Effects of postoperative immune-enhancing enteral nutrition on the immune system, inflammatory responses, and clinical outcome.
OBJECTIVE
This study was conducted to evaluate the effects of postoperative immune enhancing enteral nutrition on the immune system, inflammatory responses, and clinical outcome of patients undergoing major abdominal surgery.


METHODS
This study was designed as a multicenter, prospective, randomized and controlled clinical trial. One hundred twenty-four patients undergoing major abdominal surgery were randomly assigned to receive either an immune enhancing enteral diet or an isocaloric and isonitrogenous control enteral diet for seven days. Enteral feeding was initiated 24 hours after surgery. Host immunity was evaluated by measuring levels of IgG, IgM, IgA, CD4, CD8, and CD4/CD8, and the inflammatory response was determined by assessing IL-1alpha, IL-2, IL-6, IL-10, and TNF-alpha levels. Infectious complications were also recorded.


RESULTS
One hundred twenty patients completed the study and four patients were excluded. On postoperative day 9, among patients receiving an immune enhancing diet, IgG, IgA, CD4 and CD4/CD8 levels were significantly higher and TNF-alpha and IL-6 concentrations were significantly lower compared to the control group. Moreover, among patients receiving an immune enhancing diet, when comparing preoperation to day 9 postoperation levels, increases in IgA, CD4, and CD4/CD8 levels were significantly higher than in control patients and increases in TNF-alpha concentrations were significantly lower. No statistically significant differences were found between the two groups with regard to infectious complications.


CONCLUSIONS
Postoperative administration of immune enhancing enteral nutrition in patients undergoing major abdominal surgery can positively modulate postoperative immunosuppressive and inflammatory responses.
Jiang
Xiao-hua
XH
School of Clinical Medicine, Medical College, Nanjing University, Nanjing 210002, China. dr_jxh@163.com.cn
Li
Ning
N
Zhu
Wei-ming
WM
Wu
Guo-hao
GH
Quan
Zhi-wei
ZW
Li
Jie-shou
JS
D000005:Abdomen / Q000601:surgery*; D015704:CD4 Antigens / Q000097:blood; D016516:CD4-CD8 Ratio; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007107:Immune System / Q000502:physiology*; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007249:Inflammation / Q000503:physiopathology*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D015704:CD4 Antigens; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha