Use Of Immunonutrition Research Articles

Acute changes in serum inflammatory signatures after consumption of ready-to-drink immuno-nutrition: A case report

BackgroundImmuno-nutrition administers specific nutrients to improve host defences, in particular supporting the immune system. Given the high invasiveness of some spine operations, strengthening the immune response could effectively balance the surgical stress and boost resilience. However, it is not clear what are the early molecular signatures after the consumption of immuno-modulatory nutrients. Materials and methodsIn the context of nutritional prehabilitation, we present the case of a lady with scoliosis scheduled for surgery who was administered immuno-nutrition preoperatively and tested for acute changes in 200 biomolecules after two and four hours. ResultsAfter four hours, we mainly observed 30-fold increase in IL-10, 10-fold increase in IL-18 inhibitory protein, 6-fold increase in IL-1 inhibitory receptor, 12-fold decrease in IL-2 receptor, and 51-fold decrease in IL-23. Gene ontology annotations showed the involvement of genes regulating cytokine activity, response to external organisms, humoral and adaptive response, and lymphocyte immunity. ConclusionOverall, the trends over the first four hours showed a positive shift of the cytokine balance in favour of anti-inflammatory mediators while keeping active the cell-mediated immunity. The use of immuno-nutrition for prehabilitation patients could prove useful to patients but benefits from chronic consumption and surgical outcomes remain to be determined.

Preoperative Immuno-Nutrition and Complications After Colorectal Surgery: Results of a 2-Year Prospective Study

IntroductionPreoperative immuno-nutrition has been associated with reductions in infectious complications and length of stay, but remains unstudied in the setting of an enhanced recovery protocol. The objective was to evaluate outcomes after elective colorectal surgery with the addition of a preoperative immuno-nutrition supplement. MethodsIn October 2017, all major colorectal surgeries were given an arginine-based supplement prior to surgery. The control group consisted of cases within the same enhanced recovery protocol from three years prior. The primary outcome was a composite of overall morbidity. Secondary outcomes were infectious complications and length of stay with subgroup analysis based on degrees of malnutrition. ResultsOf 826 patients, 514 were given immuno-nutrition prospectively and no differences in complication rates (21.5% versus 23.9%, P = 0.416) or surgical site infections (SSIs) (6.4% versus 6.9%, P = 0.801) were observed. Hospitalization was slightly shorter in the immuno-nutrition cohort (5.0 [3.0, 7.0], versus 5.5 days [3.6, 7.9], P = 0.002). There was a clinically insignificant difference in prognostic nutrition index scores between cohorts (35.2 ± 5.6 versus 36.1 ± 5.0, P = 0.021); however, subgroup analysis (< 33, 34-38 and > 38) failed to demonstrate an association with complications (P = 0.275) or SSIs (P = 0.640) and immuno-nutrition use. ConclusionsComplication rates and SSIs were unchanged with the addition of immuno-nutrition before elective colorectal surgery. The association with length of stay is small and without clinical significance; therefore, the routine use of immuno-nutrition in this setting is of questionable benefit.

Effects of Immunonutrition on Cancer Patients Undergoing Surgery: A Scoping Review.

There is a large body of evidence about immunonutrition formulas; however, there are still doubts about their usefulness in routine clinical practice as compared with standard formulas. In the age of personalized medicine, new studies appear every year regarding several types of patients; therefore, an updated point of view on these formulas is necessary. The Embase database was searched from 2016 to 14 March 2022. Our criteria were articles published in English and Spanish. The evidence quality was evaluated using GRADEpro, and the review was developed according to the PRISMA statement. In this review, a total of 65 unique records were retrieved; however, 36 articles did not meet the inclusion criteria and were thus excluded. In total, 29 articles were included in the final analysis. In the last few years, many meta-analyses have attempted to identify additional existing studies of surgical patients with certain pathologies, mainly oncological patients. Immunonutrition prior to oncological surgery was shown to cause a decrease in inflammatory markers in most of the studies, and the main clinical events that changed were the infectious complications after surgery. The length of stay and mortality data are controversial due to the specific risk factors associated with these events. The use of immunonutrition in patients who have undergone oncological surgery decreases the levels of inflammatory markers and infectious postoperative complications in almost all localizations. However, more studies are needed to assess the use of immunonutrition based on Enhanced Recovery After Surgery (ERAS) protocols.

