Profiles or Immunity: Which Mechanisms Are Involved?

High current findings indicate that a substitution with pyruvate can lead to significant alterations or even improvement in neutrophil immunonutrition. However, it is still unknown which intra-cellular pathways might be involved here. Hence, in this study, we investigated whether preincu-bation with an inhibitor of ·NO-synthase (L-NAME), an ·NO donor (SNAP), an analogue of taurine (beta-alanine), an inhibitor of ornithine-decarboxylase (DFMO) as well as a glutamine-analogue (DON), is able to alter the intragranulocytic metabolic response to pyruvate, here for example studied for neutrophil intracellular amino- and α-keto acid concentrations or important neutrophil immune functions [released myeloperoxidase (MPO), the formation of superoxide anions O2- and hydrogen peroxide (H2O2)]. In summary, the interesting first results presented here showed, that any damage of specific metabolic pathways or mechanisms, which seem directly or indirectly to be involved in relevant pyruvate dependent granulocytic nutrient content or specific cellular tasks, could lead to therapeutically desired, but also to unexpected or even fatal consequences for the affected cells. We therefore continue to believe that pyruvate, irrespective of which exact biochemical mechanisms were involved, in neutrophils may satisfy the substantial metabolic demands for a potent intracellular nutrient.

Nutritional and Metabolic Support in Cancer Patients Undergoing Surgery

Substantial advances have been made in preoperative patient assessment,the reduction of postsurgical stress,and oral feeding recovery after surgery during the past few years.The use of“prehabilitation”protocols can improve the preoperative nutritional status of patients,optimizing their body composition and increasing their physical performance.Within enhanced recovery protocols,early oral feeding is possible following the majority of surgical procedures.When oral intake is not adequate,the enteral route is the first choice to nourish surgical patients,since the gut has been identified as a major regulator of the postoperative inflammatory response.The perioperative supplementation of nutrients with specific metabolic effects and the early recovery of oral feeding following surgery reduce the postoperative morbidity and shorten the hospital stay.

Nutrition Care and Minimally Invasive Pathway in Surgical Cancer Patients

Nutritional status is often neglected or under evaluated in patients with cancer,despite international guidelines suggest that nutritional deterioration negatively affects patients’survival.Preoperative malnutrition increases postoperative complications and mortality and prolongs hospital stay.Nutritional support must be given to undernourished cancer patients,as it can bring many clinical and economic advantages.Today,an inadequate nutritional support for cancer patients should be considered ethically unacceptable.Minimally invasive surgical techniques result in less operative blood loss,decreased surgical stress response,and less postoperative pain and discomfort.When associated to enhanced recovery pathway(ERP),a quicker recovery and a shorter hospital stay are obtained.Thus far,routine nutritional care and ERP have only been incorporated into the clinical practice in a minority of hospitals.Possible reasons are an insufficient awareness of the clinical relevance of undernutrition and a lack of structured collaboration between surgeons and clinical nutrition specialists.This review suggests that a better cooperation among healthcare providers,patients,and families would bring tremendous clinical benefits to patients with cancer,especially those undergoing surgery,radiotherapy,and chemotherapy.