PDF herunterladen
Aktuelle Ernährungsmedizin 2001; 26(6): 261-265
DOI: 10.1055/s-2001-19415
Originalbeitrag
© Georg Thieme Verlag Stuttgart · New York

Immunonutrition

ImmunonutritionM.  Kemen1 , M.  Senkal2 , M.  Schneider3 , U.  Eickhoff1
  • 1Chirurgische Abteilung, Evang. Krankenhaus Herne, Herne
  • 2Chirurgische Klinik der Ruhr-Universität Bochum, St. Josef-Hospital, Bochum
  • 3Health Econ, Basel
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
02. Januar 2002 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Immunonutrition beschreibt den additiven Einsatz verschiedener immunologisch aktiver Substanzen in Sondennahrung. Hierzu zählen im Besonderen die Aminosäuren Glutamin und Arginin sowie n-3-Fettsäuren und Nukleotide. In metabolischen und klinischen Studien konnten die Resorption und immunologische Aktivität bei kritisch Kranken nachgewiesen werden. Bei zwei Metaanalysen ergaben sich positive Einflüsse auf den Krankheitsverlauf bei postoperativen Trauma- und internistischen Intensivpatienten. Die enterale Immunonutrition erfüllt damit die härtesten Kriterien der „evidence-based medicine”.

Abstract

Immunonutrition involves the addition of specific nutrients known to have immunomodulating activity, to enteral nutrition, including the amino acids glutamine and arginine as well as n-3 fatty acids and nucleotides. It has been demonstrated in metabolic and clinical trials, that these immunonutrients are resorbed and that they are immunologically active in critically ill patients. Two meta-analyses further revealed that the use of immunonutrition positively influences the course of illness in postoperative, traumatised and internistically critically ill patients. Hence, enteral immunonutrition fulfills the most severe criteria of „evidence-based medicine”.

