M. Braga et al., IMMUNE AND NUTRITIONAL EFFECTS OF EARLY ENTERAL NUTRITION AFTER MAJORABDOMINAL OPERATIONS, The European journal of surgery, 162(2), 1996, pp. 105-112
Aim: To investigate the effect of early postoperative enteral nutritio
n enriched with arginine, RNA and omega-3 fatty acids on immunological
and nutritional variables after elective curative operations for gast
ric or pancreatic cancer. Design. Randomised controlled trial. Setting
: University hospital, Italy. Subjects: 78 Consecutive patients who we
re to undergo curative operations for gastric or pancreatic cancer, 60
of whom were suitable for the study. Interventions: Patients were ran
domly allocated to three groups (n = 20 each according to the type of
postoperative nutritional support: standard enteral diet, the same die
t enriched with arginine, RNA, and omega 3 fatty acids or total parent
eral nutrition. The daily nutritional goal was 25 kcal (105 kJ)/kg and
0.25 g nitrogen/kg for all patients. Main outcome measures. Serum con
centrations of immunoglobulins, albumin, transferrin, prealbumin, reti
nol binding protein (REP); cholinesterase activity, weight loss, durat
ion of operation, operative blood loss; blood transfusion; delayed hyp
ersensitivity responses, number of lymphocyte subsets, phagocytic abil
ity of monocytes, number of interleukin-2 (IL-2) plasma receptors, int
erleukin-6 (IL-6) plasma concentrations, postoperative infections and
sepsis scores. Results: All enterally fed patients but one completed t
he nutritional programme. There were significant postoperative reducti
ons in both nutritional and immunological variables in all groups. On
postoperative days 4 and 8 prealbumin concentration (p < 0.05), REP co
ncentration (p < 0.05), delayed hypersensitivity responses (p < 0.05),
phagocytic ability of monocytes (p < 0.01) and concentration of IL-2
receptors (p < 0.009) had all recovered more ill the group receiving t
he enriched solution. There was no difference in the postoperative inf
ection rates among the three groups, but the infections were less seve
re in the enriched group (p < 0.005). Conclusion: Early enteral feedin
g was well tolerated. Patients who received the enriched solution reco
vered both their nutritional and immunological status quicker than tho
se in the other two groups.