Document Detail

MedLine Citation:
PMID:  15711216     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: To outline recent findings on the efficacy of immunonutrients in patients undergoing inflammatory stress due to surgery, infection and cancer. RECENT FINDINGS: Enteral nutrition is more efficacious and poses lower risks than parenteral nutrition. It reduces infection rates and shortens ICU and hospital length of stay of critically ill patients. Beneficial effects of immunonutrition are most apparent in malnourished patients. Perioperative enteral nutrition is more effective than postoperative nutrition. In Crohn disease similar remission rates are achieved with enteral nutrition as with steroids. Glutamine, omega-3 fatty acids and antioxidants exert beneficial influences in diverse patient populations. L-arginine is an important immunonutrient having both beneficial and adverse effects. The former effect occurs in necrotizing enterocolitis; the latter influence is seen in septic patients. The gut plays a major role in whole body amino acid metabolism, particularly arginine homeostasis. Arginase and nitric oxide synthetase compete for arginine within immune cells and play a pivotal role in clinical outcome during infection. In cancer a range of antioxidants are able to ameliorate immunosuppression. Intravenous lipids may be deleterious due to the pro-inflammatory effects of omega-6 fatty acids. Omega-3 fatty acids are anti-inflammatory and combined with medium chain triglyceride (MCT) and olive oil may provide a more efficacious form of intravenous lipid. SUMMARY: Immunonutrition is effective in improving outcome in a wide range of patients when applied enterally, particularly in malnourished individuals. Parenteral immunonutrition carries a higher risk but can be efficacious in selected patient groups for whom enteral nutrition is problematic.
Robert F Grimble
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in gastroenterology     Volume:  21     ISSN:  0267-1379     ISO Abbreviation:  Curr. Opin. Gastroenterol.     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-02-15     Completed Date:  2005-05-24     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8506887     Medline TA:  Curr Opin Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  216-22     Citation Subset:  IM    
Institute of Human Nutrition, School of Medicine, Biomedical Sciences Building, University of Southampton, Bassett Crescent East, Southampton SO16 7PX, United Kingdom.
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MeSH Terms
Arginine / metabolism,  pharmacology
Fatty Acids / pharmacology
Genetic Variation
Glutamine / metabolism,  pharmacology
Glutathione / metabolism
Infection / immunology
Nutritional Support / methods*
Transcription, Genetic
Wounds and Injuries / immunology
Reg. No./Substance:
0/Fatty Acids; 56-85-9/Glutamine; 70-18-8/Glutathione; 74-79-3/Arginine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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