title: Effectiveness of immunonutrient-enriched diets in the decrease of infections and mortality in the critically ill.
abstract: OBJECTIVE
  Pharmaconutrients have been shown in clinical and laboratory studies to modulate human and animal immune responses and thus to have potential benefits for the critically ill. However, reviews and meta-analyses continue to reflect controversy in the published research and a lack of agreement regarding these benefits. The objective of this study was to contribute to the resolution of such controversy by evaluating the effectiveness of immunonutrient-enriched diets in decreasing complications and mortality in patients with different critical illnesses.
  
  
  METHODS
  The present study is a meta-analysis of randomized clinical trials that evaluated the use of immunomodulating nutrients in critically ill adults. The PubMed and CINAHL datasets were searched.
  
  
  RESULTS
  Two hundred sixteen articles were initially found, but only 39 met the established inclusion criteria. In the general population, mortality did not show a statistically significant relative risk (RR) decrease (0.92, confidence interval [CI] 0.80-1.05); infection complications were decreased, with a general RR of 0.57 (CI 0.44-0.74) and an RR of 0.56 (CI 0.46-0.68) in surgical patients; and the sepsis incidence was decreased (RR 0.48, CI 0.27-0.83).
  
  
  CONCLUSIONS
  The administration of immunomodulating nutrient-enriched diets did not change the mortality of critically ill or surgical patients, but infection complications in critically ill patients, in particular the surgical population, were decreased. Explanatory clinical trials using isolated immunomodulating nutrients in different populations of critically ill patients followed by pragmatic trials based on clinical trial results should be considered in future research.
authors.affiliation: School of Nutrition, Federal University of the State of Rio de Janeiro, Urca, Rio de Janeiro, Brazil. regina_me@hotmail.com
authors.forename: Glória Regina
authors.initials: GR
authors.lastname: Mesquita da Silveira
authors.forename: Evandro Silva
authors.initials: ES
authors.lastname: Coutinho
mesh_terms: D000818:Animals; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy*; D004032:Diet; D005527:Food, Fortified; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D017053:Infection Control / Q000379:methods; D007239:Infections / Q000178:diet therapy / Q000276:immunology*; D011183:Postoperative Complications / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D018805:Sepsis / Q000517:prevention & control
chemical_list: D007155:Immunologic Factors