Immune-enhancing Enteral Nutrition Research Articles

Preparations for enteral nutrition: an overview

Enteral nutrition is the delivery of specially formulated nutrients, called enteral preparations, either orally or via tubes to meet patients' nutritional needs and avoid malnutrition. These feeds can be life-changing or lifesaving for patients. There are three broad enteral feed types: polymeric; pre-digested and disease-specific; and immune-enhancing. This article outlines the importance and involvement of nurses in the enteral feed process, including the selection and administration of enteral feeds, as well as presenting a summary of enteral preparations, their safety and evidence-based efficacy. Nurses should work within a well-coordinated multidisciplinary team, use existing knowledge and resources and refer to national guidelines, as well as practising in line with their professional roles and responsibilities to select and administer enteral preparations and continually monitor patients receiving enteral nutrition. Research has identified that enteral nutrition intolerance is an issue, particularly among critically ill patients. However, polymeric formula has been found to improve daily energy intake and tolerance and it is more cost-effective compared with semi-elemental formula in brain-injured critically ill patients. Immune-enhancing enteral nutrition could improve the immune function in patients with severe neurological diseases. While these findings are promising and can support enteral nutrition, there is a need for more research into the efficacy of specific formulas for certain conditions and for continuing to address enteral nutrition intolerance.

Immunonutrition in ovarian cancer: clinical and immunological impact?

Malnutrition is frequent in ovarian cancer (OC) patients and may compromise post-operative outcomes. The aim of this study is to evaluate the impact of pre-operative immunonutrition on the surgical outcome of OC patients, and on their nutritional, inflammatory and peripheral blood immune status. A prospective study was performed between September 2016 and April 2020. Immune-enhancing enteral nutrition was administered to 42 patients before surgery according to their nutritional status assessed by the Malnutritional Universal Screening Tool. Biochemical and hematological monitoring was performed before and after immunonutrition. Post-operative outcomes were assessed and compared with those of a similar group of patients treated without nutritional support. Of the 42 immune-nourished patients, 23 (54.8%) had a low, 11 (26.2%) an intermediate and 8 (19%) a high risk of malnutrition. After the immunonutritional intake, significant variations of prealbumin, creatinine and white blood cells were detected. All T cell populations had an increasing trend, in particular CD3+ T lymphocytes (p=0.020), CD3+CD8+ cytotoxic T lymphocytes (p=0.046) and lymphocyte with HLA-DR expression (p=0.012). The rate of grade II-III post-operative complications was lower (21.4% vs. 42.9%, p=0.035) and the time of hospitalization was shorter (7.5 vs. 9.2, p=0.009) in the immune-nourished group. Pre-operative immunonutrition improves the surgical outcome of OC patients. After immunonutrition, an increase of CD3+CD8+ cytotoxic T lymphocytes was observed.

Effect of immune-enhancing enteral nutrition formula enriched with plant-derived n-3 fatty acids on natural killer cell activity in rehabilitation patients.

BACKGROUND/OBJECTIVESEnteral nutrition formulas with immune-enhancing nutrients, such as n-3 fatty acids, may manage patients' nutritional status and pathophysiological processes. The aim of our study was to investigate natural killer (NK) cell activity alterations and related cytokine changes resulting from feeding with soybean oil-containing enteral nutrition formula (control group) and plant-derived n-3 fatty acid-enriched enteral nutrition formula.SUBJECTS/METHODSSubjects participated for 14 consecutive days and consumed enteral formula containing canola and flaxseed oil (n3EN, test group) in nonsurgical patients hospitalized for rehabilitation. Blood samples were collected on the first day and 14 days after the consumption of each formula daily, and anthropometric parameters were collected. Hematology and biochemical values were analyzed, and NK cell activities and serum cytokine concentration were measured. A total of sixty subjects were included in the analysis, excluding dropouts.RESULTSNo significant differences were found in biochemical parameters. The n3EN group's NK cell activities at effector:tumor cell ratios of 10:1, 5:1, 2.5:1 and 0.625:1 were significantly higher than those of the control group after two weeks (P < 0.05). However, there were no statistically significant differences in serum cytokine interleukin (IL)-12, interferon-γ, IL-1β, IL-6 and tumor necrosis factor-α values between the two groups.CONCLUSIONSIn conclusion, this study elucidates the beneficial effects of plant-derived n-3 fatty acid supplementation in enteral formula on NK cell activity.