The impact of immunonutrition on pancreaticoduodenectomy outcomes

Malnutrition is a significant risk factor for decreased survival in cancer patients undergoing a pancreaticoduodenectomy (PD). Our study aims to investigate the impact of immunonutrition on length of stay (LOS), infection rates, postoperative pancreatic fistula (POPF), and delayed gastric emptying (DGE). This study retrospectively reviewed 344 patients who underwent PD between 2007 and 2018. Patients were on a regular diet or 5 days of preoperative immunonutrition. Statistical analyses were done via t -test and chi-square test with a significance cutoff of p < 0.05. Immunonutrition was associated with increased intraabdominal infection (13% vs. 23%, p = 0.021), POPF (6% vs. 19%, p = 0.001), and decreased DGE (17% vs. 8%, p = 0.013). When patients were stratified by pathology, immunonutrition was not associated with POPF or infection rates in the pancreatic adenocarcinoma (PDAC) group. In the non-PDAC group, immunonutrition was associated with longer LOS (12.4 vs. 9.9 days, p = 0.02) and higher rates of intraabdominal infection (26% vs. 10%, p = 0.02) compared to the regular diet group. In PDAC patients undergoing PD, preoperative immunonutrition did not have an impact on LOS, infections, POPF, or DGE. In non-PDAC patients, immunonutrition was associated with longer LOS and higher intraabdominal infections. Additional studies are needed to validate the routine use of immunonutrition in this patient population

SP5.2.9 Perioperative immunonutrition in reducing the infectious complications in patients undergoing colorectal cancer resections: a meta-analysis of randomized controlled trials

Abstract Objective Perioperative nutritional interventions have been reported to improve colorectal rectal cancer surgery outcomes. The objective of this article is to assess the influences of immunonutrition intervention during perioperative period in patients undergoing colorectal cancer resections. Method Meta-analysis was conducted according to the PRISMA guidelines. Systematic search of medical databases like MEBASE, MEDLINE and pubmed was performed to find studies exclusively reporting the perioperative use of immunonutrition in patients undergoing colorectal cancer resections and relevant published randomized, controlled trials (RCT) were shortlisted according to the inclusion criteria. The analysis of the pooled data was done using the RevMan statistical software. Result Ten RCTs on 1218 patients with colorectal cancer fulfilled the inclusion criteria. In the random effects model analysis, the use of perioperative immunonutrition in patients undergoing colorectal cancer resections statistically reduced the risk [odds ratio 0.59, 95% CI (0.35–1.0), z= 1.96, p=0.05] of infectious complications. However, there was significant heterogeneity [Tau2 = 0.35; Chi2= 19.11, df = 9 (P &amp;lt; 0.02; I2 = 53%)] among included studies. The variables of postoperative mortality [odds ratio 2.1, 95% CI (0.33–12.36), z= 0.75, p=0.45] and length of hospitalization [standardized mean difference 0.16, 95% CI (-0.08–0.39), z= 1.31, p=0.19] were statistically similar in patients using immunonutrition or standard conventional perioperative nutrition. Conclusion Perioperative immunonutrition in patients undergoing colorectal resections seems to reduce infectious complications but this study failed to demonstrate its role in reducing the postoperative mortality and length of hospitalization.

Updates on enhanced recovery after surgery for radical cystectomy.

