title: A randomized trial of isonitrogenous enteral diets after severe trauma. An immune-enhancing diet reduces septic complications.
abstract: OBJECTIVE
  The authors randomized patients to an enteral diet containing glutamine, arginine, omega-3 fatty acids, and nucleotides or to an isonitrogenous, isocaloric diet to investigate the effect of septic outcome. A third group of patients, without enteral access but eligible by severity of injury, served as unfed controls and were studied prospectively to determine the risk of infection.
  
  
  BACKGROUND
  Laboratory and clinical studies suggest that diets containing specialty nutrients, such as arginine, glutamine, nucleotides, and omega-3 fatty acids, reduce septic complications. Unfortunately, most clinical trials have not compared these diets versus isonitrogenous, isocaloric controls. This prospective, blinded study randomized 35 severely injured patients with an Abdominal Trauma Index > or = 25 or a Injury Severity Score > or = 21 who had early enteral access to an immune-enhancing diet ([IED] Immun-Aid, McGaw, Inc., Irvine, CA; n = 17) or an isonitrogenous, isocaloric diet (Promote [Ross Laboratories, Columbus, OH] and Casec [Mead-Johnson Nutritionals, Evansville, IN]; n = 18) diet. Patients without early enteral access but eligible by severity of injury served as contemporaneous controls (n = 19). Patients were evaluated for septic complications, antibiotic usage, hospital and intensive care unit (ICU) stay, and hospital costs.
  
  
  RESULTS
  Two patients died in the treatment group and were dropped from the study. Significantly fewer major infectious complications (6%) developed in patients randomized to the IED than patients in the isonitrogenous group (41%, p = 0.02) or the control group (58%, p = 0.002). Hospital stay, therapeutic antibiotics, and the development of intra-abdominal abscess was significantly lower in patients receiving the IED than the other two groups. This improved clinical outcome was reflected in reduced hospital costs.
  
  
  CONCLUSIONS
  An IED significantly reduces major infectious complications in severely injured patients compared with those receiving isonitrogenous diet or no early enteral nutrition. An IED is the preferred diet for early enteral feeding after severe blunt and penetrating trauma in patients at risk of subsequent septic complications. Unfed patients have the highest complication rate.
authors.affiliation: Department of Surgery, University of Tennessee, Memphis, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Kudsk
authors.forename: G
authors.initials: G
authors.lastname: Minard
authors.forename: M A
authors.initials: MA
authors.lastname: Croce
authors.forename: R O
authors.initials: RO
authors.lastname: Brown
authors.forename: T S
authors.initials: TS
authors.lastname: Lowrey
authors.forename: F E
authors.initials: FE
authors.lastname: Pritchard
authors.forename: R N
authors.initials: RN
authors.lastname: Dickerson
authors.forename: T C
authors.initials: TC
authors.lastname: Fabian
mesh_terms: D000328:Adult; D001120:Arginine / Q000008:administration & dosage; D004311:Double-Blind Method; D002149:Energy Intake; D004750:Enteral Nutrition; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D005260:Female; D005526:Food, Formulated / Q000009:adverse effects; D006801:Humans; D007109:Immunity; D008297:Male; D009711:Nucleotides / Q000008:administration & dosage; D011446:Prospective Studies; D018805:Sepsis / Q000276:immunology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*
chemical_list: D015525:Fatty Acids, Omega-3; D009711:Nucleotides; D001120:Arginine