Antioxidant enriched enteral nutrition and oxidative stress after major gastrointestinal tract surgery

Table 1 Contents of Sondalis ISO^® and Module AOX

	Sondalis ISO® per 100 mL	Module AOX per unit
kcal	100	37
Protein (g)	3.8	7.4
Glutamine (g)	0.34	6
Cysteine (g)	0.03	2.5
Vitamin C (mg)	5.4	140
Vitamin E (mg)	1	30
Β-carotene (mg)	0	6
Zinc (mg)	1	6
Selenium (μg)	4.4	50

Table 2 Patient characteristics

	Control group	Treatment group	P-value
	n = 11	n = 10
Male/Female	9/2	6/4	0.3611
Age (yr)	62 (8)	57 (10)	0.2302
Smoking/not smoking	3/8	6/4	0.1981
Bodyweight (kg)	74 (19)	67 (12)	0.2452
Height (cm)	174 (5)	174 (12)	0.6972
Body Mass Index (kg/m2)	24 (5)	22 (3)	0.1812
Albumin (g/L)	38 (5)	39 (5)	0.4262
Chemotherapy prior to surgery (Yes/No)	4/7	5/5	0.6701
Surgery type (laparoscopic/open)	4/7	2/8	0.6351
Duration of surgery (min)	337 (100)	353 (155)	0.8882
Blood loss during surgery (mL)	2168 (1726)	1720 (1232)	0.6472
Admission ICU/MCU (d)	2.5 (0.7)	3.7 (0.8)	0.2362

¹Fischer’s Exact Test;

²Mann-Whitney U Test. Data expressed as mean (standard deviation).

Table 3 Tumour characteristics (mean)

	Control group	Treatment group	P-value
Tumour size (cm)	5.93 (n = 11)	5.11 n = 92	0.9704
Positive lymph nodes (number if present)	1.36 (n = 7)	3.00 n = 51	0.4124
Metastasis (observed during surgery/post-surgery histology)	27.3% (n = 11)	30% (n = 10)	1.0003

¹One patient had 10 positive lymph nodes;

²No information on one patient;

³Fischer’s Exact Test;

⁴Mann-Whitney U Test.

Table 4 Intake of anti-oxidant nutrients per day (mean)

		Days after surgery
		1	2	3	4	5	6	7
Glutamine (g)	Control	1.2	2.5	3.4	3.9	4.3	4.1	3.2
	Treatment	4.5	7.9	11	11	12	11	7.4
Cysteine (g)	Control	0.1	0.2	0.3	0.3	0.4	0.4	0.3
	Treatment	1.4	2.5	3.2	3.4	3.5	3.5	2.2
Vitamin C (mg)	Control	18	40	54	62	68	65	51
	Treatment	94	167	219	236	239	233	153
Vitamin E (mg)	Control	3.4	7.2	10	12	13	12	9.4
	Treatment	20	35	45	49	50	48	32
β-carotene (mg)	Control	-	-	-	-	-	-	-
	Treatment	3.1	5.5	7.1	7.4	7.6	7.5	4.9
Zinc (mg)	Control	3.4	7.2	10	12	13	12	9.4
	Treatment	7.1	13	17	19	19	18	12
Selenium (μg)	Control	15	32	44	50	55	53	41
	Treatment	43	77	103	113	114	110	73
Module AOX units given	Control	-	-	-	-	-	-	-
	Treatment	0.57	1.01	1.29	1.36	1.39	1.38	0.89

Table 5 Surgery-induced response [difference between preoperative day (-1) and day after surgery (1) & difference between treatment and control groups over time, before start of intervention]