Enhanced Recovery after Surgery (ERAS) is a multimodal pathway that provides evidence-based guidance for improving perioperative care and outcomes in patients undergoing surgery. In 2013, the ERAS society released its original guidelines for radical cystectomy (RC) for bladder cancer (BC), adopting much of its supporting data from colorectal literature. In the last decade, growing interest in ERAS has increased RC-specific ERAS research, including prospective randomized controlled trials (RCTs). Collective data suggest ERAS contributes to improved complication rates, decreased hospital length-of-stay, and/or time to bowel recovery. Various institutions have adopted modified versions of the ERAS pathway, yet there remains a lack of consensus on the efficacy of specific ERAS items and standardization of the protocol. In this review, we summarize updated evidence and practice patterns of ERAS pathways for RC since the introduction of the original 2013 guidelines. Novel target interventions, including use of immunonutrition, prehabilitation, alvimopan, and methods of local analgesia are reviewed. Finally, we discuss barriers to implementing and future steps in advancing the ERAS movement.

Alternatives for the prevention of cancer recurrences: immunonutrition, Cat’s claw and Rhopalus junceus venom

Over the years, cancer treatment has focused on its eradication once it has been detected, however, it's common to find that a large number of neoplasms redevelop in patients, which reduces their quality and life expectancy when going through surgical treatments, chemotherapy and radiotherapy schemes once again. Several studies have been developed on some alternatives for the treatment of cancer that can be used as preventive methods for relapses, such as immunonutrition that is based on the administration of amino acids that contain sulfides, fatty acids, omega 3, vitamin and some minerals; the Uncaria tomentosa which is a plant that grows like a vine under tropical trees and whose extracts can induce oxidative stress; and the poison of Rhopalurus junceus(blue scorpion) which has been shown to induce necrosis or apoptosis in different malignant cell lines. This review summarizes points in favor of the use of Immunonutrition, Uncaria tomentosa and Rhopalurus junceus venom to limit a cancer recurrence.

P-OGC02 The development of an evidence based algorithm for the provision of nutrition as part of an Enhanced Recover After Surgery (ERAS) pathway in patients undergoing elective Gastrectomy and Oesophagogastrectomy for cancer

Abstract Background Following a recent merger or UGI Cancer services, a consensus was needed for the ERAS pathway nutritional elements. ERAS is a way to maintain physiological function following surgery enabling post-operative recovery without adversely affecting morbidity or mortality. It is a coordinated pathway that enables consistent, evidence based multi-modal care. Anaesthesia, nutrition, analgesia, surgical technique and physiotherapy are active and key components of enhanced recovery along with patient involvement and empowerment. ERAS in UGI revealed a significant reduction in LOS in most cases, by around 50% without increasing morbidity and mortality when compared to standard post-operative care. Methods Coupling the service redesign with the publication of guidelines in ERAS and Gastrectomy, it was decided to review the evidence base for ERAS and nutrition support specific to UGI Cancer surgery. In addition to this, aim to review the evidence for and against the use of immunonutrition (IN). Literature searches were conducted using CINAHL and PUBMED databases. The evidence was critiqued and a consensus reached. From this evidence review, an algorithm recommending the instigation of nutrition post Upper Gastrointestinal (UGI) surgery as part of an ERAS pathway was developed. Results An algorithm was produced standardising the nutritional care for patients undergoing elective UGI surgery in our centre, which formed part of the ERAS care pathway produced through the ERAS steering group. All patients were screened for risk of malnutrition at the start of their surgical care pathway and regularly throughout their journey, appropriate nutritional support will be provided by a specialist Dietitian to optimise the patient. Conclusions The evidence to support the use of IN is conflicting and is not currently recommended on this ERAS pathway. Nutritional intake in the form of Oral Nutritional Support (ONS) in subtotal gastrectomy can be commenced at Day 2. Nutritional intake in the form of ONS in Total Gastrectomy can be commenced at Day 4. Nutritional intake in the form of ONS in Oesophagogastrectomy can be commenced at Day 5. After ONS tolerated without clinical symptoms, patient can be progressed to Soups, Jellies, Ice creams for 24 hours then to an UGI specific soft menu pre discharge.

