Introduction to Effects and Clinical Applications of Enteral Immunonutrition_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Bo , WU Xiaoting

*Surgery Center of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Enteral immunonutrition; Gastrointestinal cancer; Transplantation; Critical illness

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Objective To study the effects and mechanisms of major immune nutrients and to introduce the progresses of clinical applications about enteral immunonutrition. Methods The related literatures about the effects and clinical applications of enteral immunonutrition were reviewed. Results Infection rate can be reduced and the hospitalization can be shortened as a result of the improved nutritional status and immune competence of patients which can be enhanced by reasonable enteral immune nutrition. Most of the patients suffering from serious diseases can benefit from enteral immunonutrition, such as gastrointestinal cancers, post-transplantation complications, chronic liver disorders, acute pancreatitis and so on. However, as a new nutrition therapy, the clinical use of enteral immunonutrition in critically ill patients is still controversial. Conclusions Enteral immunonutrition plays an important role in the nutritional support of patients with serious diseases, such as gastrointestinal cancers, organ failures. However, much work remains to be done.

Citation： CHEN Bo,WU Xiaoting. Introduction to Effects and Clinical Applications of Enteral Immunonutrition. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(12): 978-981. doi: Copy

1.	Bertolini G, Luciani D, Biolo G. Immunonutrition in septic patients: a philosophical view of the current situation [Ｊ]. Clin Nutr, 2007; 26(1): 25-29.
2.	Jones NE, Heyland DK. Pharmaconutrition: a new emerging paradigm [Ｊ]. Curr Opin Gastroenterol, 2008; 24(2): 215-222.
3.	Gonzales S, Polizio AH, Erario MA, et al. Glutamine is highly effective in preventing in vivo cobalt-induced oxidative stress in rat liver [Ｊ]. World J Gastroenterol, 2005; 11(23): 3533-3538.
4.	Wischmeyer PE. Glutamine: role in critical illness and ongoing clinical trials [Ｊ]. Curr Opin Gastroenterol, 2008; 24(2): 190-197.
5.	Peranzoni E, Marigo I, Dolcetti L, et al. Role of arginine metabolism in immunity and immunopathology [Ｊ]. Immunobiology, 2007; 212(9-10): 795-812.
6.	Quirino IE, Correia MI, Cardoso VN. The impact of arginine on bacterial translocation in an intestinal obstruction model in rats [Ｊ]. Clin Nutr, 2007; 26(3): 335-340.
7.	Alvarez W, Mobarhan S. Finding a place for immunonutrition [Ｊ]. Nutr Rev, 2003; 61(6 Pt 1): 214-218.
8.	Grimble RF, Howell WM, O’Reilly G, et al. The ability of fish oil to suppress tumor necrosis factor alpha production by peripheral blood mononuclear cells in healthy men is associated with polymorphisms in genes that influence tumor necrosis factor alpha production [Ｊ]. Am J Clin Nutr, 2002; 76(2): 454-459.
9.	Novak TE, Babcock TA, Jho DH, et al. NF-kappa B inhibition by omega -3 fatty acids modulates LPS-stimulated macrophage TNF-alpha transcription [Ｊ]. Am J Physiol Lung Cell Mol Physiol, 2003; 284(1): L84-L89.
10.	Trickler WJ, Mayhan WG, Miller DW. Brain microvessel endothelial cell responses to tumor necrosis factor-alpha involve a nuclear factor κB (NF-κB) signal transduction pathway [Ｊ]. Brain Res, 2005; 1048(1-2): 24-31.
11.	Calder PC. Immunomodulation by omega-3 fatty acids [Ｊ]. Prostaglandins Leukot Essent Fatty Acids, 2007; 77(5-6): 327-335.
12.	Hofmanová J, Vaculová A, Kozubík A. Polyunsaturated fatty acids sensitize human colon adenocarcinoma HT-29 cells to death receptor-mediated apoptosis [Ｊ]. Cancer Lett, 2005; 218(1): 33-41.
13.	Mayer K, Schaefer MB, Seeger W. Fish oil in the critically ill: from experimental to clinical data [Ｊ]. Curr Opin Clin Nutr Metab Care, 2006; 9(2): 140-148.
