Original Articles
Copyright ©The Author(s) 2001. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 15, 2001; 7(3): 357-362
Published online Jun 15, 2001. doi: 10.3748/wjg.v7.i3.357
Modulation of postoperative immune and inflammatory response by immune-enhancing enteral diet in gastrointestinal cancer patients
Guo-Hao Wu, Yan-Wei Zhang, Zhao-Han Wu
Guo-Hao Wu, Yan-Wei Zhang, Zhao-Han Wu, Department of General Surgery, Zhongshan Hospital, Shanghai Medical University, Shanghai 200032, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Guo-Hao Wu, Department of General Surgery, Zhongshan Hospital, Shanghai Medical University, Shanghai 200032, China. wughmc@online.sh.cn
Telephone: +86-21-64041990 Fax: 0086-21-4038472
Received: February 6, 2001
Revised: April 3, 2001
Accepted: April 12, 2001
Published online: June 15, 2001
Abstract

AIM: To evaluate if the administration of an enteral diet supplemented with glutamine, arginine and ω-3 fatty acids modulates inflammatory and immune responses after surgery.

METHODS: A prospective randomized double-blind, clinical trial was performed. Forty-eight patients with gastrointestinal cancer were randomized into two groups, one group was given an isocaloric and isonitrogenous standard diet and the other was fed with the supplemented diet with glutamine, arginine and ω-3 fatty acids. Feedings were started within 48 h after operation, and continued until day 8. All variables were measured before operation and on postoperative day 1 and 8. Immune responses were determined by phagocytosis ability, respiratory burst of polymorphonuclear cells, total lymphocytes lymphocyte subsets, nitric oxide, cytokines concentration, and inflammatory responses by plasma levels of C-reactive protein, prostaglandin E2 level.

RESULTS: Tolerance of both formula diets was excellent. There were significant differences in the immunological and inflammatory responses between the two groups. In supplemented group, phagocytosis and respiratory burst after surgery was higher and C-reactive protein level was lower (P < 0.01) than in the standard group. The supplemented group had higher levels of nitric oxide, total lymphocytes, T lymphocytes, T-helper cells, and NK cells. Postoperative levels of IL-6 and TNF-α were lower in the supplemented group (P < 0.05).

CONCLUSION: It was clearly established in this trial that early postoperative enteral feeding is safe in patients who have undergone major operations for gastrointestinal cancer. Supplementation of enteral nutrition with glutamine, arginine, and ω-3 fatty acids positively modulated postsurgical immunosuppressive and inflammatory responses.

Keywords: gastrointestinal neoplasms/surgery; enteral nutrition; immunity; inflammation; postoperative period