Effect of Immunonutrition supplementation on Post-operative outcome after major Gastrointestinal surgery for Malignancy

This prospective, pilot study evaluated the effect of immunonutrition supplementation using Pentasure Immunomax® on recovery after major gastrointestinal (GI) surgery for malignancy. It included two groups of patients (n = 25 each) who underwent major GI surgery for malignancy in two units, one of which routinely gave Pentasure Immunomax® (L – arginine, omega 3 fatty acids and ribonucleic acids) for two weeks following surgery (Group 1) while the other did not (Group 2). The pre-operative nutritional status of the patients were assessed using Subjective Global Assessment (SGA) scale. Post-operatively the following parameters were compared between the two groups: complications (using Clavien Dindo scale), calorie intake, length of intensive care unit (ICU) and hospital stay using SPSS software, version 20.0. Based on the SGA score, 66% of the entire study population was moderately malnourished, while 6% were severely malnourished. On assessing the body mass index, 26 (52%) patients were found to be overweight or obese, out of which 16 patients were found to be moderately malnourished. The mean caloric intake in Group 1 was significantly more than in Group 2 (1112.7± 51.6 versus 874.8±56.7; p = 0.0032). There was, however, no significant difference between the two groups in complications, ICU or hospital stay. The incidence of malnutrition in patients undergoing major GI surgery for malignancy is high even amongst those who are overweight/obese. Use of immunonutrition may help in better attainment of adequate calorie in post-operative period.

Nutrition in the Neurocritical Care Unit: a New Frontier.

Purpose of ReviewThis review presents the most current recommendations for providing nutrition to the neurocritical care population. This includes updates on initiation of feeding, immunonutrition, and metabolic substrates including ketogenic diet, cerebral microdialysis (CMD) monitoring, and the microbiome.Recent FindingsLittle evidence exists to support differences in feeding practices among the neurocritical care population. New areas of interest with limited data include use of immunonutrition, pre/probiotics for microbiome manipulation, ketogenic diet, and use of CMD catheters for substrate utilization monitoring.SummaryAcute neurologic injury incites a cascade of adrenergic and neuroendocrine events resulting in a pro-inflammatory and hypercatabolic state, which is associated with an increase in morbidity and mortality. Nutritional support provides substrates to mitigate the damaging effects of hypermetabolism. Despite this practice, studies on feeding delivery outcomes remain inconsistent. Guidelines suggest use of early enteral nutrition using standard polymeric formulas. Population heterogeneity, variability in interventions, complexities of the metabolic and inflammatory responses, and paucity of nutrition research in patients requiring neurocritical care have led to controversies in the field. It is imperative that more pragmatic and reproducible research be conducted to better understand underlying pathophysiology and develop interventions that may improve outcomes.

Application of ERAS protocol in esophagectomy: a national survey among Italian centers performing esophageal surgery.

The application of enhanced recovery after surgery guidelines for esophageal surgery in different units remains unclear. This survey intended to investigate how such protocol is applied among Italian esophageal surgery units. A survey with 40 questions was mailed to Italian centers that performed at least 10 esophagectomies per year. It included questions about the type of hospital and unit and pre-, intra- and post-operative items. Difficulties encountered were investigated. Thirteen (65%) centers answered the survey, and all met the minimal safety requirements, e.g., the presence of intensive care units and 24-h on-call operative endoscopy and radiology facilities. Fifty percent of esophagectomies with a minimally invasive approach were performed in 84.6% of the centers. Regarding pre-operative items, the highest scores were for the application of nutritional support, dysphagia palliation and presence of a multidisciplinary tumor board, whereas the lowest score was for the use of immunonutrition. Regarding intra-operative items, hypothermia prevention and the use of goal-directed fluid therapy and volatile anesthesia were diffusely adopted, whereas the rate of using abdominal drains was high. Regarding post-operative items, nausea prevention, multimodal analgesia and early mobilization were applied frequently, whereas the use of nasogastric tubes and regular transfer to intensive care units was diffused. The primary barriers in enhanced recovery after surgery protocol application were resistance and a lack of paramedic personnel. This survey's results highlight the efforts undertaken by several centers to apply enhanced recovery after surgery philosophy and in this regard, demonstrate a good standing in Italy.

Nutritional and metabolic supplementation for the injured brain: an update.

