Clinical outcome and immunology of postoperative arginine, ω-3 fatty acids, and nucleotide-enriched enteral feeding: A randomized prospective comparison with standard enteral and low calorie/low fat IV solutions

Schilling, Julian; Vranješ, N.; Fierz, Walter; Joller, H.; Gyurech, D; Ludwig, Elisabeth; Marathias, Katerina; Geroulanos, S

doi:10.1016/s0899-9007(96)00096-2

Cited by 103 publications

(64 citation statements)

References 14 publications

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“…Likewise, meta-analysis of 2 RCTs, both providing postoperative support in patients with gastrointestinal cancer demonstrated no significant effect from ETF vs. PN on the CRP (16.60 mg/l, 95% CI -43.33 to 79.53; Table III) (83,118). This is supported by the findings of another RCT (115); however, 2 other RCTs demonstrated a significantly lower CRP following ETF compared to PN (76,117).…”

Section: Haematological and Biochemical Outcomesmentioning

confidence: 82%

“…These included 9 RCTs (82,84,90,104,111,120,123,125,126) and 1 non-RCT (116) comparing nutritional support with routine care, 3 RCTs comparing EPA provided as either enriched ETF (102,124) or capsules (46) with routine care, and 15 RCTs comparing ETF with PN (76,80,83,85,86,90,93,98,103,112,115,117,118,122,127). One study provided data both for analysis of nutritional support vs. routine care, and ETF vs. PN (90).…”

Section: Resultsmentioning

confidence: 99%

“…The majority (n=23) utilised ETF, with only 4 studies using ONS (84,104) or a combination of oral and tube routes (46,82). The type of cancer varied; most (n=24) were gastrointestinal (46,76,80,(82)(83)(84)(85)(86)90,93,98,(102)(103)(104)111,112,115,117,118,120,(123)(124)(125)127), with 3 studies on patients with head/neck (116,126) and liver cancer (122).…”

Section: Resultsmentioning

confidence: 99%

“…Meta-analysis demonstrated no significant differences between ETF and PN in the proportion of CD3-positive lymphocytes (0.50%, 95% CI -5.24 to 6.24) using data from 2 RCTs, both providing postoperative ETF vs. PN in patients with gastrointestinal cancer (85,118), (including jejunostomy, nasogastric, nasoduodenal, and nasojejunal).…”

Section: Haematological and Biochemical Outcomesmentioning

confidence: 94%

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Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Elia

Schueren

Garvey³

et al. 2006

Int J Oncol

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Abstract. The aim of this systematic review was to determine the efficacy and potential benefits of enteral nutritional support [oral nutritional supplements (ONS) or enteral tube feeding (ETF)], and eicosapentaenoic acid (EPA, free acid, ethyl esters or fish oil; provided as capsules or enriched ONS or ETF) in patients with cancer. Clinical studies were identified using electronic databases, and studies were selected according to predetermined criteria. For each treatment modality (chemo/radiotherapy, surgery, and palliative care), the comparisons of interest were nutritional support vs. routine care (no nutritional support), EPA supplement (capsule or enriched ONS or ETF) vs. routine care (no supplement or standard supplement), ETF vs. parenteral nutrition (PN). The reviewed outcomes were dietary intake, anthropometry, clinical (mortality, length of hospital stay, complications, and quality of life) and haematological/biochemical (white blood cell count, serum transferrin and albumin, CD3-positive lymphocytes, and inflammatory markers). Meta-analyses were performed where possible. In patients undergoing radiotherapy, meta-analysis showed that ONS significantly increase dietary intake (381 kcal/day, 95% CI 193 to 569 in 3 RCTs) compared to routine care. In patients undergoing surgery, meta-analyses showed that ETF results in a significantly shorter length of hospital stay (1.72 fewer days, 95% CI 0.90 to 2.54 in 8 RCTs), lower incidence of any complications (OR 0.62, 95% CI 0.50 to 0.77 in 4 RCTs) and infectious complications (OR 0.67, 95% CI 0.55 to 0.82 in 11 RCTs) and lower sepsis scores (2.21 points, 95% CI 1.49 to 2.92 in 2 RCTs), but no difference in mortality (OR 0.72, 95% CI 0.40 to 1.29 in 7 RCTs) compared to PN. There was also no difference in mortality between ONS or ETF vs. routine care in patients undergoing chemotherapy/radiotherapy (OR 1.00, 95% CI 0.62-1.61 in 4 RCTs) or surgery (OR 2.44, 95% CI 0.75 to 7.95 in 4 RCTs). Individual studies of EPA supplementation as capsules showed improvements in survival, complications and inflammatory markers in patients undergoing bone marrow transplant (BMT). In palliative care patients receiving EPA-enriched ONS or capsules, there were inconsistent positive effects on survival and quality of life. In those undergoing surgery, EPA-enriched ETF had no effect. Further research is required to elucidate the clinical efficacy of enteral nutrition support, including the potential benefits of EPA supplementation, in patients with cancer.

