MODULATION OF POSTOPERATIVE IMMUNE-RESPONSE BY ENTERAL NUTRITION WITHA DIET ENRICHED WITH ARGININE, RNA, AND OMEGA-3-FATTY-ACIDS IN PATIENTS WITH UPPER GASTROINTESTINAL CANCER

Objective: To find out whether an enteral diet supplemented with argin ine, RNA, and omega-3 fatty acids modulated the production of interleu kin-1 (IL-1), interleukin-2 (IL-2), IL-2 receptor, interleukin-6 (IL-6 ), and tumour necrosis factor alpha (TNF-alpha) after operations for u pper gastrointestinal cancer. Design: Prospective double blind clinica l study. Setting: University hospital, Germany. Subjects: 42 patients randomised into two groups (n = 21 each), one of which was given an is ocaloric and isonitrogenous placebo diet and one of which was fed the same diet supplemented with arginine, RNA, and omega-3 fatty acids. In terventions: The cytokines were measured before operation and on posto perative days 1, 3, 7, 10, and 16. Main outcome measures: Comparison o f concentrations of cytokines in the two groups. Results: Among those receiving the placebo diet (after spontaneous stimulation) IL-6 concen trations were significantly higher on days 3 and 7 (p < 0.05) and TNF- alpha concentrations on day 7. In contrast (after stimulation with phy tohaemagglutinin) mean concentrations of IL-2 receptor were significan tly higher on days 3 and 7, and of IL-1 beta and IL-2 on day 16 (p < 0 .05) in the group receiving the supplemented diet. Conclusion: Supplem entation of an enteral diet with arginine, RNA and omega-3 fatty acids can modulate the acute phase reaction as indicated by the reduction i n concentrations of TNF-alpha and IL-6 in the group fed the supplement ed diet. Patients receiving the supplemented diet also showed accelera ted recovery in the concentrations of IL-1 beta and IL-2 receptor.