title: Enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids in patients after operation: immunologic, metabolic, and clinical outcome.
abstract: The individual nutrients arginine, RNA, and omega-3 fatty acids improve immune function, but prospective trials have not demonstrated their effects on clinical outcome. Patients (n = 85) who underwent operation for upper gastrointestinal malignancies were randomized to receive the supplemental diet or a standard enteral diet after surgery. Clinical patient characteristics were similar between the two groups. Mean caloric intakes (1421 vs 1285 kcal/day) were similar between groups. Mean nitrogen intakes (15.6 vs 9.0 gm/day) and nitrogen balances (-2.2 vs -6.6 gm/day) measured in the first 20 patients were significantly greater in the supplemented group than in the standard group (p = 0.05). In vitro lymphocyte mitogenesis was measured in the first 31 patients and was decreased on postoperative day 1 in both groups, but normal levels were regained only in the supplemented group. In the cohort of 77 eligible patients, infectious and wound complications occurred significantly less often (11% vs 37%) in the supplemented group than in the standard group (p = 0.02). Linear logistic models for infectious/wound complications with control for the amount of nitrogen suggested (p = 0.10) dietary treatment as the major factor. Mean length of stay in the hospital was significantly shorter (p = 0.01) for the supplemented group (15.8 +/- 5.1 days) than for the standard group (20.2 +/- 9.4 days). These results suggest that postoperative enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids instead of a standard enteral diet significantly improved immunologic, metabolic, and clinical outcomes in patients with upper gastrointestinal malignancies who were undergoing major elective surgery.
authors.affiliation: Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104.
authors.forename: J M
authors.initials: JM
authors.lastname: Daly
authors.forename: M D
authors.initials: MD
authors.lastname: Lieberman
authors.forename: J
authors.initials: J
authors.lastname: Goldfine
authors.forename: J
authors.initials: J
authors.lastname: Shou
authors.forename: F
authors.initials: F
authors.lastname: Weintraub
authors.forename: E F
authors.initials: EF
authors.lastname: Rosato
authors.forename: P
authors.initials: P
authors.lastname: Lavin
mesh_terms: D000368:Aged; D000596:Amino Acids / Q000097:blood*; D001120:Arginine / Q000008:administration & dosage*; D015331:Cohort Studies; D002149:Energy Intake; D004750:Enteral Nutrition; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D015993:Life Tables; D008213:Lymphocyte Activation; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000378:metabolism*; D009752:Nutritional Status; D012313:RNA / Q000008:administration & dosage*; D012044:Regression Analysis; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000596:Amino Acids; D015525:Fatty Acids, Omega-3; D012313:RNA; D001120:Arginine; D009584:Nitrogen