The aim of this study was to evaluate the potential advantages of peri
operative versus postoperative administration of an enteral immune-enh
ancing diet on host defense and protein metabolism. Thirty subjects, c
andidates for gastrectomy for cancer, were randomly allocated into two
groups. The first group (n = 15) received an enteral formula enriched
with arginine, omega-3 fatty acids, and RNA 7 d before and 7 d after
surgery; the second group (n = 15) received the same diet but only 7 d
after surgery. Postoperative immune and inflammatory responses were i
nvestigated by phagocytosis ability of polymorphonuclear cells, interl
eukin-2 receptors (IL-2R), lymphocyte subsets, interleukin-6 (IL-6), a
nd delayed hypersensitivity response (DHR). Prealbumin (PA), retinol b
inding protein, albumin, and transferrin were determined as protein sy
nthesis indicators. Perioperative immunonutrition prevented the early
postoperative impairment of phagocytosis, DHR, total number of lymphoc
ytes, and CD4/CD8 ratio (P < 0.05 versus postoperative group). The Il-
2R levels were significantly higher in the perioperative group (P < 0.
05 versus postoperative on postoperative day [POD] 4 and 8). Periopera
tive group also showed lower levels of IL-6 (P < 0.05 versus postopera
tive on POD 1, 4, and 8) and higher levels of PA (P = 0.04 versus post
operative on POD 8). The perioperative administration of immunonutriti
on ameliorated the host defense mechanisms, controlled the inflammator
y response, and improved the synthesis of short half-life constitutive
proteins. (C) Elsevier Science Inc. 1998.