Abstract
Background: Undernutrition is the main reason for the use of artificial nutrition in patients with severe neurological diseases. However, the clinical and immunological outcomes of enteral nutrition supplemented with immunomodulatory nutrients in these patients remain unclear.Methods: In this single-center, randomized controlled study, 57 patients with severe neurological diseases were randomly divided into the following two groups according to the type of enteral nutrition they would receive: immune-enhancing (IE) (n = 27) and non-IE (NIE) (n = 30). The IE and NIE groups received enteral nutrition supplemented with immunomodulatory nutrients and standard enteral nutrition, respectively. We compared the nutritional status and the state of cellular immunity between the patients of the two groups. Clinical and immunological variables were evaluated following nutritional treatment.Results: Feeding intolerance was lower in the IE than that in the NIE group (P = 0.04). However, there were no significant differences between the results of the two groups in terms of length of stay in the intensive care unit or hospital, extubation time, or body mass index (P > 0.05). The CD4+ T-lymphocyte count and CD4+/CD8+ ratio in the peripheral blood increased significantly in the IE group. The expression of CD28 activated cell surface markers was higher in the IE than in the NIE group. In addition, increased plasma interferon-γ levels were recorded in the IE group, whereas the levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-8, and IL-10 decreased.Conclusions: Immune-enhanced enteral nutrition could improve the immune status and feeding tolerance in patients with severe neurological diseases.Trial Registration:www.chictr.org.cn/index.aspx, identifier: ChiCTR-IPR-17013909.
Highlights
Due to stress response, critically ill patients have a high metabolic state, often accompanied by disturbances in consciousness and swallowing dysfunction, which directly affect the intake and utilization of nutrients, leading to malnutrition [1, 2]
Increased plasma interferon-γ levels were recorded in the IE group, whereas the levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-8, and IL-10 decreased
Several meta-analyses have reported that the addition of immunomodulatory nutrients to the enteral nutrition could significantly reduce the incidence of infectious diseases and promote the recovery from critical illnesses compared with the standard enteral nutrition [9]
Summary
Critically ill patients have a high metabolic state, often accompanied by disturbances in consciousness and swallowing dysfunction, which directly affect the intake and utilization of nutrients, leading to malnutrition [1, 2]. The Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition guidelines state that artificial nutrition should be used for specific patients, including those critically ill requiring respiratory assistance, those with severe sepsis, those recommended to undergo surgical procedures, and those hospitalized in the ICU [10]. The clinical and immunological outcomes of enteral nutrition supplemented with immunomodulatory nutrients in these patients remain unclear
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