Modulation of postoperative immune and inflammatory response by immune-enhancing enteral diet in gastrointestinal cancer patients

AIM To evaluate if the administration of an enteral diet supplemented with glutamine, arginine and omega -3-fatty acids modulates inflammatory and imm une responses after surgery. METHODS A prospective randomized double-blind, clinical trial was performed . Forty-eight patients with gastrointestinal cancer were randomized into tw o groups, one group was given an isocaloric and isonitrogenous standard die t and the other was fed with the supplemented diet with glutamine, arginine and omega -3-fatty acids. Feedings were started within 48 hours after oper ation, and continued until day 8. All variables were measured before operat ion and on postoperative day I and 8. Immune responses were determined by p hagocytosis ability, respiratory burst of polymorphonuclear cells, total ly mphocytes lymphocyte subsets, nitric oxide, cytokines concentration, and in flammatory responses by plasma levels of C-reactive protein, prostaglandin E-2 level. RESULTS Tolerance of both formula diets was excellent. There were significa nt differences in the immunological and inflammatory responses between the two groups. In supplemented group, phagocytosis and respiratory burst after surgery was higher and C-reactive protein level was lower (P <0.01) than i n the standard group. The supplemented group had higher levels of nitric ox ide, total lymphocytes, T lymphocytes, T-helper cells, and NK cells. Postop erative levels of IL-6 and TNF-alpha were lower in the supplemented group ( P <0.05). CONCLUSION It was clearly established in this trial that early postoperativ e enteral feeding is safe in patients who have undergone major operations f or gastrointestinal cancer. Supplementation of enteral nutrition with gluta mine, arginine, and omega -3 fatty acids positively modulated postsurgical immunosuppressive and inflammatory responses.