Literatur

  • 1 Alverdy J C, Aoys E, Weiss-Carrington P, Burke D A. The effect of glutamine-enriched TPN on immune cellularity.  J Surg Res. 1992;  52 34-38
    PubMedSuche in Google Scholar
  • 2 Atkinson S, Sieffert E, Bihari D. A prospective, randomized, double-blind, controlled clinical trial of enteral immunonutrition in the critically ill.  Crit Care Med. 1998;  26 1164-1172
    CrossrefPubMedSuche in Google Scholar
  • 3 Beale R J, Bryg D J, Bihari D. Immunonutrition in the critically ill: A systematic review on clinical outcome.  Crit Care Med. 1999;  27 2799-2805
    PubMedSuche in Google Scholar
  • 4 Bihari D, Atkinson S. An analysis of the intensive care costs of using enteral immune modulating nutrition in the critically ill.  Int Care Med. 1999;  25 48
    PubMedSuche in Google Scholar
  • 5 Bower R H, Cerra F B, Bershadsky B, Licari J J, Hoyt D B, Jensen L, Van Buren C T, Rothkopf M M, Daly J M, Adelsberg B R. et al . Early enteral Administration of a formula (Impact®) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: Results of a multicenter, randomized prospective randomized, clinical trial.  Crit Care Med. 1995;  23 436-449
    CrossrefPubMedSuche in Google Scholar
  • 6 Braga M, Gianotti L, Vignali A, Di Carlo V. Immunonutrition in gastric cancer surgical patients.  Nutrition. 1998;  14 831-835
    CrossrefPubMedSuche in Google Scholar
  • 7 Braga M, Gianotti L, Cestari A, Vignali A, Pellegatta F, Dolci A, Di Carlo V. Gut function and immune and inflammatory responses in patients perioperatively fed with supplemented enteral formulas.  Arch Surg. 1996a;  131 1257-1265
    PubMedSuche in Google Scholar
  • 8 Braga M, Vignali A, Gianotti L, Cestari A, Profili M, Di Carlo V. Immune and nutritional effects of early enteral nutrition after major abdominal surgery.  Eur J Surg. 1996b;  162 105-112
    PubMedSuche in Google Scholar
  • 9 Braga M, Vignali A, Gianotti L, Cestari A, Profili M, Di Carlo V. Benefits of early postoperative enteral feeding in cancer patients.  Infusionsther Transfusionsmed. 1995;  22 20-284
    PubMedSuche in Google Scholar
  • 10 Burke D J, Alverdy J C, Aoys E, Moss G S. Glutamine-supplemented total parenteral nutrition improves gut immune function.  Arch Surg. 1989;  124 1396-1399
    PubMedSuche in Google Scholar
  • 11 Calder P C. Immunoregulatory and anti-inflammatory effects of n-3-polyunsaturated fatty acids.  Braz J Med Biol Res. 1998;  31 467-490
    PubMedSuche in Google Scholar
  • 12 Calder P C. Glutamine and the immune system.  Clin Nutrition. 1994;  13 2-8
    PubMedSuche in Google Scholar
  • 13 Daly J M, Weintraub F, Shou J, Rosato E F, Lucia M. Enteral nutrition during multimodality therapy in upper gastrointestinal cancer patients.  Ann Surg. 1995;  221 327-338
    CrossrefPubMedSuche in Google Scholar
  • 14 Daly J M, Lieberman M D, Goldfine J, Shou J, Weintraub F, Rosato E F, Lavin P. Enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids in patients after operation: Immunologic, metabolic, and clinical outcome.  Surgery. 1992;  112 56-67
    PubMedSuche in Google Scholar
  • 15 Endres S, Ghorbani R, Kelley V E, Georgilis K, Lonnemann G, an der Meer J MW, Cannon J G, Rogers T S, Klemoner M S, Weber P C, Schaeffer E J, Wolff S M, Dinarello C A. The effect of dietary n-3 polyunsaturated fatty acids on the synthesis of interleukin-1 and tumor necrosis factor by mononuclear cells.  N Engl J Med. 1989;  320 265-271
    CrossrefPubMedSuche in Google Scholar
  • 16 Gadek J E, De Michele S J, Karlstad M D, Pacht E R, Donahoe M, Albertson T E, Van Hozen E, Wennberg A K, Nelson J L, Noursalehi M. Effect of enteral feeding with eicosapentanoic acid, gamma-linoleic acid, and antioxidants in patients with acute respiratory distress syndrome.  Crit Care Med. 1999;  27 1409-1420
    CrossrefPubMedSuche in Google Scholar
  • 17 Galban C, Montejo J C, Mesejo A, Marco P, Celaya S, Sanchez-Segura J M, Farré M, Bryg D J. An immune-enhancing enteral diet reduces mortality and episodes of bacteremia in septic ICU patients.  Crit Care Med. 2000;  28 643-648
    CrossrefPubMedSuche in Google Scholar
  • 18 Grimble G. Dietary nucleotides and gut mucosal defence.  Gut. 1994;  35 46-51
    PubMedSuche in Google Scholar
  • 19 Hall J C. Glycine.  JPEN. 1998;  22 393-398
    PubMedSuche in Google Scholar
  • 20 Hensler T, Hecker H, Heeg K, Heidecke C D, Bartels H, Barthlen W, Wagner H, Siewert J R, Holzmann B. Distinct mechanisms of immunosuppression as consequence of major surgery.  Infect Immun. 1997;  65 2283-2291
    PubMedSuche in Google Scholar
  • 21 Heys S D, Walker L G, Smith I, Eremi O. Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer.  Ann Surg. 1999;  229 467-477
    CrossrefPubMedSuche in Google Scholar
  • 22 Jones S M, Thurmann R G. L-arginine minimizes reperfusion injury in a low-flow, reflow model of liver perfusion.  Hepatology. 1996;  24 163-168
    PubMedSuche in Google Scholar
