Información del artículo
El objeto de esta revisión sistemática es valorar la calidad de la evidencia científica utilizada en las guías de práctica clínica, recomendaciones y consensos sobre la inmunonutrición. Estudiamos los efectos del uso de glutamina, ácidos grasos omega-3 y arginina tanto por vía gastrointestinal como parenteral. Finalizamos con una evaluación concienzuda de los trabajos clínicos más valorados en pacientes quirúrgicos, traumatológicos, quemados e ingresados en la UCI mixta. Presentamos tablas sobre la composición de los productos de nutrición enteral, así como resúmenes de los estudios clínicos llevados a cabo.
Palabras clave:
Inmunonutrición
Nutrición enteral
Paciente crítico
Glutamina
Arginina
Ácidos grasos omega-3
The aim of this systematic review was to assess the quality of the scientific evidence in clinical practice guidelines, recommendations and consensus statements on immunonutrition. We studied the effects of glutamine, omega-3 fatty acids and arginine when nutrients are delivered via the gastrointestinal tract rather than parenterally. Finally, we evaluated the most valuable clinical studies in surgical, trauma, burn and multidisciplinary ICU populations. Tables showing the composition of enteral nutrition products as well as summaries of clinical studies are presented.
Key words:
Immunonutrition
Enteral nutrition
Critical patients
Glutamine
Arginine
Omega-3 fatty acids
El Texto completo está disponible en PDF
Bibliografía
[1.]
S. Celaya Pérez.
Estudio de la relación entre variables antropométricas y bioquímicas del estado de nutrición y la respuesta inmune en el paciente quirúrgico [tesis doctoral].
[2.]
L. Dominioni, R. Dionigi.
Immunological function and nutritional assessment.
J Par Enter Nutr, 11 (1987), pp. S70-S72
[3.]
M. Navarro.
Aspectos inmunológicos de la cirugía. Zaragoza: Prensas Universitarias.
Universidad de Zaragoza,, (1997),
[4.]
R.K. Chandra, S. Tejpar.
Diet and immunocompetence.
Int J Immunopharmacol, 5 (1983), pp. 175-180
[5.]
D.T. Purtilo, D.H. Connor.
Fatal infections in protein-calorie malnoutrished children and thymolymphatic athrophy.
Arch Dis Chil, 50 (1975), pp. 149-152
[6.]
D.N. McMurray, S.A. Loomis, L.J. Casazza, H. Rey, R. Miranda.
Development of impaired cell mediated immunity in mild and moderate malnutrition.
Am J Clin Nutr, 34 (1981), pp. 68-77
[7.]
J.L. Meakins, J.B. Pietsch, O. Bubenick, R. Kelly, H. Rode, J. Gordon, et al.
Delayed hypersensitivity: indicator of acquired failure of host defenses in sepsis and trauma.
Ann Surg, 186 (1977), pp. 241-250
[8.]
R.K. Chandra.
Numerical and functional deficiency in T helper cells in protein energy malnutrition.
Clin Exp Immunol, 51 (1983), pp. 126-132
[9.]
R.P. Watso.
Nutrition, disease resistance and immune function.
Nutrition and immunity, pp. 325-336
[10.]
L. Hoffman, R. Keir.
Monocyte factors modulate in vitro T lymphocyte mitogenesis in protein malnutrition.
Clin Exp Immunol, 63 (1986), pp. 194-202
[11.]
R.K. Chandra.
Nutrition and immunity: lessons from the past and new insights into the future.
Am J Clin Nutr, 53 (1991),
[12.]
P.R. Schloerb.
Immune-enhacing diets: products, components, and their rationales.
J Par Enter Nutr, 25 (2001), pp. S3-S7
[13.]
ASPEN Board of Directors and the Clinical Guidelines Task Force.
Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients.
J Par Enter Nutr, 26 (2002),
[14.]
J.M. Lacey, D.W. Wilmore.
Is glutamine a conditionally essential amino acid?.
Nutr Rev, 48 (1990), pp. 297-309
[15.]
