Effects of an immune-enhancing diet in critically injured patients

Cynthia Mendez, Gregory Jurkovich, Iris Garcia, Donna Davis, Anne Parker, Ronald V. Maier

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

Objective: To determine the effects of an immune-enhancing experimental diet (XD = supplemental arginine, trace elements, and increased omega-3 fatty acids) versus standard diet (SD), on immune cell function and clinical outcome of critically injured patients Design: Prospective randomized clinical trial of patients admitted to the surgical intensive care unit after trauma (Injury Severity Score > 13). Materials and Methods: Patients received early enteral nutrition with either XD or SD for a minimum of 5 days. Measurements: Mortality, intensive care unit, ventilator, and hospital days, as well as incidence of adult respiratory distress syndrome (ARDS) and infectious complications were recorded. Nutritional parameters were also studied. Peripheral blood leukocytes were isolated from normal volunteers and from patients on days l, 6, and 10 of feeding. Main Results: Demographics and injury severity were similar in both groups. Both SD (n = 21) and XD (n = 22) groups revealed depressed monocyte function (tumor necrosis factor, prostaglandin E2, and procoagulant activity) on day 1 compared with a reference group (p < 0.05). However, monocytes from XD patients began to 'normalize' their response (tumor necrosis factor, prostaglandin E2, and procoagulant activity) by day 6. Although ARDS occurred more frequently in the XD group (45 vs. 19%), the majority of ARDS in both groups occurred very early, with only three patients in the XD (13.6%) and one patient in the SD (4.7%) groups developing ARDS after study entry. XD patients remained on the ventilator longer (16.4 vs. 9.7 days) and in the hospital longer (32.9 vs. 22 days) compared with the SD group, but overall mortality was nearly identical (4.5 vs. 5%). Conclusion: The exact role and timing for diets with immune- enhancing effects has yet to be defined.

Original languageEnglish (US)
Pages (from-to)933-941
Number of pages9
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume42
Issue number5
DOIs
StatePublished - May 1 1997
Externally publishedYes

Fingerprint

Diet
Adult Respiratory Distress Syndrome
Mechanical Ventilators
Dinoprostone
Intensive Care Units
Monocytes
Tumor Necrosis Factor-alpha
Injury Severity Score
Mortality
Omega-3 Fatty Acids
Wounds and Injuries
Trace Elements
Enteral Nutrition
Critical Care
Arginine
Healthy Volunteers
Leukocytes
Randomized Controlled Trials
Demography
Incidence

Keywords

  • ARDS
  • Arginine
  • Enteral nutrition
  • Immunonutrition
  • Inflammation
  • Leukocytes
  • Monocytes
  • Omega 3-fatty acids
  • Trauma
  • Wounds and injuries

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Effects of an immune-enhancing diet in critically injured patients. / Mendez, Cynthia; Jurkovich, Gregory; Garcia, Iris; Davis, Donna; Parker, Anne; Maier, Ronald V.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 42, No. 5, 01.05.1997, p. 933-941.

Research output: Contribution to journalArticle

Mendez, Cynthia ; Jurkovich, Gregory ; Garcia, Iris ; Davis, Donna ; Parker, Anne ; Maier, Ronald V. / Effects of an immune-enhancing diet in critically injured patients. In: Journal of Trauma - Injury, Infection and Critical Care. 1997 ; Vol. 42, No. 5. pp. 933-941.
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AU - Garcia, Iris

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AU - Parker, Anne

AU - Maier, Ronald V.

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N2 - Objective: To determine the effects of an immune-enhancing experimental diet (XD = supplemental arginine, trace elements, and increased omega-3 fatty acids) versus standard diet (SD), on immune cell function and clinical outcome of critically injured patients Design: Prospective randomized clinical trial of patients admitted to the surgical intensive care unit after trauma (Injury Severity Score > 13). Materials and Methods: Patients received early enteral nutrition with either XD or SD for a minimum of 5 days. Measurements: Mortality, intensive care unit, ventilator, and hospital days, as well as incidence of adult respiratory distress syndrome (ARDS) and infectious complications were recorded. Nutritional parameters were also studied. Peripheral blood leukocytes were isolated from normal volunteers and from patients on days l, 6, and 10 of feeding. Main Results: Demographics and injury severity were similar in both groups. Both SD (n = 21) and XD (n = 22) groups revealed depressed monocyte function (tumor necrosis factor, prostaglandin E2, and procoagulant activity) on day 1 compared with a reference group (p < 0.05). However, monocytes from XD patients began to 'normalize' their response (tumor necrosis factor, prostaglandin E2, and procoagulant activity) by day 6. Although ARDS occurred more frequently in the XD group (45 vs. 19%), the majority of ARDS in both groups occurred very early, with only three patients in the XD (13.6%) and one patient in the SD (4.7%) groups developing ARDS after study entry. XD patients remained on the ventilator longer (16.4 vs. 9.7 days) and in the hospital longer (32.9 vs. 22 days) compared with the SD group, but overall mortality was nearly identical (4.5 vs. 5%). Conclusion: The exact role and timing for diets with immune- enhancing effects has yet to be defined.

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KW - Wounds and injuries

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