Better understanding and clinical application of immunonutrition_West China Medical Journal

Authors：

CHEN Bo , XIONG Maoming ,  MENG Xiangling

Department of Gastrointestinal Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P. R. China;

Corresponding author：

MENG Xiangling, Email: anyimxl@163.com

Keywords：

Parenteral nutrition; Enteral nutrition; Undernutrition; Immunonutrition; Clinical application

DOI：

10.7507/1002-0179.201611034

Video：

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Abstract Full text Figures/Tables Video References Cited by

Malnutrition is associated with many adverse clinical outcomes, including increased deaths and complications in perioperative period. The immunonutrition support plays an important role in the recovery process of patients with nutritional risk. Reasonable support can efficiently improve the condition of these cases and strongly suppress the inflammatory response. The immuno-nutrients include glutamine, ω-3 polyunsaturated fatty acids, arginine, nucleotides and so on. More and more evidences show that different kinds of immuno-nutrients play a regulatory role in metabolism and inflammatory response in patients with different disease stages and courses, and affect clinical outcomes and prognosis. Nowadays, there is an urgent need to standardize immunonutrition support in clinical work. In this paper, the related literatures about immunonutrition in recent years were reviewed. Our goal is to reduce the number of irregularities in the nutrition support practice, and to help nutritional risk patients achieve better clinical outcomes.

Citation： CHEN Bo, XIONG Maoming, MENG Xiangling. Better understanding and clinical application of immunonutrition. West China Medical Journal, 2018, 33(3): 354-358. doi: 10.7507/1002-0179.201611034 Copy

