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World J Gastroenterol. Dec 7, 2008; 14(45): 6960-6969
Published online Dec 7, 2008. doi: 10.3748/wjg.14.6960
Antioxidant enriched enteral nutrition and oxidative stress after major gastrointestinal tract surgery
Mireille FM van Stijn, Gerdien C Ligthart-Melis, Petra G Boelens, Peter G Scheffer, Tom Teerlink, Jos WR Twisk, Alexander PJ Houdijk, Paul AM van Leeuwen
Mireille FM van Stijn, Department of Surgery, VU University Medical Center Amsterdam, Amsterdam and Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
Gerdien C Ligthart-Melis, Department of Surgery, VU University Medical Center Amsterdam, de Boelelaan 1105, 1007 MB, Amsterdam, The Netherlands
Petra G Boelens, Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
Peter G Scheffer, Department of Clinical Chemistry, VU University Medical Center Amsterdam, de Boelelaan 1105, 1007 MB Amsterdam, The Netherlands
Tom Teerlink, Department of Clinical Chemistry, VU University Medical Center Amsterdam, de Boelelaan 1105, 1007 MB, Amsterdam, The Netherlands
Jos WR Twisk, Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, de Boelelaan 1105, 1007 MB, Amsterdam, The Netherlands
Alexander PJ Houdijk, Department of Surgery, Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
Paul AM van Leeuwen, Department of Surgery, VU University Medical Center Amsterdam, de Boelelaan 1105, 1007 MB, Amsterdam, The Netherlands
Author contributions: Boelens PG and van Leeuwen PAM designed the research; Boelens PG and Ligthart-Melis GC performed the research; Scheffer PG, and Teerlink T contributed analytical tools; Boelens PG, Ligthart-Melis GC, van Stijn MFM, Twisk JWR analyzed the data; Ligthart-Melis GC, van Stijn MFM, Houdijk APJ and van Leeuwen PAM wrote the manuscript.
Supported by Grant of Nestlé Nutrition
Correspondence to: Paul AM van Leeuwen, Professor, Depart-ment of Surgery, VU University Medical Center Amsterdam, PO box 7057, 1007 MB Amsterdam, The Netherlands. pam.vleeuwen@vumc.nl
Telephone: +31-20-4444444-6412 Fax: +31-20-4443620
Received: June 18, 2008
Revised: October 18, 2008
Accepted: October 25, 2008
Published online: December 7, 2008
Abstract

AIM: To investigate the effects of an enteral supple-ment containing antioxidants on circulating levels of antioxidants and indicators of oxidative stress after major gastrointestinal surgery.

METHODS: Twenty-one patients undergoing major upper gastrointestinal tract surgery were randomised in a single centre, open label study on the effect of postoperative enteral nutrition supplemented with antioxidants. The effect on circulating levels of antioxidants and indicators of oxidative stress, such as F2-isoprostane, was studied.

RESULTS: The antioxidant enteral supplement showed no adverse effects and was well tolerated. After surgery a decrease in the circulating levels of antioxidant parameters was observed. Only selenium and glutamine levels were restored to pre-operative values one week after surgery. F2-isoprostane increased in the first three postoperative days only in the antioxidant supplemented group. Lipopolysaccharide binding protein (LBP) levels decreased faster in the antioxidant group after surgery.

CONCLUSION: Despite lower antioxidant levels there was no increase in the circulating markers of oxidative stress on the first day after major abdominal surgery. The rise in F2-isoprostane in patients receiving the antioxidant supplement may be related to the conversion of antioxidants to oxidants which raises questions on antioxidant supplementation. Module AOX restored the postoperative decrease in selenium levels. The rapid decrease in LBP levels in the antioxidant group suggests a possible protective effect on gut wall integrity. Further studies are needed on the role of oxidative stress on outcome and the use of antioxidants in patients undergoing major abdominal surgery.

Keywords: Antioxidants; Critical illness; Enteral nutrition; Oxidative stress; Surgery; Upper gastrointe-stinal tract