Energy dysfunction is increasingly recognized as a key factor in the pathogenesis of acute brain injury (ABI). This one characterized by a high metabolic rate and nitrogen loss is often associated with an undernutrition support. We review the metabolism evolution and nutritional status in brain injured patient and summarize evidence on nutritional support in this condition. The role of nutrition support for improving prognosis in brain injured patient has been underlined recently. A fast nutrition institution whatever the route is essential to prevent an imbalance in caloric support. Moreover, hypermetabolic state must be prevented with a sufficient nitrogen support. Glycemic control is particularly relevant in this group of patient, with the discovery of new fuel that could potentially improve cerebral metabolism and replace glucose. Few data support also the use of immunonutrition input in this group of patients. Nutritional support is a key parameter in brain injured patient and must be initiated quickly to counteract hypermetabolic state by caring to improve caloric and nitrogen input. Recent clinical data support the use of immunonutrition, glutamine and zinc in this particular setting.

Impact of Oral Immunonutrition on Postoperative Morbidity in Digestive Oncologic Surgery: A Nation-wide Cohort Study.

The objective of the present study was to assess the effect of preoperative immunonutrition on a nationwide scale. According to international guidelines, immunonutrition should be prescribed before major oncologic digestive surgery to decrease postoperative morbidity. Nevertheless, this practice remains controversial. We used a prospective national health database named "Echantillon généraliste des Bénéficiaires." Patients were selected with ICD10 codes of cancer and digestive surgery procedures from 2012 to 2016. Two groups were identified: with reimbursement of immunonutrition 45 days before surgery (IN-group) or not (no-IN-group). Primary outcome was 90-day severe morbidity. Secondary outcomes were postoperative length of stay (LOS) and overall survival. Logistic regression and survival analysis adjusted with IPW method were performed. One thousand seven hundred seventy-one patients were included. The proportion of different cancers was as follows: 72% patients were included in the colorectal group, 14% in the hepato-pancreato-biliary group, and 12% in the upper gastrointestinal group. Patients from the IN-group (n = 606, 34%) were younger (67.1 ± 11.8 vs 69.2 ± 12.2 years, P < 0.001), with increased use of other oral nutritional supplements (49.5% vs 31.8%, P < 0.001) and had more digestive anastomoses (89.4% vs 83.0%, P < 0.001). There was no significant difference between the 2 groups for 90-day severe morbidity [odds ratio (OR): 0.91, 95% confidence interval (95% CI): 0.73-1.14] or in survival (hazard ratio: 0.89, 95% CI: 0.73-1.08). LOS were shorter in the IN-group [-1.26 days, 95% CI: -2.40 to -0.10)]. The preoperative use of immunonutrition before major oncologic digestive surgery was not associated with any significant difference in morbidity or mortality. However, the LOS was significantly shorter in the IN-group.

The malnourished surgery patient: a silent epidemic in perioperative outcomes?

As many as two of every three major surgery patients are malnourished preoperatively - a diagnosis rarely made and treated even less frequently. Unfortunately, perioperative malnutrition is perhaps the least often identified surgical risk factor and is among the most treatable to improve outcomes. Two important perioperative nutrition guidelines were published recently. Both emphasize nutrition assessment as an essential component of preoperative screening. The recently published perioperative nutrition screen (PONS) readily identifies patients at malnutrition risk, allowing for preoperative nutritional optimization. The use of computerized tomography scan and ultrasound lean body mass (LBM) evaluation to identify sarcopenia associated with surgical risk and guide nutrition intervention is garnering further support. Preoperative nutrition optimization in malnourished patients, use of immunonutrition in all major surgery, avoidance of preoperative fasting, inclusion of postoperative high-protein nutritional supplements, and early postoperative oral intake have all recently been shown to improve outcomes and should be utilized. The recent publication of new surgical nutrition guidelines, the PONS score, and use of LBM assessments will allow better identification and earlier intervention on perioperative malnutrition. It is essential that in the future no patient undergoes elective surgery without nutrition screening and nutrition intervention when malnutrition risk is identified.

Why do current strategies for optimal nutritional therapy neglect the microbiome?

