A prospective, randomized clinical trial on perioperative feeding with an arginine-, omega-3 fatty acid-, and RNA-enriched enteral diet: Effect on host response and nutritional status

Background: The use of immune-enhancing enteral diets in the postoperative period has given contrasting results. The purpose of this prospective, rand omized, double-blinded clinical study was to evaluate the effect of immunon utrition given perioperatively on cytokine release and nutritional paramete rs. Methods: Patients with cancer of the stomach or colo-rectum were eligib le. Subjects consumed 1 L/d of either a control enteral formula (n = 25; co ntrol group) or a formula supplemented with arginine, omega-3 fatty acids, and RNA (n = 25; verum group) for 1 week before surgery. Both formulas were given by mouth. Six hours after the operation, jejunal infusion with the s ame diets was started and maintained for 7 days. Blood was drawn at differe nt time points to assess albumin, prealbumin (PA), transferrin, cholinester ase activity, retinol binding protein (RBP), interleukin-2 receptors alpha (IL-2R alpha), IL-6, and IL-1 soluble receptors (IL-1RII). The composite sc ore of delayed hypersensitivity response (DHR) to skin test also was determ ined (the higher the score, the lower the immune response). Results: During the 7 days of presurgical feeding, none of the above parameters changed in either group. Eight days after operation, in the control group, the concen tration of PA and REP was lower than in the verum group (0.18 vs 0.26 g/L f or PA and 30.5 vs 38.7 mg/L for REP; p < .05). IL-2R alpha concentration wa s 507 pg/mL in the verum group vs 238 pg/mL in the control group (p < .001) , whereas IL-6 and IL-1RII were higher in the control group than in the ver um group (104 vs 49 and 328 vs 183 pg/mL, respectively; p < .01). The DHR s core was 0.68 in the control group vs 0.42 in the verum group (p < .05). Co nclusions: Perioperative feeding with a supplemented enteral diet modulates cytokine production and enhances cell-mediated immunity and the synthesis of short half-life proteins.