C. Ortiz, S. Celaya.
Nutrición-Inmunidad.
Tratado de nutrición artificial Tomo I, pp. 83-95
[16.]
A.D. Fox, S.A. Kripke, J.D. De Paula, J.M. Berman, R.G. Settle, J.L. Rombeau.
Effect of a glutamine supplemented enteral diet on methotrexate induced enterocolitis.
J Par Enter Nutr, 12 (1998), pp. 325-331
[17.]
V.S. Klimberg, R.M. Salloum, M.K. Kasper, D.A. Plumley, D.J. Dolson, R.D. Hantamaki, et al.
Oral glutamine accelerates healing of the small intestine and improves outcome after whole abdominal radiation.
Arch Surg, 125 (1990), pp. 1040-1045
[18.]
H.N. Munro.
Hormones and the metabolic response to injury.
N Engl J Med, 41 (1979), pp. 300-312
[19.]
E. Vinnars, F. Hammarqvist, A. Von der Decken, J. Wernerman.
Role of glutamine and its analogs in posttraumatic muscle protein and amino acid metabolism.
J Par Enter Nutr, 14 (1990), pp. S125-S129
[20.]
M. Planas, S. Schwartz, M.A. Arbos, M. Farriol.
Plasma glutamine levels in septic patients.
J Par Enter Nutr, 17 (1993), pp. 299-300
[21.]
R.R. Van der Hulst, M.F. Von Meyenfeldt, B.K. Van Kreel, F.B. Thunnissen, R.J. Brummer, J.W. Arends, et al.
Gut permeability, intestinal morphology, and nutritional depletion.
Nutrition, 14 (1998), pp. 1-6
[22.]
B.A. Van Acker, M.F. Von Meyendeldt, R.R. Van der Hulst, K.W. Hulsewe, A.J. Wagenmarkers, N.E. Deutz, et al.
Glutamine: the pivot of our nitrogen economy?.
J Par Enter Nutr, 23 (1999), pp. S45-S48
[23.]
H. Tremel, B. Kienle, L.S. Weilemann, et al.
Glutamine dipeptide supplemented parenteral nutrition maintains intestinal function in the critically ill.
Gastroenterology, 107 (1994),
[24.]
A.L. Buchman, A.A. Moukarzel, S. Bhuta, M. Belle, M.E. Ament, C.D. Eckhert, et al.
Parenteral nutrition is associated with intestinal morphologic and functional changes in humans.
J Par Enter Nutr, 19 (1995), pp. 453-460
[25.]
C.J. Doig, L.R. Sutherland, J.D. Sandham, G.H. Fick, M. Verhoef, J.B. Meddings.
Increased intestinal permeability is associated with the development of multiple organ dysfunction syndrome in critically ill ICU patients.
Am J Respir Crit Care Med, 158 (1998), pp. 444-451
[26.]
M. Parry-Billings, J. Evans, P.C. Calder, E.A. Newsholme.
Does glutamine contribute to immunosuppression after major burns?.
Lancet, 336 (1990), pp. 523-525
[27.]
H.M. Oudemans van Straaten, R.J. Bosman, M. Treskes, H.J. Van der Spoel, D.F. Zandstra.
Plasma glutamine depletion and patient outcome in acute ICU admissions.
Intensive Care Med, 27 (2001), pp. 84-90
[28.]
P. Hammarqvist, J. Wernerman, R. Ali, A. Von der Decken, E. Vinnars.
Addition of glutamine to total parenteral nutrition after elective abdominal surgery spares free glutamine in muscle, counteracts the fall in muscle protein synthesis and improves nitrogen balance.
Ann Surg, 209 (1989), pp. 455-461
[29.]
P. Stehle, N. Mertes, C.h. Puchstein, J. Zander, S. Albers, P. Lawin.
Effect of parenteral glutamine peptide supplements on muscle glutamine loss and nitrogen balance after major surgery.
Lancet, 4 (1989), pp. 231-233
[30.]