1.	Braga M, Ljungqvist O, Soeters P, et al. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr, 2009, 28(4): 378-386.
2.	Zugasti Murillo A, Petrina Jáuregui E, Elizondo Armendáriz J. Parenteral nutrition-associated liver disease and lipid emulsions. Endocrinol Nutr, 2015, 62(6): 285-289.
3.	Wang F, Hou MX, Wu XL, et al. Impact of enteral nutrition on postoperative immune function and nutritional status. Genet Mol Res, 2015, 14(2): 6065-6072.
4.	Cerantola Y, Hübner M, Grass F, et al. Immunonutrition in gastrointestinal surgery. Br J Surg, 2011, 98(1): 37-48.
5.	Wischmeyer P. Glutamine supplementation in parenteral nutrition and intensive care unit patients: are we throwing the baby out with the bathwater? JPEN J Parenter Enteral Nutr, 2015, 39(8): 893-897.
6.	Wang X, Pierre JF, Heneghan AF, et al. Glutamine improves innate immunity and prevents bacterial enteroinvasion during parenteral nutrition. JPEN J Parenter Enteral Nutr, 2015, 39(6): 688-697.
7.	Fan J, Wu L, Li G, et al. Effects of enteral nutrition with parenteral glutamine supplementation on the immunological function in septic rats. Br J Nutr, 2015, 113(11): 1712-1722.
8.	Fan J, Li GP, Wu LD, et al. Parenteral glutamine supplementation in combination with enteral nutrition improves intestinal immunity in septic rats. Nutrition, 2015, 31(5): 766-774.
9.	Vanek VW, Matarese LE, Robinson M, et al. A.S.P.E.N. position paper: parenteral nutrition glutamine supplementation. Nutr Clin Pract, 2011, 26(4): 479-494.
10.	Tsai PH, Liu JJ, Chiu WC, et al. Effects of dietary glutamine on adhesion molecule expression and oxidative stress in mice with streptozotocin-induced type 1 diabetes. Clin Nutr, 2011, 30(1): 124-129.
11.	Kallweit AR, Baird CH, Stutzman DK, et al. Glutamine prevents apoptosis in intestinal epithelial cells and induces differential protective pathways in heat and oxidant injury models. JPEN J Parenter Enteral Nutr, 2012, 36(5): 551-555.
12.	Jordan I, Balaguer M, Esteban ME, et al. Glutamine effects on heat shock protein 70 and interleukines 6 and 10: randomized trial of glutamine supplementation versus standard parenteral nutrition in critically ill children. Clin Nutr, 2016, 35(1): 34-40.
13.	Fu X, Zhu M, Sun X, et al. Hyperbaric oxygen treatment and enteral nutrition support with glutamine relieves traumatic brain injury in the rats. Int J Clin Exp Med, 2014, 7(12): 5686-5690.
14.	Genton L, Pichard C. Protein catabolism and requirements in severe illness. Int J Vitam Nutr Res, 2011, 81(2-3): 143-152.
15.	McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr, 2009, 33(3): 277-316.
16.	Wang Y, Jiang ZM, Nolan MT, et al. The impact of glutamine dipeptide-supplemented parenteral nutrition on outcomes of surgical patients: a meta-analysis of randomized clinical trials. JPEN J Parenter Enteral Nutr, 2010, 34(5): 521-529.
17.	Kuhn KS, Muscaritoli M, Wischmeyer PA. Glutamine as indispensable nutrient in oncology: experimental and clinical evidence. Eur J Nutr, 2010, 49(4): 197-210.
18.	Guo M, Li Y, Li J. Role of growth hormone, glutamine and enteral nutrition in pediatric short bowel syndrome: a pilot follow-up study. Eur J Pediatr Surg, 2012, 22(2): 121-126.
19.	Cavalcante AA, Campelo MW, De Vasconcelos MP, et al. Enteral nutrition supplemented with L-glutamine in patients with systemic inflammatory response syndrome due to pulmonary infection. Nutrition, 2012, 28(4): 397-402.
20.	Van Zwol A, Moll HA, Fetter WP. Glutamine-enriched enteral nutrition in very low birthweight infants and allergic and infectious diseases at 6 years of age. Paediatr Perinat Epidemiol, 2011, 25(1): 60-66.
21.	Huebner J, Muecke R. Arginine-supplemented enteral nutrition. J Cancer Res Clin Oncol, 2014, 140(4): 681-683.
22.	De Luis DA, Izaola O, Terroba MC, et al. Effect of three different doses of arginine enhanced enteral nutrition on nutritional status and outcomes in well nourished postsurgical cancer patients: a randomized single blinded prospective trial. Eur Rev Med Pharmacol Sci, 2015, 19(6): 950-955.
23.	Ueno C, Fukatsu K, Maeshima Y, et al. Arginine-enriched total parenteral nutrition improves survival in peritonitis by normalizing NF kappa B activation in peritoneal resident and exudative leukocytes. Ann Surg, 2010, 251(5): 959-965.
24.	De Luis DA, Izaola O, Cuellar L, et al. High dose of arginine enhanced enteral nutrition in postsurgical head and neck cancer patients. A randomized clinical trial. Eur Rev Med Pharmacol Sci, 2009, 13(4): 279-283.
