title: Continuous administration of enteral lipid- and protein-rich nutrition limits inflammation in a human endotoxemia model.
abstract: OBJECTIVE
  An overzealous inflammatory response is an important cause of morbidity and mortality in surgical, trauma, and critically ill patients. Enteral administration of lipid-rich nutrition was previously shown to attenuate inflammation and reduce organ damage via a cholecystokinin-1 receptor-mediated vagovagal reflex in animal studies. The current preclinical study investigates the immunomodulatory potential of a custom-made enteral nutrition during systemic inflammation in man.
  
  
  METHODS
  Double-blind, randomized controlled trial.
  
  
  METHODS
  Intensive care research unit.
  
  
  METHODS
  Male volunteers.
  
  
  METHODS
  After an overnight fast, 18 healthy male subjects received an IV bolus of Escherichia coli lipopolysaccharide (2 ng/kg). Subjects in the fasted group (n = 6) were deprived of food throughout the study, while subjects in the intervention groups were fed either custom-made lipid- and protein-rich nutrition (n = 6) or isocaloric control nutrition (n = 6) via nasojejunal tube, starting 1 hour prior to lipopolysaccharide administration until 6 hours afterward.
  
  
  RESULTS
  Bolus lipopolysaccharide administration resulted in a marked inflammatory response. Continuous postpyloric administration of nutrition significantly increased plasma cholecystokinin levels throughout the lipopolysaccharide-induced inflammatory response. Lipid- and protein-rich nutrition attenuated circulating levels of the proinflammatory cytokines tumor necrosis factor-α and interleukin-6 and the interleukin-1 receptor antagonist compared with control nutrition (all p < 0.05) and fasted subjects (all p < 0.05). In additional, lipid- and protein-rich nutrition augmented the anti-inflammatory response, reflected by increased plasma levels of interleukin-10 compared with fasted subjects (p < 0.0001).
  
  
  CONCLUSIONS
  The current preclinical study expands the immunomodulating effects of enteral nutrition as previously observed in rodents to man. Continuous administration of enteral nutrition resulted in a rapid anti-inflammatory effect. Furthermore, enrichment of the nutritional composition with lipid and protein was shown to enhance the anti-inflammatory potential. Therefore, continuous enteral administration of lipid- and protein-rich nutrition is a promising intervention to modulate the immune response in the early course of systemic inflammation in man.
authors: Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands. T.Lubbers@maastrichtuniversity.nl
authors: Tim
authors: T
authors: Lubbers
authors: Matthijs
authors: M
authors: Kox
authors: Jacco-Juri
authors: JJ
authors: de Haan
authors: Jan Willem
authors: JW
authors: Greve
authors: Jan C
authors: JC
authors: Pompe
authors: Bart P
authors: BP
authors: Ramakers
authors: Peter
authors: P
authors: Pickkers
authors: Wim A
authors: WA
authors: Buurman
mesh_terms: D000328:Adult; D004044:Dietary Proteins / Q000008:administration & dosage*; D004311:Double-Blind Method; D019446:Endotoxemia / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008055:Lipids / Q000008:administration & dosage*; D008297:Male; D008954:Models, Biological; D011134:Polysaccharides / Q000494:pharmacology; D012016:Reference Values; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D004044:Dietary Proteins; D008055:Lipids; D011134:Polysaccharides