Immunonutrition in the surgical patient

Area of Science:

• Immunology
• Surgical Nutrition

Background:

• Trauma and surgery can impair cell-mediated immunity.
• This impairment is linked to increased T-helper 2 (Th2) lymphocyte expression.
• Activation of stress response systems (hypothalamic-pituitary-adrenal axis, sympathoadrenal system) and prostaglandin-E2 contribute to immune dysfunction.

Purpose of the Study:

• To investigate the role of immunomodulating enteral formulas in mitigating immune changes after trauma and surgery.
• To assess the impact of these formulas on adverse outcomes.

Main Methods:

• The study reviews evidence on the effects of malnutrition and injury on immune responses.
• It examines the mechanisms involving Th2 cells, myeloid-derived suppressor cells, and key mediators like cortisol, catecholamines, and prostaglandin-E2.
• The focus is on the potential of enteral formulas supplemented with arginine and omega-3 fatty acids.

Main Results:

• Malnutrition and injury promote Th2 cell development, leading to impaired immunity.
• Th2 cytokines drive myeloid-derived suppressor cells, causing an arginine deficiency and reduced lymphocyte function.
• Enteral formulas with arginine and omega-3 fatty acids show promise in reversing these immune alterations.

Conclusions:

• Immunomodulating enteral formulas can reverse immune deficits caused by trauma and surgery.
• Supplementation with arginine and omega-3 fatty acids is a viable strategy.
• These formulas should be considered for patients undergoing major surgery and severe trauma to reduce adverse outcomes.