Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-18T17:42:56.620Z Has data issue: false hasContentIssue false
  • English
  • Français

Immunonutrition and surgical practice

Published online by Cambridge University Press:  28 February 2007

Leán O'Flaherty  and
David J. Bouchier-Hayes
Leán O'Flaherty*
Affiliation:
Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Republic of Ireland
David J. Bouchier-Hayes
Affiliation:
Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Republic of Ireland
*
*Corresponding Author: Ms Leán O'Flaherty, present address National Dairy Council, Grattan House, Lower Mount Street, Dublin 2, Republic of Ireland, fax +353 1 6620379, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Immunonutrition generally refers to the effect of the provision of specific nutrients on the immune system. These nutrients typically have immunoenhancing properties, and recent advances in nutrition support involve studies designed to exploit the desirable biological properties of these nutrients. The term immunonutrition strictly implies that we are focusing on the effect of certain nutrients on aspects of the immune system. However, in reality immunonutrition also refers to studies that not only examine the function of lymphocytes and leucocytes, but which also study the influence of key nutrients on the acute-phase response, the inflammatory response and on gastrointestinal structure and function. The interest, therefore, is on the impact of immunonutrition on all aspects of host defence mechanisms in response to a catabolic stress. Major surgery evokes an acute-phase response, a transient immunosuppression and alterations in gastrointestinal function. Normal function is usually restored after a few days; however, in a subgroup of patients homeostasis may be lost and development of the systemic inflammatory response syndrome (SIRS) ensues. Results of recent clinical trials suggest that provision of immunomodulatory nutrients, including glutamine, arginine, n-3 polyunsaturated fatty acids and dietary nucleotides, may promote restoration of normal tissue function post-operatively and prevent the occurrence of SIRS.

Keywords

ImmunologyGlutamineArginineTaurine
Type
Symposium on ‘Nutrition and surgical practice’
Information
Proceedings of the Nutrition Society , Volume 58 , Issue 4 , November 1999 , pp. 831 - 837
Copyright
The Nutrition Society

