Immunonutrition vs Standard Nutrition for Cancer Patients: A Systematic Review and Meta‐Analysis (Part 1)

Abstract

The aim of this study was to determine the efficacy of immunonutrition vs standard nutrition in cancer patients treated with surgery. Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, EBSCOhost, and Web of Science were searched. Sixty‐one randomized controlled trials were included. Immunonutrition was associated with a significantly reduced risk of postoperative infectious complications (risk ratio [RR] 0.71 [95% CI, 0.64–0.79]), including a reduced risk of wound infection (RR 0.72 [95% CI, 0.60–0.87]), respiratory tract infection (RR 0.70 [95% CI, 0.59–0.84]), and urinary tract infection (RR 0.69 [95% CI, 0.51–0.94]) as well as a decreased risk of anastomotic leakage (RR 0.70 [95% CI, 0.53–0.91]) and a reduced hospital stay (MD −2.12 days [95% CI −2.72 to −1.52]). No differences were found between the 2 groups with regard to sepsis or all‐cause mortality. Subgroup analyses revealed that receiving arginine + nucleotides + ω‐3 fatty acids and receiving enteral immunonutrition reduced the rates of wound infection and respiratory tract infection. The application of immunonutrition at 25–30 kcal/kg/d for 5–7 days reduced the rate of respiratory tract infection. Perioperative immunonutrition reduced the rate of wound infection. For malnourished patients, immunonutrition shortened the hospitalization time. Therefore, immunonutrition reduces postoperative infection complications and shortens hospital stays but does not reduce all‐cause mortality. Patients who are malnourished before surgery who receive arginine + nucleotides + ω‐3 fatty acids (25–30 kcal/kg/d) via the gastrointestinal tract during the perioperative period (5–7 days) may show better clinical efficacy.

Immunonutrition Changes Inflammatory Response in Colorectal Cancer: Results from a Pilot Randomized Clinical Trial

“…There were differences in deep neutrophil infiltration before and after intervention in both groups, without any statistical significance. We did not observe any differences between the groups with respect to morbidity (immune group, 4 (28.5%); control group, 3 (25%); p = 0.9095), length of hospital stay (immune group, 5 [4][5][6][7][8][9][10][11][12][13][14][15]; control group, 5 [4][5][6][7][8][9] (median (IQR)); p = 0.8402) There was no mortality and only one readmission in the control group.…”

“…While the use of nutritional support to prevent or treat malnutrition in the preoperative period does not raise wider concerns, the use of immunonutrition (nutritional support containing components that interfere with the immune system: arginine, glutamine, omega-3 fatty acids, nucleotides, and zinc) is not widely accepted. The positive impact of immunonutrition compared with standard nutritional support in the reduction of postoperative infectious complications and other surgical outcomes has been reported [ 5 , 6 ]. However, this only refers to short-term clinical outcomes.…”

Dietary restriction of amino acids for Cancer therapy

“…Immunonutrition has been investigated for decades, including arginine, glutamine, cysteine, n-3 fatty acids, nucleotides vitamins and trace elements [99]. However, according to the latest systematic review and metaanalysis [100], immunonutrition alone didn't reduce allcause mortality of cancer patients although reduces postoperative infection complications. In 1998, Vanderhoof conjectured the immunomodulatory effects of carbohydrates, which had little attention and few literature at that time [101].…”

Targeting zinc metalloenzymes in coronavirus disease 2019

“…This strategy is often used in critical illnesses (Calder, 2003). For example, a meta‐analysis of 61 randomized controlled trials on immunonutrition in cancer patients has shown that immunonutrition was associated with reduced risk of post‐operative infectious complications, including reduced risk for respiratory tract infection (Yu et al, 2019), compared with standard nutrition. In the study on immunonutrition in COVID‐19, patients with confirmed SARS‐Cov‐2 infection, who do not require intensive care unit admission, will receive oral nutrition supplement (ONS) enriched in eicosapentaenoic acid (EPA), γ‐linolenic acid (GLA), vitamin A, vitamin C, vitamin E, selenium and 5.7‐mg zinc (Oxepa, Abbott Nutrition, Abbott Laboratories) or isocaloric–isonitrogenous product (prepared by the same manufacturer).…”