14.	American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee [Ｊ]. Circulation, 2006; 114(1): 82-96.
15.	Sturtzel B, Mikulits C, Gisinger C, et al. Use of fiber instead of laxative treatment in a geriatric hospital to improve the wellbeing of seniors [Ｊ]. J Nutr Health Aging, 2009; 13(2): 136-139.
16.	Salvatore S, Hauser B, Vandenplas Y. Chronic enteropathy and feeding [Ｊ]. Nestle Nutr Workshop Ser Pediatr Program, 2007; 59（1）: 115-126.
17.	Bengmark S. Ecoimmunonutrition: a challenge for the third millennium [Ｊ]. Nutrition, 1998; 14(7-8): 563-572.
18.	Alvarez-Olmos MI, Oberhelman RA. Probiotic agents and infectious diseases: a modern perspective on a traditional therapy [Ｊ]． Clin Infect Dis, 2001; 32(11): 1567-1576.
19.	Gupta V, Garg R. Probiotics [Ｊ]. Indian J Med Microbiol, 2009; 27(3): 202-209.
20.	于江涛, 陈利生. 肠内微生态营养支持与结直肠癌的治疗 [Ｊ]. 结直肠肛门外科, 2008; 14(3): 216-219.
21.	Peng S, Lin JY, Lin MY. Antiallergic effect of milk fermented with lactic acid bacteria in a murine animal model [Ｊ]. J Agric Food Chem, 2007; 55(13): 5092-5096.
22.	Callaway TR, Edrington TS, Anderson RC, et al. Probiotics, prebiotics and competitive exclusion for prophylaxis against bacterial disease [Ｊ]. Anim Health Res Rev, 2008; 9(2): 217-225.
23.	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 [Ｊ]. Eur J Clin Nutr, 2008; 62(7): 923-930.
24.	朱翠凤, 刘晓平, 白植军, 等. 生态免疫营养对消化道恶性肿瘤患者术后营养状况、炎症反应和预后的影响 [Ｊ]. 中国临床营养杂志, 2007; 15(2): 90-94.
25.	唐朝晖, 余彦, 白祥军, 等. 生态免疫肠内营养对严重多发伤患者调节性T细胞的影响 [Ｊ]. 中国急救医学, 2008; 28(7): 583-585.
26.	胡建昆．外科手术后早期肠内营养 [Ｊ]．中国普外基础与临床杂志， 2003； 10(4)： 407-409.
27.	李江，刘斌，侯宇，等．腹部外科术后早期肠内营养的临床研究与应用 [Ｊ]．中国普外基础与临床杂志， 2006; 13(3): 355-357.
28.	Takeuchi H, Ikeuchi S, Kawaguchi Y, et al. Clinical significance of perioperative immunonutrition for patients with esophageal cancer [Ｊ]. World J Surg, 2007; 31(11): 2160-2167.
29.	Moskovitz DN, Kim YI. Does perioperative immunonutrition reduce postoperative complications in patients with gastrointestinal cancer undergoing operations? [Ｊ]. Nutr Rev, 2004; 62(11): 443-447.
30.	Braga M, Gianotti L. Preoperative immunonutrition: cost-benefit analysis [Ｊ]. JPEN J Parenter Enteral Nutr, 2005; 29(1 Suppl): S57-S61.
31.	Braga M, Gianotti L, Vignali A, et al. Preoperative oral arginine and ω-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer [Ｊ]. Surgery, 2002; 132(5): 805-814.
32.	江志伟, 李宁, 黎介寿. 消化道肿瘤病人术前肠内免疫营养支持 [Ｊ]. 中国实用外科杂志, 2005; 25(5): 305-306.
33.	Warnecke HB, Schirmeier A, Nüssler AK, et al. The combined treatment with L-arginine and methylprednisolone improves graft morphology and mucosal barrier function [Ｊ]. Transplant Proc, 2002; 34(3): 996-998.
34.	Alexander JW, Metze TJ, McIntosh MJ, et al. The influence of immunomodulatory diets on transplant success and complications [Ｊ]. Transplantation, 2005; 79(4): 460-465.
35.	Nickkholgh A, Schneider H, Encke J, et al. PROUD: Ef-fects of preoperative long-term immunonutrition in patients listed for liver transplantation [Ｊ]. Trials, 2007; 8（1）: 20.
36.	赵德芳, 陈大志, 张珂, 等. 肝移植围手术期肠内免疫营养治疗的观察 [Ｊ]. 肠外与肠内营养, 2008; 15(2): 88-91.
37.	次仁桑珠，王征夏，张辉，等. 免疫营养剂对器官移植的作用 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(2): 243-244.
38.	李为苏, 黎介寿. 肝硬化患者营养不良与围手术期营养支持 [Ｊ]. 实用临床医药杂志, 2004; 8(5): 26-28.
39.	Mssner J, Teich N. Nutrition in acute pancreatitis [Ｊ]. Z Gastroenterol, 2008; 46(8): 784-789.
40.	Darvas K, Futó J, Okrs I, et al. Principles of intensive care in severe acute pancreatitis in 2008 [Ｊ]. Orv Hetil, 2008; 149(47): 2211-2220.
41.	Montejo JC, Zarazaga A, López-Martínez J, et al. Immunonutrition in the intensive care unit. A systematic review and consensus statement [Ｊ]. Clin Nutr, 2003; 22(3): 221-233.
42.	Marik PE, Zaloga GP. Immunonutrition in critically ill patients: a systematic review and analysis of the literature [Ｊ]. Intensive Care Med, 2008; 34(11): 1980-1990.
43.	Galbán C, Montejo JC, Mesejo A, et al. An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients [Ｊ]. Crit Care Med, 2000; 28(3): 643-648.