References

Ahlman, B, Ljungqvist, O, Andersson, K & Wernerman, J (1995a) Free amino acids in the human intestinal mucosa; impact of surgery and critical illness. Clinical Nutrition 14, 54–55.CrossRefGoogle Scholar
Ahlman, B, Ljungqvist, O, Persson, B, Bindsley, L & Wernerman, J (1995b) Intestinal amino acid content in critically ill patients. Journal of Parenteral and Enteral Nutrition 19, 272–278.CrossRefGoogle ScholarPubMed
Alexander, JW, Saito, H & Trocki, O (1986) The importance of lipid type in the diet after burn injury. Annals of Surgery 204, 1–8.CrossRefGoogle ScholarPubMed
Athlin, L, Holmberg, SB & Hafstrom, L (1991) Macrophage function and surgery. European Journal of Surgery 157, 163–170.Google ScholarPubMed
Atkinson, S, Sieffert, E & Bihari, D (1998) A prospective, randomised, double-blind, controlled clinical trial of enteral immunonutrition in the critically ill. Critical Care Medicine 26, 1164–1172.CrossRefGoogle ScholarPubMed
Barbul, A (1986) Arginine biochemistry, physiology, and therapeutic implications. Journal of Parenteral and Enteral Nutrition 10, 227–238.CrossRefGoogle ScholarPubMed
Barbul, A, Lazarou, SA, Efron, DT, Wasser Krug, HL & Efron, G (1990) Arginine enhances wound healing and lymphocyte immune responses in humans. Surgery 108, 331–336.Google ScholarPubMed
Baumann, H & Gauldie, J (1994) The acute phase response. Immunology Today 15, 74–80.CrossRefGoogle ScholarPubMed
Bengmark, S (1998) Immunonutrition: role of biosurfactants, fibre, and probiotic bacteria. Nutrition 14, 585–594.CrossRefGoogle ScholarPubMed
Bergstrom, J, Furst, P, Noree, LO & Vinners, E (1974) Intracellular free amino acid concentration in human muscle tissue. Journal of Applied Physiology 36, 693–697.CrossRefGoogle ScholarPubMed
Bone, RC (1996) Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: what we do and do not know about cytokine regulation. Critical Care Medicine 24, 163–172.CrossRefGoogle Scholar
Bower, RH, Cerra, FB, Fershadsky, B, Licari, JJ, Hoyt, DB, Jensen, GL, VanBuren, CT, Rothkopf, MM, Daly, JM & Adelsberg, MD (1995) Early enteral administration of a formula (IMPACT) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: results of a multicentre prospective randomised clinical trial. Critical Care Medicine 23, 436–449.CrossRefGoogle Scholar
Braga, M, Gianotti, L, Cestari, A, Vignali, A, Pellega, F, Dolci, A & DiCarlo, V (1996a) Gut function and immune and inflammatory reponses in patients perioperatively fed with supplemented enteral formulas. Archives of Surgery 131, 1257–1264.CrossRefGoogle Scholar
Braga, M, Vignali, A, Gianotti, L, Cestari, A, Profili, M & Carlo, VD (1996b) Immune and nutritional effects of early enteral nutrition after major abdominal operations. European Journal of Surgery 162, 105–112.Google ScholarPubMed
Chang, HR & Bistrian, B (1998) The role of cytokines in the catabolic consequences of infection and injury. Journal of Parenteral and Enteral Nutrition 22, 156–166.CrossRefGoogle ScholarPubMed
Daly, JM, Lieberman, MD, Goldfine, J, Shou, J, Weintraub, F, Rosato, EF & Lavin, P (1992) Enteral nutrition with supplemented arginine, RNA, and omega three fatty acids in patients after operation: Immunologic, metabolic and clinical outcome. Surgery 112, 56–67.Google Scholar
Daly, JM, Weintraub, FN, Shou, J, Rosato, EF & Lucia, M (1995) Enteral nutrition during multimodality therapy in upper gastrointestinal cancer patients. Annals of Surgery 221, 327–338.CrossRefGoogle ScholarPubMed
Davies, MG & O'Hagen, PO (1997) Systemic inflammatory response syndrome. British Journal of Surgery 84, 920–935.CrossRefGoogle ScholarPubMed
Deitch, EA (1994) Bacterial translocation: the influence of dietary variables. Gut 35, Suppl. 1, S23–S27.CrossRefGoogle ScholarPubMed
Edwards, PD, Topping, P, Kontaridis, MI, Moldiver, LL, Copeland, EMIII & Lind, DS (1997) Arginine-enhanced enteral nutrition augments the growth of a nitric oxide producing tumour. Journal of Parenteral and Enteral Nutrition 21, 215–219.CrossRefGoogle Scholar
Evoy, D, Lieberman, MD, Fahey, TJ & Daly, JM (1998) Immunonutrition: the role of arginine. Nutrition 14, 611–617.CrossRefGoogle ScholarPubMed
