EARLY POSTOPERATIVE ENTERAL NUTRITION WITH ARGININE-OMEGA-3 FATTY-ACIDS AND RIBONUCLEIC ACID-SUPPLEMENTED DIET VERSUS PLACEBO IN CANCER-PATIENTS - AN IMMUNOLOGICAL EVALUATION OF IMPACT

Objective: To evaluate the effect of early postoperative feeding with a nutritionally complete enteral diet supplemented with the nutrients arginine, ribonucleic acid (RNA), and omega-3 fatty acids on the immun e function in patients undergoing surgery for upper gastrointestinal ( GI) malignancies, Design: Prospective, randomized, placebo-controlled, double-blind study, Setting: Surgical intensive care unit (ICU) in a German university hospital, Patients: Forty-two consecutive patients r eceiving an enteral diet via needle catheter jejunostomy after GI surg ery for cancer, Interventions: Patients were randomized to receive eit her the arginine, RNA, and omega-3 fatty acids supplemented diet or an isocaloric and isonitrogenous placebo diet. Early enteral nutrition w as started on postoperative day 1 in the surgical ICU with 20 mL/hr an d progressed to the optimal goal of 80 mL/hr by postoperative day 5. M easurements and Main Results: Clinical examination and adverse GI symp toms were recorded on a daily basis. Body weight was determined twice weekly, Immunoglobulin concentrations were determined by laser nephelo metry, Interferon-gamma concentrations were measured with a modified e nzyme-linked immunosorbent assay method, Fluorescence-activated cell s can flow cytometry was performed to analyze B cells, T lymphocytes and their subsets, Clinical patient characteristics and mean caloric inta ke were similar between the two groups and both formulas were well tol erated, The number of T lymphocytes and their subsets, helper T cells (CD4) and activated T cells (CD3, HLA-DR), were significantly higher i n the supplemented diet group on postoperative days 10 and 16 (p < .05 ), Mean interferon-gamma concentration after phytohemagglutinin stimul ation was higher in the supplemented diet group on postoperative day 1 6, In the supplemented diet group, mean immunoglobulin M concentration s were significantly higher on postoperative day 10 and mean immunoglo bulin G concentrations were higher on postoperative day 16 (p < .05) c ompared with the results in the placebo group, B-lymphocyte indices we re significantly higher in the supplemented vs, the placebo diet group on postoperative days 7 and 10 (p < .05). Conclusions: Supplementatio n of enteral diet with arginine, RNA, and omega-3 fatty acids in the e arly postoperative time period improves postoperative immunologic resp onses and helps to overcome more rapidly the immunologic depression af ter surgical trauma.