1. Bertolini G, Luciani D, Biolo G. Immunonutrition in septic patients: a philosophical view of the current situation [Ｊ]. Clin Nutr, 2007; 26(1): 25-29.
2. Jones NE, Heyland DK. Pharmaconutrition: a new emerging paradigm [Ｊ]. Curr Opin Gastroenterol, 2008; 24(2): 215-222.
3. Gonzales S, Polizio AH, Erario MA, et al. Glutamine is highly effective in preventing in vivo cobalt-induced oxidative stress in rat liver [Ｊ]. World J Gastroenterol, 2005; 11(23): 3533-3538.
4. Wischmeyer PE. Glutamine: role in critical illness and ongoing clinical trials [Ｊ]. Curr Opin Gastroenterol, 2008; 24(2): 190-197.
5. Peranzoni E, Marigo I, Dolcetti L, et al. Role of arginine metabolism in immunity and immunopathology [Ｊ]. Immunobiology, 2007; 212(9-10): 795-812.
6. Quirino IE, Correia MI, Cardoso VN. The impact of arginine on bacterial translocation in an intestinal obstruction model in rats [Ｊ]. Clin Nutr, 2007; 26(3): 335-340.
7. Alvarez W, Mobarhan S. Finding a place for immunonutrition [Ｊ]. Nutr Rev, 2003; 61(6 Pt 1): 214-218.
8. Grimble RF, Howell WM, O’Reilly G, et al. The ability of fish oil to suppress tumor necrosis factor alpha production by peripheral blood mononuclear cells in healthy men is associated with polymorphisms in genes that influence tumor necrosis factor alpha production [Ｊ]. Am J Clin Nutr, 2002; 76(2): 454-459.
9. Novak TE, Babcock TA, Jho DH, et al. NF-kappa B inhibition by omega -3 fatty acids modulates LPS-stimulated macrophage TNF-alpha transcription [Ｊ]. Am J Physiol Lung Cell Mol Physiol, 2003; 284(1): L84-L89.
10. Trickler WJ, Mayhan WG, Miller DW. Brain microvessel endothelial cell responses to tumor necrosis factor-alpha involve a nuclear factor κB (NF-κB) signal transduction pathway [Ｊ]. Brain Res, 2005; 1048(1-2): 24-31.
11. Calder PC. Immunomodulation by omega-3 fatty acids [Ｊ]. Prostaglandins Leukot Essent Fatty Acids, 2007; 77(5-6): 327-335.
12. Hofmanová J, Vaculová A, Kozubík A. Polyunsaturated fatty acids sensitize human colon adenocarcinoma HT-29 cells to death receptor-mediated apoptosis [Ｊ]. Cancer Lett, 2005; 218(1): 33-41.
13. Mayer K, Schaefer MB, Seeger W. Fish oil in the critically ill: from experimental to clinical data [Ｊ]. Curr Opin Clin Nutr Metab Care, 2006; 9(2): 140-148.
14. American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee [Ｊ]. Circulation, 2006; 114(1): 82-96.
15. Sturtzel B, Mikulits C, Gisinger C, et al. Use of fiber instead of laxative treatment in a geriatric hospital to improve the wellbeing of seniors [Ｊ]. J Nutr Health Aging, 2009; 13(2): 136-139.
16. Salvatore S, Hauser B, Vandenplas Y. Chronic enteropathy and feeding [Ｊ]. Nestle Nutr Workshop Ser Pediatr Program, 2007; 59（1）: 115-126.
17. Bengmark S. Ecoimmunonutrition: a challenge for the third millennium [Ｊ]. Nutrition, 1998; 14(7-8): 563-572.
18. Alvarez-Olmos MI, Oberhelman RA. Probiotic agents and infectious diseases: a modern perspective on a traditional therapy [Ｊ]． Clin Infect Dis, 2001; 32(11): 1567-1576.
19. Gupta V, Garg R. Probiotics [Ｊ]. Indian J Med Microbiol, 2009; 27(3): 202-209.
20. 于江涛, 陈利生. 肠内微生态营养支持与结直肠癌的治疗 [Ｊ]. 结直肠肛门外科, 2008; 14(3): 216-219.
21. Peng S, Lin JY, Lin MY. Antiallergic effect of milk fermented with lactic acid bacteria in a murine animal model [Ｊ]. J Agric Food Chem, 2007; 55(13): 5092-5096.