  • 23 Kemen M, Senkal M, Homann H H, Mumme A, Dauphin A K, Baier J, Windeler J, Neumann H, Zumtobel V. Early postoperative enteral nutrition with arginine-ω-3-fatty acids and ribonucleid acid-supplemented diet versus placebo in cancer patients: An immunologic evaluation of impact.  Crit Care Med. 1995;  23 652-659
    PubMedSuche in Google Scholar
  • 24 Kirk S J, Barbul A. Role of arginine in trauma, sepsis and immunity.  JPEN. 1990;  14 226-229
    PubMedSuche in Google Scholar
  • 25 Kudsk K A, Croce M A, Fabian T C, Minard G, Tolley E A, Poret H A, Kuhl M R, Brown R O. Enteral versus parenteral feeding. E: Effects on septic morbidity after blunt and penetrating trauma.  Ann Surg. 1992;  215 503-513
    CrossrefPubMedSuche in Google Scholar
  • 26 Kulkarni A D, Fanslow W C, Rudolph F B, Van Buren C T. Modulation of delayed hypersensitivity in mice by dietary nucleotide restriction.  Transplantation. 1987;  44 847-849
    PubMedSuche in Google Scholar
  • 27 Meydani S N, Yogeeswaran G, Liu S, Baskar S, Meydani M. Fish oil and tocopherol-induced changes in natural killer cell-mediated cytotoxicity and PGE2 synthesis in young and old mice.  J Nutr. 1998;  118 1245-1252
    PubMedSuche in Google Scholar
  • 28 Moncada S, Higgs A. The L-arginine - nitric oxide pathway.  N Engl J Med. 1993;  329 2002-2012
    CrossrefPubMedSuche in Google Scholar
  • 29 Moore F A, Feliciano D V, Andrassy R J, Mc Ardle A H, Booth F V, Morgenstein T B, Kellum J M, Welling R E, Moore E E. Early enteral feeding, compared with parenteral, reduces postoperative septic complications.  Ann Surg. 1992;  216 172-183
    CrossrefPubMedSuche in Google Scholar
  • 30 Razenberger M, Splittler A, Roth E. Zytoprotektive und immunomodulierende Eigenschaften von Glyzin.  Akt Ernähr Med. 1998;  23 269-274
    PubMedSuche in Google Scholar
  • 31 Rudolph F B, Kulkarni A D, Fanslow W C, Pizzini R P, Kumar S, van Buren C T. Role of RNA as a dietary source of pyrimidines and purines in immune function.  Nutrition. 1990;  6 45-51
    PubMedSuche in Google Scholar
  • 32 Senkal M, Zumtobel V, Bauer K H, Marpe B, Wolfram G, Frei A, Eickhof U, Kemen M. Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients with elective upper gastrointestinal surgery: A prospective randomized study.  Arch Surg. 1999;  134 1309-1316
    CrossrefPubMedSuche in Google Scholar
  • 33 Senkal M, Mumme A, Eickhof U, Geier B, Späth G, Wulfert D, Joosten U, Frei A, Kemen M. Early postoperative enteral immunonutrition: Clinical outcome and cost-comparison analysis in surgical patients.  Crit Care Med. 1997;  25 1489-1496
    CrossrefPubMedSuche in Google Scholar
  • 34 Senkal M, Mumme A, Eickhoff U, Geier B, Späth G, Wulfert D, Joosten U, Frei A, Kemen M. Early postoperative enteral immunonutrition: Clinical outcome and cost-comparison analysis in surgical patients.  Crit Care Med. 1997;  25 1489-1496
    CrossrefPubMedSuche in Google Scholar
  • 35 Snyderman C H, Kachman K, Molseed L, Wagner R, D'Amico F, Bumpous J, Rueger R. Reduced postoperative infections with an immune-enhancing nutritional supplement.  Laryngoscope. 1999;  109 915-921
    CrossrefPubMedSuche in Google Scholar
  • 36 Souba W W, Klimberg V S, Plumey R M, Salloum T, Flynn C, Bland K I, Copeland E M. The role of glutamine in maintaining a healthy gut and supporting the metabolic response to injury and infection.  J Surg Res. 1990;  48 383-391
    CrossrefPubMedSuche in Google Scholar
  • 37 Stapleton P P, O'Flaherty L, Redmond P, Boucher-Hayes D J. Host-defense - a role for the amino acid taurine.  JPEN. 1998;  22 42-48
    PubMedSuche in Google Scholar
  • 38 Tartter P I, Martinelli G, Steinberg B, Barron D. Changes in peripheral T-cell subsets and natural killer cytotoxicity in relation to colorectal surgery.  Cancer Detect Prev. 1986;  9 359-364
    PubMedSuche in Google Scholar
  • 39 Uauy R, Quan R, Gil A. Role of nucleotides in intestinal development and repair: Implications for infant nutrition.  J Nutr. 1994;  124 1436-1441
    PubMedSuche in Google Scholar
  • 40 Wachtler P, Hilger R A, König W, Bauer K H, Kemen M, Köller M. Influence of a pre-operative enteral supplement on functional activities of peripheral leukocytes from patients with major surgery.  Clin Nutrition. 1995;  14 275-282
    CrossrefPubMedSuche in Google Scholar
  • 41 Weimann A, Bastian L, Bischoff W E, Grotz M, Hansel M, Lotz J, Trautwein C, Tusch G, Schlitt H J, Regel G. Influence of arginine, omega-3-fatty acids and nucleotide-supplemented enteral support on systemic inflammatory response syndrome and multiple organ failure in patients after severe trauma.  Nutrition. 1998;  14 165-172
    CrossrefPubMedSuche in Google Scholar
  • 42 Zaloga G. Immune-enhancing enteral diets: Where is the beef?.  Crit Care Med. 1998;  7 1143-1146
    PubMedSuche in Google Scholar

Dr. M. Kemen

Chirurgische Abteilung · Evang. Krankenhaus Herne

Wiescherstraße 24

44623 Herne