Effetto della via di somministrazione e della formulazione dei supporti nutrizionali postoperatori sulla risposta metabolico-immunitaria e sull'outcome postoperatorio

Translated title of the contribution: Route and composition of postoperative nutritional support: Impact on immune-metabolic response and postoperative outcome

L. Gianotti, M. Braga, A. Vignali, P. Bisagni, V. Di Carlo

Research output: Contribution to journalArticle

3 Citations (Scopus)

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 languageItalian
Pages (from-to)173-182
Number of pages10
JournalRivista Italiana di Nutrizione Parenterale ed Enterale
Volume16
Issue number3
Publication statusPublished - 1998

Fingerprint

Nutritional Support
nutritional support
Length of Stay
prealbumin
enteral feeding
interleukin-6
Prealbumin
Enteral Nutrition
immune response
Small Intestine
Interleukin-6
postoperative complications
randomized clinical trials
delayed hypersensitivity
acute phase proteins
total parenteral nutrition
parenteral feeding
interleukin-2
protein metabolism
phagocytosis

ASJC Scopus subject areas

  • Food Science
  • Anatomy
  • Critical Care and Intensive Care Medicine
  • Nutrition and Dietetics

Cite this

@article{65d62b1e9eea464ab9e42f6ae6e71a18,
title = "Effetto della via di somministrazione e della formulazione dei supporti nutrizionali postoperatori sulla risposta metabolico-immunitaria e sull'outcome postoperatorio",
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.",
keywords = "Cytokine, Enteral nutrition, Immunity, Neoplasm, Outcome, Parenteral nutrition, Postoperative complications, Surgery",
author = "L. Gianotti and M. Braga and A. Vignali and P. Bisagni and {Di Carlo}, V.",
year = "1998",
language = "Italian",
volume = "16",
pages = "173--182",
journal = "Rivista Italiana di Nutrizione Parenterale ed Enterale",
issn = "0393-5582",
publisher = "Wichtig Publishing",
number = "3",

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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

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AN - SCOPUS:0031773855

VL - 16

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EP - 182

JO - Rivista Italiana di Nutrizione Parenterale ed Enterale

JF - Rivista Italiana di Nutrizione Parenterale ed Enterale

SN - 0393-5582

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