Effects of postoperative immune-enhancing enteral nutrition on the immune system, inflammatory responses, and clinical outcome
Jiang, X-hua.; Li, N.; Zhu, W-ming.; Wu, G-hao.; Quan, Z-wei.; Li, J-shou.
Chinese Medical Journal 117(6): 835-839
2004
ISSN/ISBN: 0366-6999 PMID: 15198882 Document Number: 579908
Objective: This study was conducted, in China between January 2001 and January 2002, to evaluate the effects of postoperative immune enhancing enteral nutrition on the immune system, inflammatory responses, and clinical outcome of patients undergoing major abdominal surgery. Methods: This study was designed as a multicenter, prospective, randomized and controlled clinical trial. 124 patients undergoing major abdominal surgery were randomly assigned to receive either an immune enhancing enteral diet or an isocaloric and isonitrogenous control enteral diet for 7 days. Enteral feeding was initiated 24 hours after surgery. Host immunity was evaluated by measuring levels of IgG, IgM, IgA, CD4, CD8, and CD4/CD8, and the inflammatory response was determined by assessing IL-1 alpha , IL-2, IL-6, IL-10, and TNF- alpha levels. Infectious complications were also recorded. Results: 120 patients completed the study and 4 patients were excluded. On postoperative day 9, among patients receiving an immune enhancing diet, IgG, IgA, CD4 and CD4/CD8 levels were significantly higher and TNF- alpha and IL-6 concentrations were significantly lower compared to the control group. Moreover, among patients receiving an immune enhancing diet, when comparing preoperation to day 9 postoperation levels, increases in IgA, CD4, and CD4/CD8 levels were significantly higher than in control patients and increases in TNF- alpha concentrations were significantly lower. No statistically significant differences were found between the two groups with regard to infectious complications. Conclusions: Postoperative administration of immune enhancing enteral nutrition in patients undergoing major abdominal surgery can positively modulate postoperative immunosuppressive and inflammatory responses.