25.	Marik PE, Zaloga GP. Immunonutrition in high-risk surgical patients: a systematic review and analysis of the literature. JPEN J Parenter Enteral Nutr, 2010, 34(4): 378-386.
26.	Bertolini G, Iapichino G, Radrizzani D, et al. Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial. Intensive Care Med, 2003, 29(5): 834-840.
27.	Terashima M, Aoyama-Ishikawa M, Ueda TA, et al. The effects of n-3 polyunsaturated fatty acid-rich total parenteral nutrition on neutrophil apoptosis in a rat endotoxemia. J Clin Biochem Nutr, 2013, 52(2): 154-159.
28.	Xu Z, Li Y, Wang J, et al. Effect of omega-3 polyunsaturated fatty acids to reverse biopsy-proven parenteral nutrition-associated liver disease in adults. Clin Nutr, 2012, 31(2): 217-223.
29.	Tillman EM, Helms RA. Omega-3 long chain polyunsaturated fatty acids for treatment of parenteral nutrition-associated liver disease: a review of the literature. J Pediatr Pharmacol Ther, 2011, 16(1): 31-38.
30.	D’Ascenzo R, D’Egidio S, Angelini L, et al. Parenteral nutrition of preterm infants with a lipid emulsion containing 10% fish oil: effect on plasma lipids and long-chain polyunsaturated fatty acids. J Pediatr, 2011, 159(1): 33-38.
31.	Chen B, Zhou Y, Yang P, et al. Safety and efficacy of fish oil-enriched parenteral nutrition regimen on postoperative patients undergoing major abdominal surgery: a meta-analysis of randomized controlled trials. JPEN J Parenter Enteral Nutr, 2010, 34(4): 387-394.
32.	Nandivada P, Cowan E, Carlson SJ, et al. Mechanisms for the effects of fish oil lipid emulsions in the management of parenteral nutrition-associated liver disease. Prostaglandins Leukot Essent Fatty Acids, 2013, 89(4): 153-158.
33.	Waitzberg DL, Torrinhas RS. Fish oil lipid emulsions and immune response: what clinicians need to know. Nutr Clin Pract, 2009, 24(4): 487-499.
34.	Berger MM, Delodder F, Liaudet L, et al. Three short perioperative infusions of n-3 PUFAs reduce systemic inflammation induced by cardiopulmonary bypass surgery: a randomized controlled trial. Am J Clin Nutr, 2013, 97(2): 246-254.
35.	Heller AR, Rössel T, Gottschlich B, et al. Omega-3 fatty acids improve liver and pancreas function in postoperative cancer patients. Int J Cancer, 2004, 111(4): 611-616.
36.	Jiang ZM, Wilmore DW, Wang XR, et al. Randomized clinical trial of intravenous soybean oil alone versus soybean oil plus fish oil emulsion after gastrointestinal cancer surgery. Br J Surg, 2010, 97(6): 804-809.
37.	Wang J, Yu JC, Kang WM, et al. Superiority of a fish oil-enriched emulsion to medium-chain triacylglycerols/long-chain triacylglycerols in gastrointestinal surgery patients: a randomized clinical trial. Nutrition, 2012, 28(6): 623-629.
38.	Cabré E, Mañosa M, Gassull MA. Omega-3 fatty acids and inflammatory bowel diseases - a systematic review. Br J Nutr, 2012, 107(Suppl 2): S240-S252.
39.	Xu XD, Shao F. Enteral ecoimmunonutrition reduced enteral permeability and serum ghrelin activity in severe cerebral stroke patients with lung infection. Cell Biochem Biophys, 2015, 71(1): 195-198.
40.	Wang G, Wen J, Xu L, et al. Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis. J Surg Res, 2013, 183(2): 592-597.
41.	Qin HL, Zheng JJ, Tong DN, et al. Effect of lactobacillus plantarum enteral feeding on the gut permeability and septic complications in the patients with acute pancreatitis. Eur J Clin Nutr, 2008, 62(7): 923-930.
42.	He Q, Gao Y, Jie Z, et al. Two distinct metacommunities characterize the gut microbiota in Crohn’s disease patients. Gigascience, 2017, 6(7): 1-11.
43.	Liu Z, Qin H, Yang Z, et al. Randomised clinical trial: the effects of perioperative probiotic treatment on barrier function and post-operative infectious complications in colorectal cancer surgery: a double-blind study. Aliment Pharmacol Ther, 2011, 33(1): 50-63.
44.	Höermannsperger G, Haller D. Molecular crosstalk of probiotic bacteria with the intestinal immune system: clinical relevance in the context of inflammatory bowel disease. Int J Med Microbiol, 2010, 300(1): 63-73.
45.	Ferrie S, Daley M. Lactobacillus GG as treatment for diarrhea during enteral feeding in critical illness: randomized controlled trial. JPEN J Parenter Enteral Nutr, 2011, 35(1): 43-49.
46.	Barnes JL, Hartmann B, Holst JJ, et al. Intestinal adaptation is stimulated by partial enteral nutrition supplemented with the prebiotic short-chain fructooligosaccharide in a neonatal intestinal failure piglet model. JPEN J Parenter Enteral Nutr, 2012, 36(5): 524-537.
47.	Wang QH. Effect of ecological immune-enhanced enteral nutrition on patients with gastrointestinal fistulas. Eur Rev Med Pharmacol Sci, 2017, 21(9): 2261-2267.