Effect of Immune-Enhancing Enteral Nutrition Enriched with or without Beta-Glucan on Immunomodulation in Critically Ill Patients.

We investigated whether high-protein enteral nutrition with immune-modulating nutrients (IMHP) enriched with β-glucan stimulates immune function in critically ill patients. In a randomized double-blind placebo-controlled study, 30 patients consumed one of three types of enteral nutrition: a control or IMHP with and without β-glucan. The IMHP with β-glucan group showed increases in natural killer (NK) cell activities relative to the baseline, and greater increases were observed in NK cell activities relative to the control group after adjusting for age and gender. The IMHP groups with and without β-glucan had greater increases in serum prealbumin and decreases in high-sensitivity C-reactive protein (hs-CRP) than the control group. The control group had a greater decrease in peripheral blood mononuclear cell (PBMC) interleukin (IL)-12 production than the IMHP with and without β-glucan groups. In all patients, the change (Δ) in hs-CRP was correlated with Δ prealbumin and Δ PBMC IL-12, which were correlated with ΔNK cell activity and Δ prealbumin. This study showed beneficial effects of a combination treatment of β-glucan and IMHP on NK cell activity. Additionally, strong correlations among changes in NK cell activity, PBMC IL-12, and hs-CRP suggested that β-glucan could be an attractive candidate for stimulating protective immunity without enhanced inflammation (ClinicalTrials.gov: NCT02569203).

PTH-161 The effects of immunonutrition in upper gastrointestinal surgery: a systematic review and meta-analysis

Introduction The beneficial of immunonutrition on overall morbidity and mortality remains uncertain. We undertook a systematic review to evaluate the effects of immune-enhancing enteral nutrition (IEN) in upper gastrointestinal (GI) surgery. Method Main electronic databases [MEDLINE via Pubmed, EMBASE, Scopus, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library, and clinical trial registry (ClinicalTrial.gov)] were searched for studies reported clinical outcomes comparing standard enteral nutrition (SEN) and immunonutrition (IEN). The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis was analysed using fixed and random-effects models. Results Nineteen RCTs with a total of 2016 patients (1017 IEN and 999 SEN) were included in the final pooled analysis. IEN significantly reduced post-operative wound infection (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.50 to 0.94). Although, the combined results showed that IEN had a shorter hospital stay (RR –2.51 days, 95% CI –3.47 to –1.55), there was significant heterogeneity observed across these studies. There was no statistically significant benefit on other post-operative morbidities of interest (e.g. anastomotic leak and pulmonary infection) and mortality. Conclusion IEN decreases wound infection rates and reduces length of stay. It can be recommended as routine nutritional support in upper GI surgery. Disclosure of interest None Declared.

A randomized controlled trial comparing antioxidant-enriched enteral nutrition with immune-enhancing enteral nutrition after esophagectomy for cancer: a pilot study

The objective of this study was to compare the effects of two types of enteral supplements, an antioxidant-enriched enteral nutrition (AeEN) and an immune-enhancing enteral nutrition (IeEN), on the nutrition, immunoinflammatory response, antioxidant capacity and clinical outcomes in patients after esophagectomy for cancer. Patients (n = 20) undergoing esophagectomy for cancer were randomized in this single-center, open-label study. Two types of enteral supplements were used for 5 days before surgery and 7 days after surgery. The circulating levels of nutritional markers, immunoinflammatory markers, oxidative stress markers, and the antioxidant capacity were compared throughout the perioperative period, and the patients' clinical outcomes were also compared. The circulating levels of nutritional markers decreased after surgery, but the changes were not significantly different between the AeEN group and the IeEN group throughout the perioperative period. Surgery increased the immunoinflammatory markers, and the levels were not significantly different between the groups after surgery. Surgery also increased the levels of oxidative stress markers, but there were no significant differences between the groups throughout the study period. The results of this pilot study suggest that AeEN and IeEN have a similar effect on nutrition, the immunoinflammatory response, antioxidant capacity and clinical outcomes after esophagectomy for cancer. These findings, therefore, warrant further studies on a larger scale.

