Abstract
Current opinion supports the use of perioperative TPN in patients with gastrointestinal disease only if they are severely malnourished (1-3). There is, however, a substantial body of data suggesting that one major cause of postoperative infection is the decrease in immune response due to surgical trauma, anaesthesia, perioperative care and the disease itself irrespective of the nutritional status of the patients. There is also experimental and clinical evidence that some nutritional substrates have important immune-enhancing effects, and that nutrition via the enteral route is more beneficial in modulating metabolic response to the surgical trauma than intravenous nutrition. The purpose of this paper is to briefly review the main metabolic effects of certain immune-enhancing substrates in human beings, to report on randomized clinical trials in surgical patients, and to speculate on the preliminary conclusions of these clinical investigations.
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