title: Impact of early versus late enteral nutrition on cell mediated immunity and its relationship with glucagon like peptide-1 in intensive care unit patients: a prospective study.
abstract: BACKGROUND
  Glucagon-like peptide-1 (GLP-1) originates from the gastrointestinal system in response to the presence of nutrition in the intestinal lumen and potentiates postprandial insulin secretion. Also, it acts as an immune-modulator which has influences on cell-mediated immunity.
  
  
  METHODS
  The study was designed as a prospective, single-blinded study and carried out in the neurology intensive care unit (ICU) of a university hospital. Twenty-four naive patients with acute thromboembolic cerebrovascular events, with National Institute of Health (NIH) stroke scores between 12 and 16, were included. Any condition interfering with GLP-1 and immunity was regarded as exclusion criterion. Two patients died, and two dropped out of the study due to complicating conditions.
  
  
  RESULTS
  Group 1 and Group 2 exhibited similar GLP-1 levels in the pre-feeding and post-feeding periods for both the first time and the third day of enteral feeding. Also, no significant change in pre-/post-feeding GLP-1 levels was observed within groups. T-helper and T-regulatory cells increased, T-cytotoxic cells decreased significantly in Group 1 (P=0.02; P=0.036; P=0.0019), but remained the same in Group 2 after enteral feeding. Positive but statistically insignificant clinical effects in terms of predisposition to infections (10% vs 40%) and median time of ICU stay (10 vs 15 days) were observed in Group 1.
  
  
  CONCLUSIONS
  Depending on our findings, we propose that early enteral feeding may cause amelioration in cell-mediated immunity via factors other than GLP-1 in ICU patients with acute thromboembolic stroke. However, the possible deleterious effects of parenteral nutrition cannot be ruled out.
authors.forename: Okan
authors.initials: O
authors.lastname: Bakiner
authors.forename: Emre
authors.initials: E
authors.lastname: Bozkirli
authors.forename: Semih
authors.initials: S
authors.lastname: Giray
authors.forename: Zulfikar
authors.initials: Z
authors.lastname: Arlier
authors.forename: Ilknur
authors.initials: I
authors.lastname: Kozanoglu
authors.forename: Nurzen
authors.initials: N
authors.lastname: Sezgin
authors.forename: Cagla
authors.initials: C
authors.lastname: Sariturk
authors.forename: Eda
authors.initials: E
authors.lastname: Ertorer
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D004750:Enteral Nutrition / Q000379:methods* / Q000639:trends; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000097:blood*; D006801:Humans; D007111:Immunity, Cellular / Q000502:physiology*; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method; D013997:Time Factors
chemical_list: D015415:Biomarkers; D052216:Glucagon-Like Peptide 1