Strategies for providing optimal nutritional therapy have evolved over time, with the emphasis on specific directives (such as route, use of immunonutrition, high protein, organ-specific formulas, etc.), achieving variable degrees of success for improving outcomes in the intensive care unit. As the largest immune organ in the body comprising the largest interface between the host and the external environment, the gut can have an amplifying effect on a pattern of dysbiosis, immune dysregulation, and multiple organ failure seen in the critically ill patient. Conversely, maintenance of gut integrity can serve to restore a pattern of homeostasis, appropriate immune responses, symbiosis, and clinical recovery. Simply providing refined polymeric formulas as enteral nutrition may not take full advantage of the potential for optimal outcome that could be derived by giving therapy designed to directly stimulate gut defenses and support the intestinal microbiota. This article describes a series of strategies (such as use of intact whole food formulas, soluble fiber, fecal microbial transplantation, serum bovine immunoglobulin, or agents to promote commensal behavior) that should modulate the gut microbiome and shift the critically ill patient toward a pattern of health and recovery.

Immunonutrition Is Associated With a Decreased Incidence of Graft-Versus-Host Disease in Bone Marrow Transplant Recipients: A Meta-Analysis.

Graft-versus-host disease (GVHD) is a serious complication of bone marrow transplantation (BMT), requiring higher doses of glucocorticoids or immunosuppressive therapies and further straining transplant recipients. Immunonutrition, such as vitamins and amino acid supplements, increase immunity and decrease inflammation and oxidative stress. This meta-analysis examines the impact of immunonutrition on the incidence of GVHD and postoperative infections among BMT recipients. A comprehensive literature search for all published randomized controlled trials was conducted with PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (1966-2016). Keywords in the search included variations of terms related to immunonutrition, such as "vitamin," "glutamine," and "transplant." Outcomes included incidence of GVHD and infection. Ten randomized controlled trials involving 681 BMT recipients were analyzed: 332 receiving immunonutrition and 349 receiving standard nutrition. Immunonutrition is correlated with a decreased incidence of GVHD by 19% (relative risk [RR] = 0.810, 95% CI: 0.695-0.945, P = .007). There was no significant difference in the incidence of infections with immunonutrition (RR = 1.016, 95% CI: 0.819-1.261, P = .885). Subgroup analysis of glutamine compared with N-acetylcysteine, selenium, and eicosapentaenoic acid showed no significant difference in the incidence of GVHD or infections (RR = 0.913, 95% CI: 0.732-1.139, P = .419; RR = 0.951, 95% CI: 0.732-1.235; P = .708, respectively). The use of immunonutrition is associated with a reduced risk of GVHD in BMT recipients, potentially as a result of improved immune support and free radical scavenging. Providing immunonutrient supplements is a valuable adjunct in the routine care of BMT recipients, helping to alleviate a common and deadly complication.

Efeitos da imunonutrição no tratamento de pacientes com câncer e suas complicações – uma revisão

O objetivou deste trabalho foi revisar, de forma sucinta e objetiva, as evidências disponíveis nos bancos de dados digitais, sobre os efeitos da imunonutrição para a resposta ao tratamento de pacientes com câncer em pré e pós-operatório. Foi realizada uma revisão de literatura, por meio de buscas bibliográficas nos bancos de dados informatizados Medline/Pubmed, Scielo e Lilacs, no período de julho a setembro de 2014, de artigos que investigaram os efeitos da imunonutrição na recuperação do estado nutricional e em procedimentos pré e pós-operatório de pacientes com câncer. Foram encontrados 32 artigos, dos quais 27 atenderam aos critérios de inclusão do estudo, compreendendo artigos de revisão, caso-controle, epidemiológicos e transversais. A partir desta revisão de literatura foi possível verificar o benefício do uso da dieta imunomoduladora em pacientes oncológicos submetidos ao tratamento no pré-operatório de cirurgias de grande porte abdominal, diminuindo complicações sépticas e inflamatórias no período pós-operatório e consequentemente o tempo de internação hospitalar. Dessa forma, o uso da imunonutrição mostra-se com capacidade de reverter alterações orgânicas e imunológicas causadas tanto pela desnutrição como pelo próprio tumor em pacientes com câncer.

