Immunonutrition--supplementary amino acids and fatty acids ameliorate immune deficiency in critically ill patients.
BACKGROUND
Immunonutrition with omega-3 fatty acids and the "conditionally essential" amino acids arginine, glutamine, cysteine, and taurine can enhance the immune response in critically ill patients. This is due to the immunomodulating properties of these nutrients. Immunonutrition is especially important when a patient's immune response is compromised, as is the case post-operatively or after trauma. Immune deficiency is severely aggravated in sepsis and the systemic inflammatory response syndrome (SIRS). The resulting metabolic stress is characterized by glycolysis, lipolysis, and proteolysis, which may escalate to an hypercatabolic response or "autocannabilism." Catabolic metabolism results in insufficiency of both specific and unspecific immunocompetent cells.


CONCLUSIONS
Immunonutrition should be started early in such patients for an optimal beneficial effect, preferably via the enteral route. It should include medium chain and long chain triglycerides, polyunsaturated omega-3 and omega-6 fatty acids (in the ratio 1:2), olive oil, and conventional amino acid preparations supplemented with the conditionally essential amino acids arginine, glutamine, cysteine, and taurine.
Grimm
H
H
Department of General and Thoracic Surgery, Justus Liebig University, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany. helmut.grimm@chiru.med.uni-giessen.de
Kraus
A
A
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000601:Amino Acids, Essential / Q000627:therapeutic use*; D016638:Critical Illness; D019587:Dietary Supplements; D004731:Endotoxins / Q000097:blood; D004750:Enteral Nutrition / Q000379:methods; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D006801:Humans; D016867:Immunocompromised Host / Q000502:physiology*; D007153:Immunologic Deficiency Syndromes / Q000178:diet therapy* / Q000209:etiology / Q000378:metabolism; D050356:Lipid Metabolism; D011506:Proteins / Q000187:drug effects / Q000378:metabolism; D015398:Signal Transduction / Q000187:drug effects
D000276:Adjuvants, Immunologic; D000601:Amino Acids, Essential; D004731:Endotoxins; D015525:Fatty Acids, Omega-3; D011506:Proteins