C.K. Ogle, J.D. Ogle, J.X. Mao, J. Simon, J.G. Noel, B.G. Li, et al.
Effect of glutamine on phagocytosis and bacterial killing by normal and pediatric burn patient neutrophils.
J Par Enter Nutr, 18 (1994), pp. 128-133
[31.]
M.G. O'Riordain, A. De Beaux, K.C. Fearon.
Effect of glutamine on immune function in the surgical patient.
Nutrition, 12 (1996), pp. S82-S84
[32.]
T.R. Ziegler, L.S. Young, K. Benfell, M. Scheltings, K. Hortos, R. Bye, et al.
Clinical and metabolic efficacy of glutamine supplemented parenteral nutrition after bone marrow transplantation.
Ann Intern Med, 116 (1992), pp. 824-827
[33.]
P.R. Schloerb, M. Amare.
Total parenteral nutrition with glutamine in bone marrow transplantation and other clinical applications.
J Par Enter Nutr, 17 (1993), pp. 407-413
[34.]
B.J. Morlion, P. Stehle, P. Wachtler, H.P. Siedhoff, M. Koller, W. Konig, et al.
Total parenteral nutrition with glutamine dipeptide after major abdominal surgery. A randomized, double blind, controlled study.
Ann Surg, 226 (1997), pp. 302-308
[35.]
R.D. Griffiths, C. Jones, A. Palmer.
Six month outcome of critically ill patients given glutamine supplemented parenteral nutrition.
Nutrition, 13 (1997), pp. 295-302
[36.]
S.M. Murray, S. Pindoria.
Nutrition support for bone marrow transplant patients.
Cochrane Database of Systematic Reviews, 1 (2003),
[37.]
R.L. Ziegler TR Bye, R.L. Persinger, L.S. Young, J.H. Antin, D.W. Wilmore.
Effects of glutamine supplementation on circulating lymphocytes after bone marrow transplantation: a pilot study.
Am J Med Sci, 315 (1998), pp. 4-10
[38.]
M. MacBurney, L.S. Young, T.R. Ziegler, D.W. Wilmore.
A costevaluation of glutamine-supplemented parenteral nutrition in adult bone marrow transplant patients.
J Am Diet Assoc, 94 (1994), pp. 1263-1266
[39.]
M.R. Scheltinga, L.S. Young, K. Benfell, R.L. Bye, T.R. Ziegler, A.A. Santos.
Glutamine-enriched intravenous feedings attenuate extracellular fluid expansion after a standard stress.
Ann Surg, 214 (1991), pp. 385-395
[40.]
L.S. Young, R. Bye, M. Scheltinga, T.R. Ziegler, D.O. Jacobs, D.W. Wilmore.
Patients receiving glutamine-supplemented intravenous feedings report an improvement in mood.
J Par Enter Nutr, 17 (1993), pp. 422-427
[41.]
S.A. Brown, A. Goringe, C. Fegan, S.V. Davies, J. Giddings, J.A. Whittaker.
Parenteral glutamine protects hepatic function during bone marrow transplantation.
Bone Marrow Transplant, 22 (1998), pp. 281-284
[42.]
B. Raynard, G. Nitenberg, G. Gory Delabaere, J.H. Bourhis, P. Bachmann, R.J. Bensadoun, et al.
Féderation Nationale des Centres de Lutte Contre le Cancer. Standards, options et recommandations pour la nutrition artificielle au cours et au décours de la greffe de cellules souches hématopoïétiques.
Bull Cancer, 89 (2002), pp. 381-400
[43.]
M. Muscaritoli, G. Grieco, S. Capria, A.P. Iori, R. Fanelli.
Nutritional and metabolic support in patients undergoing bone marrow transplantation.
Am J Clin Nutr, 75 (2002), pp. 183-190
[44.]
D.W. Wilmore, P.R. Schloerb, T.R. Ziegler.
Glutamine in the support of patients following bone marrow transplantation.