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Section: Haematological and Biochemical Outcomesmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Haematological and Biochemical Outcomesmentioning

confidence: 94%

See 2 more Smart Citations

Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Elia

Schueren

Garvey³

et al. 2006

Int J Oncol

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“…CRP decreased in both groups and lymphocyte counts increased. Schilling et al (1996) did not find significant differences in phagocytic activity of monocytes, activated surface antigen HLA-DR, and CRP levels between a control formula and a formula supplemented with arginine, omega 3 fatty acids and nucleotides; however both formulas were better than a low energy=low fat intravenous solution. However, Taylor et al (1999) showed a decrease in CRP levels in head injury patients treated with an enhanced formula without differences in other biochemical parameters.…”

Section: Discussionmentioning

confidence: 60%

Effect of c-reactive protein and interleukins blood levels in postsurgery arginine-enhanced enteral nutrition in head and neck cancer patients

et al. 2003

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Objective: It is known that the immune system is frequently affected in patients with head and neck cancer. Although immune dysfunction could be multifactorial, this immune system may be modulated by specific nutritional substrates, such as arginine. The aim of our study was to evaluate the effect of enteral nutrition supplemented with arginine on c-reactive protein (CRP), interleukin 6 (IL-6) and tumour necrosis factor (TNFa) in surgical head and neck cancer patients. Design: Randomized trial. Setting: Tertiary care. Subjects: A population of 36 patients with oral and laryngeal cancer were enrolled. Interventions: At surgery patients were randomly allocated to two groups: (a) patients receiving an enteral diet supplements with arginine and dietary fibre (group I, n ¼ 18); (b) patients receiving an isocaloric, isonitrogenous enteral formula (group II, n ¼ 18). Perioperatively and on postoperative day 5 the following parameters were evaluated: serum values of prealbumin, transferrin, albumin, total number of lymphocytes, interleukin 6, tumour necrosis factor a and c-reactive protein.Results: The mean age was 59.6 AE 10.9 y (two females=34 males). No significant intergroup differences in the trend of the three plasma proteins and weight were detected. CRP decreased in both groups (group I: 152.9 AE 76.9 vs 68.9 AE 82.5 mg=dl; P < 0.05; and group II: 105.9 AE 92 vs 43.6 AE 59.1 mg=dl; P < 0.05). Interleukin 6 did not change (group I: 16.3 AE 12.3 vs 35.6 AE 83.4 pg=ml; NS; and group II: 22.8 AE 40 vs 9.9 AE 17.7 pg=ml; NS). TNFa did not show any differences (group I: 4.6 AE 1.6 vs 5.1 AE 1.5 pg=ml; NS; and group II: 8.8 AE 6.1 vs 5.8 AE 1.7 pg=ml; NS). Lymphocytes increased in both groups (group I: 1405.6 AE 517 vs 1634 AE 529Â10 6 =ml; P < 0.05; and group II: 1355 AE 696 vs 1561 AE 541Â10 6 =ml; P < 0.05). Conclusions: Enhanced formula did not change IL6 and TNFa levels. Further studies are needed to determine whether route of nutrition or type of formula is the key in these patients.

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Should Immunonutrition Become Routine in Critically Ill Patients?

Heyland

Novák²,

Drover³

et al. 2001

JAMA

834

444

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Clinical outcome and immunology of postoperative arginine, ω-3 fatty acids, and nucleotide-enriched enteral feeding: A randomized prospective comparison with standard enteral and low calorie/low fat IV solutions

Cited by 103 publications

References 14 publications

Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

Effect of c-reactive protein and interleukins blood levels in postsurgery arginine-enhanced enteral nutrition in head and neck cancer patients

Should Immunonutrition Become Routine in Critically Ill Patients?

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