Immunonutrition - supplementary amino acids and fatty acids ameliorate immune deficiency in critically ill patients

Background: Immunonutrition with omega -3 fatty acids and the "conditionall y essential" amino acids arginine, glutamine, cysteine, and taurine can enh ance the immune response in critically ill patients. This is due to the imm unomodulating properties of these nutrients. Imnumonutrition is especially important when a patient's immune response is compromised, as is the case p ost-operatively or after trauma. Immune deficiency is severely aggravated i n sepsis and the systemic inflammatory response syndrome (SIRS). The result ing metabolic stress is characterized by glycolysis, lipolysis, and proteol ysis, which may escalate to an hypercatabolic response or "autocannabilism. " Catabolic metabolism results in insufficiency of both specific and unspec ific immunocompetent cells. Conclusions: Immunonutrition should be started early in such patients for an optimal beneficial effect, preferably via the enteral route. It should include medium chain and long chain triglycerides , polyunsaturated omega -3 and omega -6 fatty acids (in the ratio 1:2), oli ve oil, and conventional amino acid preparations supplemented with the cond itionally essential amino acids arginine, glutamine, cysteine, and taurine.