Abstract
Objective: To study the effect of the route of delivery and the formulation of the postoperative nutritional support on host defense, protein metabolism, infectious complications, and outcome. Methods: This was a prospective, randomised, clinical trial involving two hundred and sixty subjects who were candidate for pancreatoduodenectomy or gastrectomy for cancer. The patients were randomly allocated to three groups during surgery. Starting 6 hours after operation, the first group received a standard enteral formula (standard group; n = 87); the second the same enteral formula enriched with arginine, omega-3 fatty acids, and RNA (immunonutrition group; n = 87), and the third total parenteral nutrition (parenteral group; n = 86). The three regimens were isocaloric and isonitrogenous. The nutritional goal was 25 kcal/kg/day. Immune response was studied by the phagocytosis ability of polymorphonuclear cells (PMNs), interleukin 2 receptors (IL-2R), delayed hypersensitivity response (DHR) as well as protein synthesis by interleukin 6 (IL-6) and prealbumin (PA). Tolerance of enteral feeding, incidence of postoperative complications, and length of hospital stay (LOS) were also reduced. Results: Subjects receiving immunonutrition had a significantly better recovery of the immune parameters, a reduced synthesis of IL-6 and and increased production of PA on postoperative day 8 compared to the other two groups. Only 6.3% of the enterally fed patients did not reach the nutritional goal. The postoperative infection rate was 14.9% in the immunonutrition group, 22.9% in the standard group, and 27.9% in the parenteral group (p = 0.06). LOS was 16.1 ± 6.2 days, 19.2 ± 7.9, and 21.6 ± 8.9 in the immunonutrition, standard and parenteral group, respectively (p <0.005). Conclusion: Early postoperative enteral feeding is a valid alternative to parenteral nutrition in surgical patients. Immunonutrition ameliorates the immune response, induces a switch from acute phase proteins to constitutive proteins, and improves outcome.
| Original language | Italian |
|---|---|
| Pages (from-to) | 173-182 |
| Number of pages | 10 |
| Journal | Rivista Italiana di Nutrizione Parenterale ed Enterale |
| Volume | 16 |
| Issue number | 3 |
| Publication status | Published - 1998 |
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ASJC Scopus subject areas
- Food Science
- Anatomy
- Critical Care and Intensive Care Medicine
- Nutrition and Dietetics
Cite this
Effetto della via di somministrazione e della formulazione dei supporti nutrizionali postoperatori sulla risposta metabolico-immunitaria e sull'outcome postoperatorio. / Gianotti, L.; Braga, M.; Vignali, A.; Bisagni, P.; Di Carlo, V.
In: Rivista Italiana di Nutrizione Parenterale ed Enterale, Vol. 16, No. 3, 1998, p. 173-182.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effetto della via di somministrazione e della formulazione dei supporti nutrizionali postoperatori sulla risposta metabolico-immunitaria e sull'outcome postoperatorio
AU - Gianotti, L.
AU - Braga, M.
AU - Vignali, A.
AU - Bisagni, P.
AU - Di Carlo, V.
PY - 1998
Y1 - 1998
N2 - Objective: To study the effect of the route of delivery and the formulation of the postoperative nutritional support on host defense, protein metabolism, infectious complications, and outcome. Methods: This was a prospective, randomised, clinical trial involving two hundred and sixty subjects who were candidate for pancreatoduodenectomy or gastrectomy for cancer. The patients were randomly allocated to three groups during surgery. Starting 6 hours after operation, the first group received a standard enteral formula (standard group; n = 87); the second the same enteral formula enriched with arginine, omega-3 fatty acids, and RNA (immunonutrition group; n = 87), and the third total parenteral nutrition (parenteral group; n = 86). The three regimens were isocaloric and isonitrogenous. The nutritional goal was 25 kcal/kg/day. Immune response was studied by the phagocytosis ability of polymorphonuclear cells (PMNs), interleukin 2 receptors (IL-2R), delayed hypersensitivity response (DHR) as well as protein synthesis by interleukin 6 (IL-6) and prealbumin (PA). Tolerance of enteral feeding, incidence of postoperative complications, and length of hospital stay (LOS) were also reduced. Results: Subjects receiving immunonutrition had a significantly better recovery of the immune parameters, a reduced synthesis of IL-6 and and increased production of PA on postoperative day 8 compared to the other two groups. Only 6.3% of the enterally fed patients did not reach the nutritional goal. The postoperative infection rate was 14.9% in the immunonutrition group, 22.9% in the standard group, and 27.9% in the parenteral group (p = 0.06). LOS was 16.1 ± 6.2 days, 19.2 ± 7.9, and 21.6 ± 8.9 in the immunonutrition, standard and parenteral group, respectively (p <0.005). Conclusion: Early postoperative enteral feeding is a valid alternative to parenteral nutrition in surgical patients. Immunonutrition ameliorates the immune response, induces a switch from acute phase proteins to constitutive proteins, and improves outcome.
AB - Objective: To study the effect of the route of delivery and the formulation of the postoperative nutritional support on host defense, protein metabolism, infectious complications, and outcome. Methods: This was a prospective, randomised, clinical trial involving two hundred and sixty subjects who were candidate for pancreatoduodenectomy or gastrectomy for cancer. The patients were randomly allocated to three groups during surgery. Starting 6 hours after operation, the first group received a standard enteral formula (standard group; n = 87); the second the same enteral formula enriched with arginine, omega-3 fatty acids, and RNA (immunonutrition group; n = 87), and the third total parenteral nutrition (parenteral group; n = 86). The three regimens were isocaloric and isonitrogenous. The nutritional goal was 25 kcal/kg/day. Immune response was studied by the phagocytosis ability of polymorphonuclear cells (PMNs), interleukin 2 receptors (IL-2R), delayed hypersensitivity response (DHR) as well as protein synthesis by interleukin 6 (IL-6) and prealbumin (PA). Tolerance of enteral feeding, incidence of postoperative complications, and length of hospital stay (LOS) were also reduced. Results: Subjects receiving immunonutrition had a significantly better recovery of the immune parameters, a reduced synthesis of IL-6 and and increased production of PA on postoperative day 8 compared to the other two groups. Only 6.3% of the enterally fed patients did not reach the nutritional goal. The postoperative infection rate was 14.9% in the immunonutrition group, 22.9% in the standard group, and 27.9% in the parenteral group (p = 0.06). LOS was 16.1 ± 6.2 days, 19.2 ± 7.9, and 21.6 ± 8.9 in the immunonutrition, standard and parenteral group, respectively (p <0.005). Conclusion: Early postoperative enteral feeding is a valid alternative to parenteral nutrition in surgical patients. Immunonutrition ameliorates the immune response, induces a switch from acute phase proteins to constitutive proteins, and improves outcome.
KW - Cytokine
KW - Enteral nutrition
KW - Immunity
KW - Neoplasm
KW - Outcome
KW - Parenteral nutrition
KW - Postoperative complications
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=0031773855&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0031773855&partnerID=8YFLogxK
M3 - Articolo
AN - SCOPUS:0031773855
VL - 16
SP - 173
EP - 182
JO - Rivista Italiana di Nutrizione Parenterale ed Enterale
JF - Rivista Italiana di Nutrizione Parenterale ed Enterale
SN - 0393-5582
IS - 3
ER -