Nutrition in the ICU: An Evidence-Based Approach

Providing artificial nutrition is an important part of caring for critically ill patients. However, because of a paucity of robust data, the practice has been highly variable and often based more on dogma than evidence. A number of studies have been published investigating many different aspects of critical care nutrition. Although the influx of data has better informed the practice, the results have often been conflicting or counter to prevailing thought, resulting in discordant opinions and different interpretations by experts in the field. In this article, we review and summarize the data from a number of the published studies, including studies investigating enteral vs parenteral nutrition, supplementing enteral with parenteral nutrition, and use of immunonutrition. In addition, published studies informing the practice of how best to provide enteral nutrition will be reviewed, including the use of trophic feedings, gastric residual volumes, and gastric vs postpyloric tube placement.

Nutritional management of acute pancreatitis in dogs and cats

To review current and emerging nutritional approaches in the management of acute pancreatitis (AP) in people, dogs, and cats, and to provide a framework for further investigation in this field. Veterinary retrospective studies and reviews, human prospective clinical trials and reviews, and experimental animal studies focusing on nutritional management during AP. Nutritional management is an important part of the treatment plan for patients with AP. In human medicine, the general approach for providing nutrition in patients with AP has changed in recent years and favors enteral over parenteral nutrition with an emphasis on early enteral nutrition (EN). Although there are limited data available, there is increasing evidence in the veterinary literature that supports the beneficial role of EN in AP and contradicts previous assumptions about poor tolerance to enteral feeding in this patient population. Parenteral nutrition may be appropriate alone or in combination with EN as a temporary measure in malnourished patients that do not tolerate adequate EN; however, enteral feeding should be attempted first in most cases. Immunonutrition is being investigated for its positive role in modulating pancreatic inflammation and improving gut barrier function in cases of human AP. The nutritional management of veterinary patients with AP remains challenging. Based on clinical evidence in people, experimental animal studies, and preliminary studies in dogs and cats, the choice of EN over parenteral nutritional support during AP in dogs and cats appears to be beneficial and well tolerated. Optimization of nutritional therapies in dogs and cats including the use of immunonutrition during AP warrants further investigation.

Preoperative oral supplementation support in patients with esophageal cancer.

Surgeries for cancer of the esophagus are still associated with a high rate of postoperative morbidity. There are few reports of perioperative nutritional support for patients undergoing esophageal cancer surgery, and there is insufficient evidence to recommend routine use of immunonutrition in these patients. The aim of this study was to determine whether preoperative immunonutrition positively influences key clinical outcomes such as postoperative infectious complications, mortality, length of hospital stay, and short-term survival in this population. We undertook a retrospective investigation of the effects of preoperative nutritional support on the postoperative course of esophageal cancer surgery at the Department of Gastroenterological Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan. Fifty-five patients who underwent esophagectomy for esophageal cancer were included in this study. Of the 55 patients, 26 patients consumed a liquid dietary supplement (IMPACT group) before surgery and 29 patients did not (STANDARD group). Before surgery, the IMPACT group consumed 750 ml (3 packs)/day of Impact for 5 consecutive days. The analysis was based on postoperative complications, hospital mortality, length of hospital stay, and short-term survival. Significantly fewer patients developed postoperative infections in the IMPACT group compared with the STANDARD group (p=.007): 4 of 21 patients in the IMPACT group and 10 of 29 patients in the STANDARD group. Either an infectious complication or another complication developed in 8 patients in the IMPACT group and 13 patients in the STANDARD group, with the result that 6 patients in the STANDARD group died of postoperative complications (p=.001). The duration of hospitalization was 34 days in the IMPACT group and 48 days in the STANDARD group; hence, hospitalization was significantly shorter in patients treated with Impact (p=.008). The mean 6-month survival rates for the IMPACT group and the STANDARD group were 92% (24/26) and 72% (21/29), respectively (p=.028). Simple preoperative supplementation significantly improved outcome. Administration of the supplemental diet before esophageal surgery appeared to be an effective strategy in reducing infectious complications, mortality, and hospitalization, and improving short-term survival.