A double blind, randomised, placebo controlled, feasibility phase III clinical trial of peri-operative immune-enhancing enteral nutrition in patients undergoing surgery for advanced head and neck cancer

Summary Background & aims Conflicting evidence exists as to whether post-operative infections in patients with Squamous Cell carcinoma of the Head and Neck (SCCHN) are reduced by peri-operative enteral feeding with immune-enhancing feeds such as Impact, which contains l -arginine, nucleotides and omega-3 fatty acids. Our study aimed to address this conflict. Methods We conducted a single centre, double blind, randomised, placebo controlled, clinical trial. Patients undergoing surgery for SCCHN were fed enterally with either Impact or an iso-nitrogenous, iso-caloric control feed for five days pre and seven days post-surgery. The rates of systemic and local infective complications, length of hospital stay and peri-operative mortality rates were compared between the two groups. Results Data for analysis were available for 57 patients; 28 who received IMPACT and 29 the control feed. A primary infection occurred in 35% (20/57) of patients; 43% (12/28) in the Impact group and 28% (8/29) in the control group, (P = 0.27, Fishers Exact test). No differences in secondary infection rates or length of hospital stay were observed between the groups. Conclusions In this under-powered study, peri-operative use of Impact in patients undergoing surgery for SCCHN did not lead to significant differences in infective complications, length of hospital stay or peri-operative mortality. Larger studies are required.

Effects of Immune-Enhancing Enteral Nutrition on Mortality and Oxygenation in Acute Lung Injury and Acute Respiratory Distress Syndrome: A Meta-Analysis

Purpose The contribution of the immune system to the pathogenesis of acute respiratory distress syndrome (ARDS) has led to a recent interest in the use of immune-enhancing enteral nutrition as a treatment modality. The purpose of this meta-analysis was to determine the effectiveness of immune-enhancing enteral nutrition as compared with standard enteral nutrition, with respect to mortality and change in oxygenation status, in patients with acute lung injury (ALI)/ARDS. Methods A systematic review was conducted of randomized controlled trials comparing immune-enhancing enteral nutrition with standard enteral nutrition in adult intensive care unit (ICU) patients with ALI/ARDS. Data were combined in a meta-analysis with STATA SE version 9.2 (StataCorp) using a random effects model. Results Three studies fulfilled inclusion criteria, totaling 411 patients. These studies demonstrated a statistically significant relative risk (RR) for in-hospital mortality, favoring patients who received immune-enhancing enteral nutrition (RR, 0.58; 95% confidence interval [CI], 0.42-0.79). With respect to change in oxygenation status, a statistically significant standardized mean difference (SMD) was observed at day 4 (SMD, 1.97; 95% CI, 0.27-3.67), favoring the immune-enhancing enteral nutrition group. At study day 7, the SMD did not reach statistical significance (SMD, 1.71; 95% CI, −0.13 to 3.56). Conclusions Oxygenation and mortality benefits of immune-enhancing enteral nutrition in adult ICU patients with ALI/ARDS have been shown in individual trials and meta-analyses. Subsequent clinical trials and meta-analyses are required to fully elucidate the role of immune-enhancing enteral nutrition in this patient population.

Postoperative complications in gastrointestinal cancer patients: The joint role of the nutritional status and the nutritional support

This study investigated the effects of nutritional support on postoperative complications, in relation with demographic and nutritional factors, intraoperative factors, type and routes of nutritional regimens. A series of 1410 subjects underwent major abdominal surgery for gastrointestinal cancer and received various types of nutritional support: standard intravenous fluids (SIF; n=149), total parenteral nutrition (TPN; n=368), enteral nutrition (EN; n=393), and immune-enhancing enteral nutrition (IEEN; n=500). Postoperative complications, considered as major (if lethal or requiring re-operation, or transfer to intensive care unit), or otherwise minor, were recorded. Major and minor complications occurred in 101 (7.2%) and 446 (31.6%) patients, respectively. Factors correlated with postoperative complications at multivariate analysis were pancreatic surgery, (p<0.001), advanced age (p=0.002), weight loss (p=0.019), low serum albumin (p=0.019) and nutritional support (p=0.001). Nutritional support reduced morbidity versus SIF with an increasing protective effect of TPN, EN, and IEEN. This effect remained valid regardless the severity of risk factors identified at the multivariate analysis and it was more evident by considering infectious complications only. Pancreatic surgery, advanced age, weight loss and low serum albumin are independent risk factors for the onset of postoperative complications. Nutritional support, particularly IEEN, significantly reduced postoperative morbidity.