1. Braga M, Ljungqvist O, Soeters P, et al. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr, 2009, 28(4): 378-386.
2. Zugasti Murillo A, Petrina Jáuregui E, Elizondo Armendáriz J. Parenteral nutrition-associated liver disease and lipid emulsions. Endocrinol Nutr, 2015, 62(6): 285-289.
3. Wang F, Hou MX, Wu XL, et al. Impact of enteral nutrition on postoperative immune function and nutritional status. Genet Mol Res, 2015, 14(2): 6065-6072.
4. Cerantola Y, Hübner M, Grass F, et al. Immunonutrition in gastrointestinal surgery. Br J Surg, 2011, 98(1): 37-48.
5. Wischmeyer P. Glutamine supplementation in parenteral nutrition and intensive care unit patients: are we throwing the baby out with the bathwater? JPEN J Parenter Enteral Nutr, 2015, 39(8): 893-897.
6. Wang X, Pierre JF, Heneghan AF, et al. Glutamine improves innate immunity and prevents bacterial enteroinvasion during parenteral nutrition. JPEN J Parenter Enteral Nutr, 2015, 39(6): 688-697.
7. Fan J, Wu L, Li G, et al. Effects of enteral nutrition with parenteral glutamine supplementation on the immunological function in septic rats. Br J Nutr, 2015, 113(11): 1712-1722.
8. Fan J, Li GP, Wu LD, et al. Parenteral glutamine supplementation in combination with enteral nutrition improves intestinal immunity in septic rats. Nutrition, 2015, 31(5): 766-774.
9. Vanek VW, Matarese LE, Robinson M, et al. A.S.P.E.N. position paper: parenteral nutrition glutamine supplementation. Nutr Clin Pract, 2011, 26(4): 479-494.
10. Tsai PH, Liu JJ, Chiu WC, et al. Effects of dietary glutamine on adhesion molecule expression and oxidative stress in mice with streptozotocin-induced type 1 diabetes. Clin Nutr, 2011, 30(1): 124-129.
11. Kallweit AR, Baird CH, Stutzman DK, et al. Glutamine prevents apoptosis in intestinal epithelial cells and induces differential protective pathways in heat and oxidant injury models. JPEN J Parenter Enteral Nutr, 2012, 36(5): 551-555.
12. Jordan I, Balaguer M, Esteban ME, et al. Glutamine effects on heat shock protein 70 and interleukines 6 and 10: randomized trial of glutamine supplementation versus standard parenteral nutrition in critically ill children. Clin Nutr, 2016, 35(1): 34-40.
13. Fu X, Zhu M, Sun X, et al. Hyperbaric oxygen treatment and enteral nutrition support with glutamine relieves traumatic brain injury in the rats. Int J Clin Exp Med, 2014, 7(12): 5686-5690.
14. Genton L, Pichard C. Protein catabolism and requirements in severe illness. Int J Vitam Nutr Res, 2011, 81(2-3): 143-152.
15. McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr, 2009, 33(3): 277-316.
16. Wang Y, Jiang ZM, Nolan MT, et al. The impact of glutamine dipeptide-supplemented parenteral nutrition on outcomes of surgical patients: a meta-analysis of randomized clinical trials. JPEN J Parenter Enteral Nutr, 2010, 34(5): 521-529.
17. Kuhn KS, Muscaritoli M, Wischmeyer PA. Glutamine as indispensable nutrient in oncology: experimental and clinical evidence. Eur J Nutr, 2010, 49(4): 197-210.
18. Guo M, Li Y, Li J. Role of growth hormone, glutamine and enteral nutrition in pediatric short bowel syndrome: a pilot follow-up study. Eur J Pediatr Surg, 2012, 22(2): 121-126.
19. Cavalcante AA, Campelo MW, De Vasconcelos MP, et al. Enteral nutrition supplemented with L-glutamine in patients with systemic inflammatory response syndrome due to pulmonary infection. Nutrition, 2012, 28(4): 397-402.
20. Van Zwol A, Moll HA, Fetter WP. Glutamine-enriched enteral nutrition in very low birthweight infants and allergic and infectious diseases at 6 years of age. Paediatr Perinat Epidemiol, 2011, 25(1): 60-66.
21. Huebner J, Muecke R. Arginine-supplemented enteral nutrition. J Cancer Res Clin Oncol, 2014, 140(4): 681-683.
22. De Luis DA, Izaola O, Terroba MC, et al. Effect of three different doses of arginine enhanced enteral nutrition on nutritional status and outcomes in well nourished postsurgical cancer patients: a randomized single blinded prospective trial. Eur Rev Med Pharmacol Sci, 2015, 19(6): 950-955.
23. Ueno C, Fukatsu K, Maeshima Y, et al. Arginine-enriched total parenteral nutrition improves survival in peritonitis by normalizing NF kappa B activation in peritoneal resident and exudative leukocytes. Ann Surg, 2010, 251(5): 959-965.
24. De Luis DA, Izaola O, Cuellar L, et al. High dose of arginine enhanced enteral nutrition in postsurgical head and neck cancer patients. A randomized clinical trial. Eur Rev Med Pharmacol Sci, 2009, 13(4): 279-283.
25. Marik PE, Zaloga GP. Immunonutrition in high-risk surgical patients: a systematic review and analysis of the literature. JPEN J Parenter Enteral Nutr, 2010, 34(4): 378-386.
