Most agree that enteral nutrition is the ideal way to feed critically ill patients who have a functional gastrointestinal tract, but selecting the appropriate enteral formula can be difficult. Specifically, the use of immune-modulating diets has brought much excitement as well as debate. Literature to date presents both positive and potential adverse effects. To aid the clinician in the decision-making process, this article reviews the current research and recommendations regarding the use of immune-modulating diets.
TongBBarbulA. Cellular and physiological effects of arginine. Mini-Reviews in Medical Chemistry. 2004;4:823-832.
3.
WitteMBarbulA. Arginine physiology and its implication for wound healing. Wound Repair Regen. 2003;11:419-423.
4.
OchoaJBMakarenkovaVBansalV. A rational use of immune enhancing diets: when should we use dietary arginine supplementation?Nutr Clin Pract. 2004;19:216-225.
5.
SmithR. Glutamine metabolism and its physiologic importance. JPENJ Parenter Enteral Nutr. 1990;14(suppl):40S-44S.
6.
SchloerbPR. Immune-enhancing diets: products, components, and their rationales. JPEN J Parenter Enteral Nutr. 2000;25:3s-7s.
7.
SchmidtHMartindaleR. Specialized nutrient formulas (neutraceuticals). In: ShikoraS, ed. Nutritional Considerations in the Intensive Care Unit. Dubuque, IA: Kendall/Hunt; 2002:381-399.
8.
CalderPC. N-3 Polyunsaturated fatty acids and inflammation: from molecular biology to the clinic. Lipids. 2003;38:343-352.
9.
BistrianBR. Practical recommendations for immune-enhancing diets. J Nutr. 2004;134(suppl):2868S-2872S.
10.
BansalVSyresKMakarenkovaV. Interactions between fatty acids and arginine metabolism:implications for the design of immune-enhancing diets. JPEN J Parenter Enteral Nutr. 2005;29:S75-S80.
11.
HeysSDWalkerLGSmithIEreminO. Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer: a meta-analysis of randomized controlled clinical trials. Ann Surg. 1999;229:467-477.
12.
BealeRJBrygDJBihariDJ. Immunonutrition in the critically ill: a systematic review of clinical outcome. Crit Care Med. 1999;27:2799-2805.
13.
HeylandDKNovakFDroverJWJainMSuXSuchnerU. Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA. 2001;286:944-953.
14.
MontejoJCZarazagaALopez-MartinezJ.Immunonutrition in the intensive care unit: a systemic review and consensus statement. Clin Nutr. 2003;22:221-233.
15.
WaitzbergDLSaitoHPlankLD.Postsurgical infectious are reduced with specialized nutrition support. World J Surg. 2006;30:1592-1604.
16.
MarikPEZalogaGP. Immunonutrition in critically ill patients: a systematic review and analysis of the literature [published online ahead of print July 15, 2008]. Intensive Care Med. 2008;34:1980-1990.
17.
MarikPEZalogaGP. Immunonutrition in high-risk surgical patients: a systematic review and analysis of the literature. JPEN J Parenter Enteral Nutr. 2010;34:378-386.
18.
CerantolaYHubnerMGrassNDemartinesNSchaferM. Immunonutrition in gastrointestinal surgery. Br J Surg. 2010;98:37-48.
19.
DroverJWDhaliwalRWeitzelL. Perioperative use of arginine-supplemented diets: a systematic review of the evidence. J Am Coll Surg. In press.
20.
KudskKASchloerbPRDeLeggeMH. Consensus recommendations from the U.S. summit on immune-enhancing enteral therapy. JPEN J Parenter Enteral Nutr. 2001;25:61S-63S.
21.
CresciG. Targeting use of specialized formulas in surgery and critical care. JPEN JParenter Enteral Nutr. 2004;20:92S-95S.
22.
RathmacherJANissenDVMPantonL. Supplementation with a combination of β-hydroxy-β-methylbutyrate(HMB), arginine, and glutamine is safe and could improve hematological parameters. JPEN J Parenter Enteral Nutr. 2003;28:65-75.
23.
Abou-AssiSMihasAGavisE. Safety of an immune-enhancing nutrition supplement in cirrhotic patients with history of encephalopathy. JPEN J Parenter Enteral Nutr. 2006;30:91-96.
24.
KalilADannerR. L-arginine supplementation in sepsis: beneficial or harmful. Curr Opin Crit Care. 2006;12:303-308.
25.
LuikingYCPoezeMPreiserJ. L-arginine infusion in severely septic patients does not enhance protein nitrosylation or haemodynamic instability. e-SPEN. 2006;1:14-15.
26.
BowerRHCerraFBBershadskyB. Early administration of a formula (Impact) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: results of a multicenter, prospective, randomized clinical trial. Crit Care Med. 1995;23:436-449.
27.
DentDLHeylandDKLevyH. Immunonutrition may increase mortality in critically ill patients with pneumonia: results of a randomized trial. Crit Care Med. 2003;30:A17.
28.
BertoliniGIapichinoGRadrizzaniD. Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial. Intensive Care Med. 2003;29:834-840.
29.
StricklandABroganAKraussJ. Is the use of specialized nutritional formulations a cost-effective strategy? A national database evaluation. JPEN J Parenter Enteral Nutr. 2005;29:81S-91S.
McClaveSMartindaleRVanekV. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. JPEN J Parenter Enteral Nutr. 2009;33:277-316.
American Dietetic Association. Critical illness guideline. www.adaevidencelibrary. Accessed January 20, 2011.
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