Effects of an immune-enhancing diet in critically injured patients.
OBJECTIVE
To determine the effects of an immune-enhancing experimental diet (XD = supplemental arginine, trace elements, and increased omega-3 fatty acids) versus standard diet (SD), on immune cell function and clinical outcome of critically injured patients.


METHODS
Prospective randomized clinical trial of patients admitted to the surgical intensive care unit after trauma (Injury Severity Score > 13).


METHODS
Patients received early enteral nutrition with either XD or SD for a minimum of 5 days.


METHODS
Mortality, intensive care unit, ventilator, and hospital days, as well as incidence of adult respiratory distress syndrome (ARDS) and infectious complications were recorded. Nutritional parameters were also studied. Peripheral blood leukocytes were isolated from normal volunteers and from patients on days 1, 6, and 10 of feeding.


RESULTS
Demographics and injury severity were similar in both groups. Both SD (n = 21) and XD (n = 22) groups revealed depressed monocyte function (tumor necrosis factor, prostaglandin E2, and procoagulant activity) on day 1 compared with a reference group (p < 0.05). However, monocytes from XD patients began to "normalize" their response (tumor necrosis factor, prostaglandin E2, and procoagulant activity) by day 6. Although ARDS occurred more frequently in the XD group (45 vs. 19%), the majority of ARDS in both groups occurred very early, with only three patients in the XD (13.6%) and one patient in the SD (4.7%) groups developing ARDS after study entry. XD patients remained on the ventilator longer (16.4 vs. 9.7 days) and in the hospital longer (32.9 vs. 22 days) compared with the SD group, but overall mortality was nearly identical (4.5 vs. 5%).


CONCLUSIONS
The exact role and timing for diets with immune-enhancing effects has yet to be defined.
Mendez
C
C
Department of Surgery, University of Washington, Harborview Medical Center, Seattle 98104, USA.
Jurkovich
G J
GJ
Garcia
I
I
Davis
D
D
Parker
A
A
Maier
R V
RV
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001120:Arginine / Q000627:therapeutic use; D016638:Critical Illness; D004750:Enteral Nutrition / Q000379:methods*; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005260:Female; D005526:Food, Formulated / Q000032:analysis; D006801:Humans; D007902:Length of Stay; D007962:Leukocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000276:immunology* / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D016037:Single-Blind Method; D016019:Survival Analysis; D014131:Trace Elements / Q000627:therapeutic use
D000276:Adjuvants, Immunologic; D015525:Fatty Acids, Omega-3; D014131:Trace Elements; D001120:Arginine