Immunmodulation durch Ernährung - Neue Befunde

Zusammenfassung

Fragestellung Trotz der Komplexizität des Krankheitsbildes beim kritisch Kranken haben sich evidenzbasiert in den letzten 10 Jahren weitere Fortschritte auf dem Weg einer gezielt günstigen Immunmodulation durch besonders angereicherte enterale und parenterale Ernährung ergeben. Dies findet sich auch in aktuellen Leitlinienempfehlungen und soll hier noch einmal dargestellt und diskutiert werden. Material und Methodik Übersicht der aktuellen klinischen Studien zur Immunmodulation im Konzept einer Pharmakonutrition durch supplementierte Ernährung bei chirurgischen und kritisch kranken Patienten. Ergebnisse Die Wirksamkeit von Substanzen wie Glutamin, Arginin, Omega-3-Fettsäuren, Antioxidanzien und Synbiotika bei der Immunmodulation ist belegt. Aus den berechtigterweise hohen Anforderungen an die Qualität von klinischen Studien resultiert ein erheblicher logistischer und finanzieller Aufwand, sodass der Zuwachs an Evidenz nur langsam voranschreiten wird. Dies wirkt sich nicht zuletzt aufgrund erhöhter Kosten limitierend auf die Einführung in die Klinik aus. Vor dem Hintergrund von ökonomisch gebotener Rationalisierung und Rationierung sollte aber gerade bei kritisch Kranken nicht außer Acht gelassen werden, dass eine adäquate Ernährung per se auch eine günstige Beeinflussung des Immunsystems als Voraussetzung für das Erreichen eines guten Therapieergebnisses darstellt. Schlussfolgerung Das Ziel einer Pharmakonutrition wird partiell durch den Nachweis zur Wirkung einzelner Substrate erreicht, bleibt jedoch aufgrund noch ungenügender Daten zu den Dosis-Wirkungs-Beziehungen und Toxizitätsgrenzen zunächst noch eine realistische Vision.

Abstract

Purpose With regard to the complexicity of critical illness the last decade has led to some progress on the field of immune-enhancement by supplemented enteral and parenteral nutrition. The improvement of knowledge has been incorporated in present clinical guidelines and will be presented. Material and Methods Review of recent clinical trials about immune-enhancement in the concept of pharmaconutrition in surgery and critical illness. Results New studies have confirmed the effectiveness of immune-enhancement by substrates like glutamin, arginine, omega-3-fatty acids, antioxidants, and synbiotics. The need for well designed and performed clinical studies of high quality is a considerable logistic and financial burden, which will limit the growth of evidence. Related to economic rationing in the intensive care unit one should be always aware about the immune-enhancing impact of clinical nutrition per se on outcome. Conclusion Aiming on pharmaconutrition some progress about immune-enhancement in surgical and critically ill patients has been obtained. There is still a lack of data about the effects related to dosage and the limits by potential toxicity. So far, pharmaconutrition will remain a realistic vision.

Schlüsselwörter

Immunmodulation - Immunonutrition - kritisch krank

Key words

immune-enhancement - immunonutrition - critically ill

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