Early postoperative enteral nutrition with arginine-omega-3 fatty acids and ribonucleic acid-supplemented diet versus placebo in cancer patients: an immunologic evaluation of Impact.
OBJECTIVE
To evaluate the effect of early postoperative feeding with a nutritionally complete enteral diet supplemented with the nutrients arginine, ribonucleic acid (RNA), and omega-3 fatty acids on the immune function in patients undergoing surgery for upper gastrointestinal (GI) malignancies.


METHODS
Prospective, randomized, placebo-controlled, double-blind study.


METHODS
Surgical intensive care unit (ICU) in a German university hospital.


METHODS
Forty-two consecutive patients receiving an enteral diet via needle catheter jejunostomy after GI surgery for cancer.


METHODS
Patients were randomized to receive either the arginine, RNA, and omega-3 fatty acids supplemented diet or an isocaloric and isonitrogenous placebo diet. Early enteral nutrition was started on postoperative day 1 in the surgical ICU with 20 mL/hr and progressed to the optimal goal of 80 mL/hr by postoperative day 5.


RESULTS
Clinical examination and adverse GI symptoms were recorded on a daily basis. Body weight was determined twice weekly. Immunoglobulin concentrations were determined by laser nephelometry. Interferon-gamma concentrations were measured with a modified enzyme-linked immunosorbent assay method. Fluorescence-activated cell scan flow cytometry was performed to analyze B cells, T lymphocytes and their subsets. Clinical patient characteristics and mean caloric intake were similar between the two groups and both formulas were well tolerated. The number of T lymphocytes and their subsets, helper T cells (CD4) and activated T cells (CD3, HLA-DR), were significantly higher in the supplemented diet group on postoperative days 10 and 16 (p < .05). Mean interferon-gamma concentration after phytohemagglutinin stimulation was higher in the supplemented diet group on postoperative day 16. In the supplemented diet group, mean immunoglobulin M concentrations were significantly higher on postoperative day 10 and mean immunoglobulin G concentrations were higher on postoperative day 16 (p < .05) compared with the results in the placebo group. B-lymphocyte indices were significantly higher in the supplemented vs. the placebo diet group on postoperative days 7 and 10 (p < .05).


CONCLUSIONS
Supplementation of enteral diet with arginine, RNA, and omega-3 fatty acids in the early postoperative time period improves postoperative immunologic responses and helps to overcome more rapidly the immunologic depression after surgical trauma.
Kemen
M
M
Department of Surgery, Ruhr-University Bochum, St. Josef Hospital, FRG.
Senkal
M
M
Homann
H H
HH
Mumme
A
A
Dauphin
A K
AK
Baier
J
J
Windeler
J
J
Neumann
H
H
Zumtobel
V
V
D000368:Aged; D001120:Arginine / Q000008:administration & dosage*; D004311:Double-Blind Method; D004750:Enteral Nutrition; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005260:Female; D005526:Food, Formulated; D005770:Gastrointestinal Neoplasms / Q000276:immunology* / Q000601:surgery; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007362:Intensive Care Units; D007371:Interferon-gamma / Q000097:blood; D008213:Lymphocyte Activation; D018655:Lymphocyte Count; D016131:Lymphocyte Subsets; D008297:Male; D011182:Postoperative Care; D011446:Prospective Studies; D012313:RNA / Q000008:administration & dosage*
D015525:Fatty Acids, Omega-3; D006684:HLA-DR Antigens; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012313:RNA; D007371:Interferon-gamma; D001120:Arginine