	Group	Day -1	Day 1	P-value1	∆ control and treatment group over time2, P-value
Glutamine (μmol/L)	Control	557 (99)	434 (149)	0.021	0.888
	Treatment	596 (81)	457 (106)	0.007
Vitamin C (μmol/L)	Control	53.5 (24.9)	22.3 (10.3)	0.003	0.379
	Treatment	68.6 (27.9)	29.4 (15.5)	0.007
Vitamin E (μmol/L)	Control	27.4 (6.7)	11.0 (5.9)	0.003	0.458
	Treatment	29.1 (6.5)	10.9 (4.6)	0.005
β-carotene (μmol/L)	Control	0.67 (0.78)	0.20 (0.23)	0.003	0.916
	Treatment	0.81 (1.09)	0.32 (0.45)	0.005
Zinc (μmol/L)	Control	11.7 (2.1)	4.5 (2.1)	0.003	0.761
	Treatment	11.4 (2.6)	4.7 (2.0)	0.008
Selenium (μmol/L)	Control	1.27 (0.28)	0.77 (0.23)	0.003	0.305
	Treatment	1.19 (0.25)	0.78 (0.21)	0.008
MDA (μmol/L)	Control	10.29 (2.6)	12.61 (5.3)	0.091	0.035
	Treatment	10.32 (1.9)	9.35 (2.0)	0.285
GSH-Px (U/g Hb)	Control	12.67 (3.55)	12.00 (2.54)	0.423	0.359
	Treatment	11.75 (2.08)	12.05 (1.63)	0.415
Cysteine total (μmol/L)	Control	335 (46)	193 (40)	0.012	0.817
	Treatment	324 (39)	196 (56)	0.018
WBC (E9/L)	Control	9 (2.7)	11.5 (5.2)	0.142	0.751
	Treatment	6.5 (1.6)	9.9 (3.4)	0.022
IL-6 (pg/mL)	Control	10.7 (17.5)	261.7 (424.8)	0.003	1.000
	Treatment	3.0 (1.8)	337.2 (545.8)	0.005

Data expressed as mean (standard deviation); MDA = malondialdehyde; GSH-Px = glutathione peroxidase; creat = creatinine; Hb = hemoglobin; WBC = white blood cell count; IL-6 = interleukin 6;

¹Wilcoxon Signed Rank Test;

²Mann-Whitney U Test.

Table 6 Postoperative response; 3, 5, 7 d after surgery

	Group	Day 3, P	Day 5, P	Day 7, P
Glutamine (μmol/L)	Control	494 (82)	566 (137)	624 (279)
		0.821	0.349	0.151
	Treatment	503 (91)	512 (108)	544 (83)
Vitamin C (μmol/L)	Control	18.3 (7.3)	23.1 (11.2)	32.2 (32.7)
		0.123	0.014	0.602
	Treatment	31.9 (13.5)	41.9 (13.9)	46.8 (16.6)
Vitamin E (μmol/L)	Control	17.6 (8.7)	21.9 (9.6)	20.6 (9.1)
		0.130	0.293	0.185
	Treatment	19.5 (4.7)	23.8 (8.7)	25.8 (11.6)
β-carotene (μmol/L)	Control	0.28 (0.31)	0.30 (0.28)	0.19 (0.23)
		0.458	0.301	0.087
	Treatment	0.34 (0.46)	0.39 (0.43)	0.45 (0.45)
Zinc (μmol/L)	Control	6.6 (2.9)	8.7 (3.4)	9.7 (3.6)
		0.704	0.426	0.280
	Treatment	6.9 (2.5)	8.5 (3.1)	10.3 (3.0)
Selenium (μmol/L)	Control	0.74 (0.26)	0.98 (0.25)	0.99 (0.25)
		0.123	0.002	0.006
	Treatment	0.89 (0.32)	1.15 (0.36)	1.29 (0.39)
MDA (μmol/L)	Control	11.55 (3.94)	11.71 (2.19)	10.69 (2.58)
		0.104	0.392	0.095
	Treatment	11.04 (4.21)	10.13 (1.98)	11.01 (2.73)
GSH-Px (U/g Hb)	Control	11.29 (1.39)	11.44 (1.76)	10.85 (1.51)
		0.648	0.945	0.165
	Treatment	11.84 (1.63)	11.83 (1.72)	11.78 (1.63)
Cysteine total (μmol/L)	Control	253 (49)	295 (50)	307 (84)
		0.836	0.278	0.419
	Treatment	251 (52)	308 (73)	320 (85)
WBC (E9/L)	Control	10.8 (2.1)	9.7 (2.9)	10.9 (4.1)
		0.595	0.447	0.893
	Treatment	8.2 (2.4)	6.3 (1.3)	10.0 (3.8)
IL-6 (pg/mL)	Control	91.6 (165)	25.1 (25.8)	33.7 (39)
		0.547	0.708	0.650
	Treatment	43.5 (37.6)	28.1 (27.6)	20.1 (16.3)

Data expressed as mean (standard deviation); MDA = malondialdehyde; GSH-Px = glutathione peroxidase; creat = creatinine; Hb = hemoglobin; GEE-analysis was used for statistical analysis; P, difference between the treatment and control group over time, corrected for baseline.