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

Abstract

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.

Immunoenhanced enteral nutrition, effect on inflammatory markers in head and neck cancer patients

“…There is evidence suggesting that enteral nutrition, supplemented with different agents including arginine and dietary fiber, improve immune function and reduce postoperative complications, in head and neck cancer patients (Van Bokhorstde van der Schueren et al, 2001) (De Luis et al, 2002). Our group (De Luis et al, 2003) did not find influence on interleukins blood levels with an arginine-enhanced enteral formula in a randomized clinical trial with two intervention groups. These groups have two differences in enteral formulas (arginine and fiber).…”

“…Our group (De Luis et al, 2003) showed no differences between two enteral formulas (arginine-and fiber-enhanced formula vs no arginine and no fiber formula) (De Luis et al, 2003). In this study, perhaps fiber could bias results, due to dietary fiber contained in arginine-enhanced formula and no in control group.…”

“…In our new study, with only arginine as different nutrient between both enteral formulas, IL6 and CRP levels decreased in both groups. Perhaps, this decrease in IL-6 levels, previously designed (de Luis et al, 2003) showed only a decrease in CRP, are due to different genetic status of patients (TNFa polymorphisms) (Jacob et al, 1990) or other analytical aspects.…”

A systematic review of the role of immunonutrition in patients undergoing surgery for head and neck cancer

“…It may be difficult to detect any effects on postoperative outcomes in trials conducted at a late stage of disease. Six trials came from one centre [2][3][4][5][6][7] and all trials had methodological limitations. The aspects of trial quality most consistently associated with treatment effect estimates were concealment of the allocation sequence and double blinding 17 .…”

“…Ten randomised controlled trials published between 1999 and 2004 were identified with a total of 605 patients all undergoing surgery for head and neck for cancer (Tables 1 and 2) [2][3][4][5][6][7]11,16,18,20,21 . Additional unpublished data were obtained for the DE LUIS et al 2,3,5,6 and RISO et al 16 studies (these data contained methodology, patient characteristics, operation types and outcomes).…”