Perioperative Oral Supplement with Immunonutrients in Gastrointestinal Cancer Patients

Authors: NİHAL ZEKİYE ERDEM, İ. HAKAN KULAÇOĞLU, MEHTAP AKCİL TEMEL, AHMET ÇINAR YASTI, NURİ AYDIN KAMA, NAZAN BOZKURT

Abstract: Significant benefits have been gained with pre or peri-operative nutritional support in surgical patients with malnutrition. Recent studies have also shown that some enteral formulas including certain nutrients like glutamine could provide more benefit than the standard formulas. In this prospective-randomized study, the effects of perioperative oral supplement with enteral formulas containing glutamine in comparison with a standard enteral formula in patients who were operated on for GI malignancies were examined. Thirty-two patients were divided into two groups: the study group was given oral supplement with an elemental diet (Alitraq®) for 7 days preoperatively and 10 days postoperatively as 30-35% of total daily requirement (standard hospital diet: 65-70%), while the control group received a polymeric formula (Ensure®) as the same proportion of the daily intake for the same duration. Freidman two-way ANOVA test, Wilcoxon matched pairs signed ranks test and Mann Whitney U test were used for statistical analysis. One patient developed a minor complication (wound infection) and another had a major complication (anastomotic disruption) in the control group, whereas no surgical complications were encountered in the study group. The difference between the two groups did not reach statistical significance (p=0.21). There was no significant difference between the groups with respect to the intolerance of dietary supplements. No nutritional indices showed any difference between preoperative day 0 and preoperative day 8. Obvious declines were observed in all plasma proteins immediately following surgery. Prealbumin values in both groups reached significantly high levels after 10-day postoperative nutritional support, but albumin, prealbumin and transferrin levels increased significantly only in the group on the diet with glutamine during the postoperative period. The results of the study group in lymphocyte percentage and skin tests were significantly better on postoperative day 11. The present study revealed that the patients given enteral nutrition with glutamine had improved immunologic measurements, and developed no postoperative complications. In addition, postoperative nutritional support seemed to be more effective than preoperative feeding.

Keywords: Enteral nutrition, oral supplement, glutamine, gastrointestinal cancer.

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