Fish, J, Sporay, G, Eyer, K, Jones, J, Kihara, T, Kennedy, A, Aporan, C & Jensen, GL (1997) A prospective randomized study of glutamine enriched parenteral compared with enteral feeding in postoperative patients. American Journal of Clinical Nutrition 65, 977–983.CrossRefGoogle ScholarPubMed
Furst, P & Stehle, P (1993) The potential use of parenteral dipeptides in clinical nutrition. Nutrition in Clinical Practice 8, 106–114.CrossRefGoogle ScholarPubMed
Gaull, GE & Rassin, DK (1979) Taurine and brain development: human and animal correlates. In Development and Neurobiology, pp. 461–477 [Meisami, E and Braziers, MAB, editors]. New York: Raven Press.Google Scholar
Gardiner, K & Barbul, A (1993) Intestinal amino acid transport during sepsis. Journal of Parenteral and Enteral Nutrition 17, 277–283.CrossRefGoogle ScholarPubMed
Gardiner, KR, Gardiner, RE & Barbul, A (1995) Reduced intestinal absorption of arginine during sepsis. Critical Care Medicine 23, 1227–1232.CrossRefGoogle ScholarPubMed
Giroir, BP (1993) Mediators of septic shock: new approaches for interrupting the endogenous inflammatory cascade. Critical Care Medicine 21, 780–789.CrossRefGoogle ScholarPubMed
Gordon, RE, Shaked, AA & Solano, DF (1986) Taurine protects hamster bronchioles from acute NO2 induced alterations. American Journal of Pathology 125, 585–600.Google ScholarPubMed
Gottschlich, M, Jenkins, M, Warden, G, Baumer, T, Havens, P, Snook, J & Alexander, JW (1990) Differential effects of three enteral dietary regimens on selected outcome variables in burn patients. Journal of Parenteral and Enteral Nutrition 14, 225–236.CrossRefGoogle ScholarPubMed
Griffiths, RD, Jones, C & Palmer, TE (1997) Six month outcome of critically ill patients given glutamine-supplemented parenteral nutrition. Nutrition 13, 295–302.Google ScholarPubMed
Hall, JC, Heel, K & McCauley, R (1996) Glutamine. British Journal of Surgery 83, 305–312.CrossRefGoogle ScholarPubMed
Hoffman, WD & Natanson, C (1993) Endotoxin in septic shock. Anesthesia and Analgesia 77, 613–624.CrossRefGoogle ScholarPubMed
Hong, RW, Helton, WS, Rounds, JD & Wilmore, DW (1990) Glutamine supplemented TPN preserves hepatic glutathione and improves survival following chemotherapy. Surgical Forum 41, 9–11.Google Scholar
Hong, RW, Rounds, DJ, Helton, WS, Robinson, MK & Wilmore, DW (1992) Glutamine preserves liver glutathione after lethal hepatic injury. Annals of Surgery 215, 114–119.CrossRefGoogle ScholarPubMed
Houdijk, AP, Rjinsburger, ER, Jansen, J, Wesdorp, J, Weiss, JK, McCarnish, MA, Teerlink, T, Meuwissen, SG, Haarman, HJ, Thijs, LG & van Leeuwen, PA (1998) Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma. Lancet 352, 772–776.CrossRefGoogle ScholarPubMed
Huxtable, RH (1992) Physiological actions of taurine. Physiological Reviews 72, 101–163.CrossRefGoogle ScholarPubMed
Kohn, CL & Keithly, JK (1989) Enteral nutrition: potential complications and patient monitoring. Nursing Clinics of North America 24, 339–353.CrossRefGoogle ScholarPubMed
Lacey, JM & Wilmore, DW (1990) Is glutamine a conditionally essential amino acid? Nutrition Reviews 48, 297–309.CrossRefGoogle ScholarPubMed
Lieberman, MD, Nishioka, K, Redmond, BP & Daly, JM (1992) Enhancement of interleukin–immunotherapy with l-arginine. Annals of Surgery 215, 157–165.CrossRefGoogle Scholar
MacBurney, M, Young, LS, Ziegler, TR & Wilmore, DW (1994) A cost-evaluation of glutamine-supplemented parenteral nutrition following bone marrow transplantation. Journal of the American Dietetic Association 94, 1263–1266.CrossRefGoogle Scholar
McLoughlin, DM, Stapleton, PP & Bloomfield, FJ (1991) Influence of taurine and a substituted taurine on the respiratory burst pathway in the inflammatory response. Biochemical Society Transactions 19, 73–78.CrossRefGoogle Scholar
Masuda, M, Horiksaka, K & Koeda, T (1986) Effect of taurine on neutrophil function in hyperlipidaemic rats. Japanese Journal of Pharmacology 40, 478–480.CrossRefGoogle Scholar
Morlion, BJ, Stehle, P, Wachtler, P, Siedhoff, HP, Koller, M, Konig, M, Furst, P & Puchstein, C (1998) Total parenteral nutrition with glutamine dipeptide after abdominal surgery: a randomised double blind, controlled study. Annals of Surgery 227, 302–308.CrossRefGoogle Scholar