22. Callaway TR, Edrington TS, Anderson RC, et al. Probiotics, prebiotics and competitive exclusion for prophylaxis against bacterial disease [Ｊ]. Anim Health Res Rev, 2008; 9(2): 217-225.
23. 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 [Ｊ]. Eur J Clin Nutr, 2008; 62(7): 923-930.
24. 朱翠凤, 刘晓平, 白植军, 等. 生态免疫营养对消化道恶性肿瘤患者术后营养状况、炎症反应和预后的影响 [Ｊ]. 中国临床营养杂志, 2007; 15(2): 90-94.
25. 唐朝晖, 余彦, 白祥军, 等. 生态免疫肠内营养对严重多发伤患者调节性T细胞的影响 [Ｊ]. 中国急救医学, 2008; 28(7): 583-585.
26. 胡建昆．外科手术后早期肠内营养 [Ｊ]．中国普外基础与临床杂志， 2003； 10(4)： 407-409.
27. 李江，刘斌，侯宇，等．腹部外科术后早期肠内营养的临床研究与应用 [Ｊ]．中国普外基础与临床杂志， 2006; 13(3): 355-357.
28. Takeuchi H, Ikeuchi S, Kawaguchi Y, et al. Clinical significance of perioperative immunonutrition for patients with esophageal cancer [Ｊ]. World J Surg, 2007; 31(11): 2160-2167.
29. Moskovitz DN, Kim YI. Does perioperative immunonutrition reduce postoperative complications in patients with gastrointestinal cancer undergoing operations? [Ｊ]. Nutr Rev, 2004; 62(11): 443-447.
30. Braga M, Gianotti L. Preoperative immunonutrition: cost-benefit analysis [Ｊ]. JPEN J Parenter Enteral Nutr, 2005; 29(1 Suppl): S57-S61.
31. Braga M, Gianotti L, Vignali A, et al. Preoperative oral arginine and ω-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer [Ｊ]. Surgery, 2002; 132(5): 805-814.
32. 江志伟, 李宁, 黎介寿. 消化道肿瘤病人术前肠内免疫营养支持 [Ｊ]. 中国实用外科杂志, 2005; 25(5): 305-306.
33. Warnecke HB, Schirmeier A, Nüssler AK, et al. The combined treatment with L-arginine and methylprednisolone improves graft morphology and mucosal barrier function [Ｊ]. Transplant Proc, 2002; 34(3): 996-998.
34. Alexander JW, Metze TJ, McIntosh MJ, et al. The influence of immunomodulatory diets on transplant success and complications [Ｊ]. Transplantation, 2005; 79(4): 460-465.
35. Nickkholgh A, Schneider H, Encke J, et al. PROUD: Ef-fects of preoperative long-term immunonutrition in patients listed for liver transplantation [Ｊ]. Trials, 2007; 8（1）: 20.
36. 赵德芳, 陈大志, 张珂, 等. 肝移植围手术期肠内免疫营养治疗的观察 [Ｊ]. 肠外与肠内营养, 2008; 15(2): 88-91.
37. 次仁桑珠，王征夏，张辉，等. 免疫营养剂对器官移植的作用 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(2): 243-244.
38. 李为苏, 黎介寿. 肝硬化患者营养不良与围手术期营养支持 [Ｊ]. 实用临床医药杂志, 2004; 8(5): 26-28.
39. Mssner J, Teich N. Nutrition in acute pancreatitis [Ｊ]. Z Gastroenterol, 2008; 46(8): 784-789.
40. Darvas K, Futó J, Okrs I, et al. Principles of intensive care in severe acute pancreatitis in 2008 [Ｊ]. Orv Hetil, 2008; 149(47): 2211-2220.
41. Montejo JC, Zarazaga A, López-Martínez J, et al. Immunonutrition in the intensive care unit. A systematic review and consensus statement [Ｊ]. Clin Nutr, 2003; 22(3): 221-233.
42. Marik PE, Zaloga GP. Immunonutrition in critically ill patients: a systematic review and analysis of the literature [Ｊ]. Intensive Care Med, 2008; 34(11): 1980-1990.
43. Galbán C, Montejo JC, Mesejo A, et al. An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients [Ｊ]. Crit Care Med, 2000; 28(3): 643-648.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Introduction to Effects and Clinical Applications of Enteral Immunonutrition

Abstract Full text Figures/Tables Video References Cited by

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