Immunosupression and Infection After Major Surgery: A Nutritional Deficiency

Zhu, Xinmei; Herrera, Gabriel; Ochoa, Juan B.

doi:10.1016/j.ccc.2010.04.004

Cited by 74 publications

(48 citation statements)

References 33 publications

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“…30 Arginine, one of the key components of an IN strategy, is rapidly depleted in surgery and after major metabolic stresses. 6 Supplementation can promote cell growth and differentiation and microvascular perfusion in these patients. Omega-3 fatty acids in several perioperative randomized trials have been demonstrated to modulate proinflammatory and antiinflammatory mediators in the heart, gut, liver, and in tumor tissue.…”

Section: Resultsmentioning

confidence: 99%

“…Studies have shown that arginine deficiency occurs as a result of surgical injury. 6 Immunonutrition supplements have varying concentrations of these key ingredients and the ideal dosages are not well defined. In fact, the relative dosages of the immune-modulating ingredients even vary at times from country to country in products made by the same manufacturer.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative Standard Oral Nutrition Supplements vs Immunonutrition: Results of a Systematic Review and Meta-Analysis

Hegazi

Hustead

Evans

2014

Journal of the American College of Surgeons

113

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Multiple studies and meta-analyses have suggested some benefit to immunonutrition (IN) supplements. These studies have often included pre-and post-operative regimens and have utilized inconsistent controls ranging from standard non-supplemented oral diets to high-quality isonitrogenous controls. This study aims to compare outcomes after preoperative nutritional supplementation with IN vs. standard oral nutritional supplements (ONS) or a regular diet without supplements.We performed a systematic literature review. 8 randomized controlled trials (RCTs) of preoperative IN vs. ONS were identified and 9 RCTs of IN vs. no supplements were also identified. Meta-analysis was performed for reported outcomes including wound infection, infectious and non-infectious complications, and length of stay (LOS). The meta-analysis was prepared in accordance with Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) recommendations.We identified 561 patients in 8 RCTs of preoperative IN vs. ONS. 895 patients were identified in 9 RCTs of IN vs. no supplements. When compared to ONS, preoperative IN was not associated with reduced wound infection (OR 0.97, 95% Confidence Interval (CI) 0.45 to 2.11), all infectious complications (OR 0.71, 95% CI 0.30 to 1.68), non-infectious complications (OR 1.25, 95% CI 0.64 to 2.43), or LOS (mean difference 0.07 days, 95% CI À2.29 to 2.43). In RCTs controlled with non-supplemented standard diets, preoperative IN was associated with decreased infectious complications (OR 0.49, 95% CI 0.30 to 0.83, p 0.01) and LOS (mean difference À2.22 days, 95% CI À2.99 to À1.45, p 0.01).In conclusion, there was no evidence for IN to be superior to ONS on several key clinical outcomes. Therefore standard ONS may offer an alternative to IN for preoperative nutritional supplementation.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preoperative Standard Oral Nutrition Supplements vs Immunonutrition: Results of a Systematic Review and Meta-Analysis

Hegazi

Hustead

Evans

2014

Journal of the American College of Surgeons

113

View full text Add to dashboard Cite

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“…It was observed that within hours of physical injury, large number of arginase-1 (ARG1)-expressing immature myeloid cells (IMCs) accumulate in the spleen and other lymphoid tissue (Makarenkova et al 2006). These cells inhibit T lymphocyte growth and function, resulting in impairment of T cell proliferative response (Zhu et al 2010). The preventive goal in this situation is to minimize the immunosuppression and to promote healing and tissue repair that is the rationale for immunomodulating diet suspected to improve surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Low-grade dietary-related inflammation and survival after colorectal cancer surgery

Gałaś

Kulig

2014

J Cancer Res Clin Oncol

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PurposeProlong inflammation is a central process observed in several chronic conditions and may be responsible for survival. There is an increasing evidence showing the role of diet in inflammation and habitual diet may be responsible for low-grade inflammation. The purpose of our study was to assess the effect of inflammatory properties of habitual diet measured by the Dietary Inflammatory Index (DII) on survival among surgical patients treated for colorectal cancer (CRC).MethodsA follow-up study among 689 CRC patients (mean age 58 years, ±8.9; 56.7 % males) treated surgically was performed in Krakow, Poland. Habitual diet was assessed by a standardized semiquantitative food frequency questionnaire. Next, 23 dietary items were used to calculate DIIs. Vital records were verified to determine status of the participants.ResultsStudy has shown linear association between DII and survival time among CRC patients with totally removed cancer treated by chemotherapy (b = −0.13, p = 0.024). After adjustment for several important covariates, DII was associated with survival during up to 3 years after surgery, but only in patients without distant metastases (3-year HRDII>−2.27 = 0.61, 95 % CI 0.38–0.99).ConclusionsThe results of the investigation have shown the usefulness of the DII as a potential predictor of survival among patients without distant metastases treated surgically for CRC.

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“…2,7 Th2 cytokines increase the expression of arginase-1 in myeloid-derived suppressor cells (MDSCs), causing an arginine deficiency state, which further impairs lymphocyte function. 2,12,13 Although numerous studies have been directed towards these immune cells and the distinct processes of their interaction after trauma and surgery, it is not known which immune cell type is predominately responsible for immunosuppression in humans under these conditions. Experimental studies in mice suggest that APC initiate immunosuppression after trauma and blood loss, 14 whereas T-cells play a key role in the perpetuation of diminished T-cell-APC interaction.…”

Section: Introductionmentioning

confidence: 99%

Major surgical trauma differentially affects T-cells and APC

et al. 2014

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Macrophages have been reported to initiate immunosuppression following trauma and hemorrhage, and recent experimental studies suggest a pivotal role of T-cells in maintaining immunosuppression. The aim of the present study was to investigate the interaction of APC and T-cells in humans following major surgery. First, APC and T-cells from 14 surgical patients were isolated, counted and characterized by their specific surface marker profile 2 and 24 h postoperatively. Then, these cells were co-incubated with cells of the other type, which had been isolated pre-operatively. Chemokine secretion from pre-operative cells as measured by enzyme immunoassay served as a bioassay for the function of the stimulating postoperative cells. CD3(+) T-cells and surface marker CD28 were markedly suppressed postoperatively, while CD3(+)CD25(+)CD127(-)Tregs were not suppressed. CD14(+)APC counts were increased with the most significant increase observed in CD14(+)HLA-DR(-) myeloid-derived suppressor cells. In co-cultures, APC showed increased postoperative secretion of TNF-α and IL-6 independently of whether they had been co-incubated with pre- or postoperative T-cells. T-cells incubated with CD14(+) cells 2 h postoperatively secreted diminished amounts of IFN-γ. The results of the study suggest that T-cells play a pivotal role in mediating immunosuppression after major abdominal surgery.

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Immunosupression and Infection After Major Surgery: A Nutritional Deficiency

Cited by 74 publications

References 33 publications

Preoperative Standard Oral Nutrition Supplements vs Immunonutrition: Results of a Systematic Review and Meta-Analysis

Preoperative Standard Oral Nutrition Supplements vs Immunonutrition: Results of a Systematic Review and Meta-Analysis

Low-grade dietary-related inflammation and survival after colorectal cancer surgery

Major surgical trauma differentially affects T-cells and APC

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