O'Flaherty, L, Stapleton, PP, Redmond, HP & Bouchier-Hayes, DJ (1997) Dexamethasone and lipopolysaccharide regulation of taurine transport in Caco-2 cells. Journal of Surgical Research 69, 331–336.CrossRefGoogle ScholarPubMed
O'Flaherty, L, Stapleton, PP, Redmond, HP & Bouchier-Hayes, DJ (1998) Taurine modulates immune response and reduces bacterial translocation and gut atrophy in a murine model of sepsis. Proceedings of the Nutrition Society 57, 143A.Google Scholar
O'Riordán, MG, De, Beaux DE & Fearon, KCH (1996) Effect of glutamine on immune function in the surgical patient. Nutrition 12, S82–S84.CrossRefGoogle Scholar
Pasantes-Morales, H, Wright, CE & Gaull, GE (1985) Taurine protection of lymphoblastoid cells from iron-ascorbate induced damage. Biochemical Pharmacology 34, 2205–2207.CrossRefGoogle ScholarPubMed
Park, KG, Hey, SD, Blessing, K, Kelly, P, McNurlan, MA, Emermion, O & Garlick, PJ (1992) Stimulation of human breast cancers by dietary arginine. Clinical Science 82, 413–417.CrossRefGoogle Scholar
Reynolds, JV, Daly, JM & Zhang, S (1998) Immunomodulatory mechanisms of arginine. Surgery 194, 142–151.Google Scholar
Senkal, M, Kemen, M, Homann, HH, Eickhoff, U, Baier, J & Zumtobel, V (1995) Modulation of postoperative immune responses by enteral nutrition by a diet enriched with arginine, RNA and omega three fatty acids in patients with upper gastrointestinal cancer. European Journal of Surgery 161, 115–122.Google Scholar
Senkal, M, Mumme, A, Eickhoff, U, Geier, B, Spath, G, Wulfert, D, Joosten, U, Frei, A & Kemen, M (1997) Early postoperative enteral immunonutrition: clinical outcome and cost-comparison analysis in surgical patients. Critical Care Medicine 25, 1489–1496.CrossRefGoogle ScholarPubMed
Slade, MS, Simmons, RL, Yumis, E & Greenberg, LJ (1975) Immunodepression after major surgery in normal patients. Surgery 78, 363–372.Google ScholarPubMed
Souba, WW (1993) Intestinal glutamine metabolism and nutrition. Journal of Nutritional Biochemistry 4, 2–8.CrossRefGoogle Scholar
Stapleton, PP, Redmond, HP & Bouchier-Hayes, DJ (1998) Myeloperoxidase (MPO) may mediate neutrophil adherance to the endothelium through upregulation of CD11b expression–an effect down regulated by taurine. Advances in Experimental and Medical Biology 442, 183–192.CrossRefGoogle Scholar
Utoh, J, Yamamoto, T, Utsonomiya, T, Kambara, T, Goto, H & Miyauchi, Y (1988) Effect of surgery on neutrophil functions, superoxide and leukotriene production. British Journal of Surgery 75, 682–685.CrossRefGoogle ScholarPubMed
Wang, XD, Andersson, R, Soltesz, V, Wang, WQ, Ar'Rajab, A & Bengmark, S (1994) Phospholipids prevent enteric bacterial translocation in the early stage of experimental acute liver failure in the rat. Scandinavian Journal of Gastroenterology 29, 1117–1121.CrossRefGoogle ScholarPubMed
Watson, RWG, Redmond, HP & Bouchier-Hayes, D (1994) Taurine upregulates antimicrobial function of human inflammatory cells. Surgical Forum 45, 679–681.Google Scholar
Weimann, A, Bastian, L, Bischoff, WE, Grotz, M, Lotz, J, Trautwein, C, Tusch, G, Schlitt, HJ & Regel, G (1998) Influence of arginine, omega-3 fatty acids and nucleotide supplemented enteral support on systemic inflammatory response syndrome on multiple organ failure in patients after severe trauma. Nutrition 14, 165–172.CrossRefGoogle ScholarPubMed
Wilmore, D & Shabert, JK (1998) Role of glutamine in immunologic responses. Nutrition 14, 618–626.CrossRefGoogle ScholarPubMed
Yamaguchi, S, Miyazaki, Y, Oka, S & Yano, I (1994) Stimulatory effect of gangliosides phagosome-lysosome fusion, and intracellular signal transduction system by human polymorphonuclear leukocytes. Glycoconjugate Journal 14, 707–714.CrossRefGoogle Scholar
Yeatman, TJ, Risley, GL & Brunson, ME (1991) Depletion of dietary arginine inhibits growth of metastatic tumor. Archives of Surgery 126, 1376–1381.CrossRefGoogle ScholarPubMed
Zaporozhets, TS, Besednova, NN, Liamkin, GP, Leonko, IN & Popov, AM (1991) Immunodulating properties of pectin from sea grass zostera. Antibiotiki i Khimioterapira 36, 31–34.Google Scholar
Ziegler, TR, Bye, RI, Persiner, RI, Young, LS, Antin, JH & Wilmore, DW (1998) Effects of glutamine supplementation: a pilot study. American Journal of Medical Science 315, 4–10.Google ScholarPubMed