Effect of c-reactive protein and interleukins blood levels in postsurgery arginine-enhanced enteral nutrition in head and neck cancer patients.
OBJECTIVE
It is known that the immune system is frequently affected in patients with head and neck cancer. Although immune dysfunction could be multifactorial, this immune system may be modulated by specific nutritional substrates, such as arginine. The aim of our study was to evaluate the effect of enteral nutrition supplemented with arginine on c-reactive protein (CRP), interleukin 6 (IL-6) and tumour necrosis factor (TNFalpha) in surgical head and neck cancer patients.


METHODS
Randomized trial.


METHODS
Tertiary care.


METHODS
A population of 36 patients with oral and laryngeal cancer were enrolled.


METHODS
At surgery patients were randomly allocated to two groups: (a) patients receiving an enteral diet supplements with arginine and dietary fibre (group I, n=18); (b) patients receiving an isocaloric, isonitrogenous enteral formula (group II, n=18). Perioperatively and on postoperative day 5 the following parameters were evaluated: serum values of prealbumin, transferrin, albumin, total number of lymphocytes, interleukin 6, tumour necrosis factor alpha and c-reactive protein.


RESULTS
The mean age was 59.6+/-10.9 y (two females/34 males). No significant intergroup differences in the trend of the three plasma proteins and weight were detected. CRP decreased in both groups (group I: 152.9+/-76.9 vs 68.9+/-82.5 mg/dl; P<0.05; and group II: 105.9+/-92 vs 43.6+/-59.1 mg/dl; P<0.05). Interleukin 6 did not change (group I: 16.3+/-12.3 vs 35.6+/-83.4 pg/ml; NS; and group II: 22.8+/-40 vs 9.9+/-17.7 pg/ml; NS). TNFalpha did not show any differences (group I: 4.6+/-1.6 vs 5.1+/-1.5 pg/ml; NS; and group II: 8.8+/-6.1 vs 5.8+/-1.7 pg/ml; NS). Lymphocytes increased in both groups (group I: 1405.6+/-517 vs 1634+/-529 x 10(6)/ml; P<0.05; and group II: 1355+/-696 vs 1561+/-541 x 10(6)/ml; P<0.05).


CONCLUSIONS
Enhanced formula did not change IL6 and TNFalpha levels. Further studies are needed to determine whether route of nutrition or type of formula is the key in these patients.
de Luis
D A
DA
Institute of Endocrinology and Nutrition, Medicine School and Hospital Rio Hortega, Valladolid, Spain. ddlr@pulso.com
Izaola
O
O
Cuellar
L
L
Terroba
M C
MC
Arranz
M
M
Fernandez
N
N
Aller
R
R
D001120:Arginine / Q000008:administration & dosage* / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis*; D004043:Dietary Fiber / Q000008:administration & dosage / Q000627:therapeutic use; D004750:Enteral Nutrition; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000601:surgery / Q000628:therapy*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008214:Lymphocytes / Q000097:blood; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000276:immunology / Q000517:prevention & control; D011182:Postoperative Care; D011183:Postoperative Complications / Q000276:immunology / Q000517:prevention & control; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D004043:Dietary Fiber; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D001120:Arginine