26. Bertolini G, Iapichino G, Radrizzani D, et al. Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial. Intensive Care Med, 2003, 29(5): 834-840.
27. Terashima M, Aoyama-Ishikawa M, Ueda TA, et al. The effects of n-3 polyunsaturated fatty acid-rich total parenteral nutrition on neutrophil apoptosis in a rat endotoxemia. J Clin Biochem Nutr, 2013, 52(2): 154-159.
28. Xu Z, Li Y, Wang J, et al. Effect of omega-3 polyunsaturated fatty acids to reverse biopsy-proven parenteral nutrition-associated liver disease in adults. Clin Nutr, 2012, 31(2): 217-223.
29. Tillman EM, Helms RA. Omega-3 long chain polyunsaturated fatty acids for treatment of parenteral nutrition-associated liver disease: a review of the literature. J Pediatr Pharmacol Ther, 2011, 16(1): 31-38.
30. D’Ascenzo R, D’Egidio S, Angelini L, et al. Parenteral nutrition of preterm infants with a lipid emulsion containing 10% fish oil: effect on plasma lipids and long-chain polyunsaturated fatty acids. J Pediatr, 2011, 159(1): 33-38.
31. Chen B, Zhou Y, Yang P, et al. Safety and efficacy of fish oil-enriched parenteral nutrition regimen on postoperative patients undergoing major abdominal surgery: a meta-analysis of randomized controlled trials. JPEN J Parenter Enteral Nutr, 2010, 34(4): 387-394.
32. Nandivada P, Cowan E, Carlson SJ, et al. Mechanisms for the effects of fish oil lipid emulsions in the management of parenteral nutrition-associated liver disease. Prostaglandins Leukot Essent Fatty Acids, 2013, 89(4): 153-158.
33. Waitzberg DL, Torrinhas RS. Fish oil lipid emulsions and immune response: what clinicians need to know. Nutr Clin Pract, 2009, 24(4): 487-499.
34. Berger MM, Delodder F, Liaudet L, et al. Three short perioperative infusions of n-3 PUFAs reduce systemic inflammation induced by cardiopulmonary bypass surgery: a randomized controlled trial. Am J Clin Nutr, 2013, 97(2): 246-254.
35. Heller AR, Rössel T, Gottschlich B, et al. Omega-3 fatty acids improve liver and pancreas function in postoperative cancer patients. Int J Cancer, 2004, 111(4): 611-616.
36. Jiang ZM, Wilmore DW, Wang XR, et al. Randomized clinical trial of intravenous soybean oil alone versus soybean oil plus fish oil emulsion after gastrointestinal cancer surgery. Br J Surg, 2010, 97(6): 804-809.
37. Wang J, Yu JC, Kang WM, et al. Superiority of a fish oil-enriched emulsion to medium-chain triacylglycerols/long-chain triacylglycerols in gastrointestinal surgery patients: a randomized clinical trial. Nutrition, 2012, 28(6): 623-629.
38. Cabré E, Mañosa M, Gassull MA. Omega-3 fatty acids and inflammatory bowel diseases - a systematic review. Br J Nutr, 2012, 107(Suppl 2): S240-S252.
39. Xu XD, Shao F. Enteral ecoimmunonutrition reduced enteral permeability and serum ghrelin activity in severe cerebral stroke patients with lung infection. Cell Biochem Biophys, 2015, 71(1): 195-198.
40. Wang G, Wen J, Xu L, et al. Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis. J Surg Res, 2013, 183(2): 592-597.
41. Qin HL, Zheng JJ, Tong DN, et al. Effect of lactobacillus plantarum enteral feeding on the gut permeability and septic complications in the patients with acute pancreatitis. Eur J Clin Nutr, 2008, 62(7): 923-930.
42. He Q, Gao Y, Jie Z, et al. Two distinct metacommunities characterize the gut microbiota in Crohn’s disease patients. Gigascience, 2017, 6(7): 1-11.
43. Liu Z, Qin H, Yang Z, et al. Randomised clinical trial: the effects of perioperative probiotic treatment on barrier function and post-operative infectious complications in colorectal cancer surgery: a double-blind study. Aliment Pharmacol Ther, 2011, 33(1): 50-63.
44. Höermannsperger G, Haller D. Molecular crosstalk of probiotic bacteria with the intestinal immune system: clinical relevance in the context of inflammatory bowel disease. Int J Med Microbiol, 2010, 300(1): 63-73.
45. Ferrie S, Daley M. Lactobacillus GG as treatment for diarrhea during enteral feeding in critical illness: randomized controlled trial. JPEN J Parenter Enteral Nutr, 2011, 35(1): 43-49.
46. Barnes JL, Hartmann B, Holst JJ, et al. Intestinal adaptation is stimulated by partial enteral nutrition supplemented with the prebiotic short-chain fructooligosaccharide in a neonatal intestinal failure piglet model. JPEN J Parenter Enteral Nutr, 2012, 36(5): 524-537.
47. Wang QH. Effect of ecological immune-enhanced enteral nutrition on patients with gastrointestinal fistulas. Eur Rev Med Pharmacol Sci, 2017, 21(9): 2261-2267.

West China Medical Journal

Better understanding and clinical application of immunonutrition

Abstract Full text Figures/Tables Video References Cited by

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