Curr Opin Clin Nutr Metab Care, 2 (1999), pp. 323-327
[45.]
F. Novak, D.K. Heyland, A. Avenell, J.W. Drover, X. Su.
Glutamine supplementation in serious illness: a systematic review of the evidence.
Crit Care Med, 30 (2002), pp. 2022-2029
[46.]
J. Powell-Truck, C.P. Jamieson, G.E.A. Bettani, O. Obeid, H.V. Fawcett, C. Archer, et al.
A double blind, randomised, controlled trial of glutamine supplementation in parenteral nutrition.
Gut, 45 (1999), pp. 82-88
[47.]
P. Wischmeyer, J. Liedel, J. Lynch, R. Wolfson, J. Riehm, L. Gottlieb, et al.
Glutamine administration reduces Gram negative bacteriemia in severely burned patients.
Crit Care Med, 29 (2001), pp. 2075-2080
[48.]
D.K. Heyland, S. MacDonald, L. Keefe.
Total parenteral nutrition in the critically ill patient: a meta analysis.
JAMA, 280 (1998), pp. 2013-2019
[49.]
D.K. Heyland, F. Novak, J. Drover, M. Jain, X. Su, U. Suchner.
Should immunonutrition become routine in critically ill patients: a systematic review of the evidence.
JAMA, 286 (2001), pp. 944-953
[50.]
C.h. Goeters, A. Wenn, N. Mertes, C. Wempe, H. Van Aken, P. Stehle, et al.
Parenteral L alanyl L glutamine improves 6 month outcome in critically ill patients.
Crit Care Med, 30 (2002), pp. 2032-2037
[51.]
D.K. Heyland, R. Dhaliwal, J.W. Drover, L. Gramlich, P. Dodek.
and the Canadian Critical Care Clinical Practice Guidelines Committee. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically adult patients.
J Par Enter Nutr, 27 (2003), pp. 355-373
[52.]
P. Dechelotte, G. Bleichner, M. Hasselmann.
Improved clinical outcome in ICU patients receiving alanyl glutamine supplemented total parenteral nutrition.
Clin Nutr, 21 (2002), pp. S1
[53.]
P.M. Anderson, G. Schroeder, K.M. Skubitz.
Oral glutamine reduces the duration and severity of stomatitis after cytotoxic cancer chemotherapy.
Cancer, 83 (1998), pp. 1433
[54.]
P.R. Schloerb, B.S. Skikne.
Oral and parenteral glutamine in bone marrow transplantation: a randomized, double blind study.
J Par Enter Nutr, 23 (1999), pp. 117-122
[55.]
S.A. Jebb, R. Marcus, M. Elia.
A pilot study of oral glutamine supplementation in patients receiving bone marrow transplants.
Clin Nutr, 14 (1995), pp. 162-165
[56.]
T.M.C. Dickson, R.M. Wong, R.S. Negrin, J.A. Shizuru, L.J. Johnston, W.W. Hu, et al.
Effect of oral glutamine supplementation during bone marrow transplantation.
J Par Enter Nutr, 24 (2000), pp. 61-66
[57.]
P.M. Anderson, N.K.C. Ramsay, X.O. Shu, N. Rydholm, J. Rogosheske, R. Nicklow, et al.
Effect of low dose oral glutamine on painful stomatitis during bone marrow transplantation.
Bone Marrow Transplant, 22 (1998), pp. 339
[58.]
A. García de Lorenzo, A. Zarazaga, P.P. García Luna, F. González-Huix, J. López-Martínez, A. Miján, et al.
Clinical evidence for enteral nutrional support with glutamine: a systematic review.
Nutrition, 19 (2003), pp. 805-811
[59.]
A.P. Houdijk, E.R. Rijnsburger, J. Jansen, R.I. Wesdorp, J.K. Weiss, M.A. McCamish, et al.
Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma.
Lancet, 352 (1998), pp. 772-776
[60.]
S. Brantley, J. Pierce.
Effects of enteral glutamine on trauma patients.
Nutr Clin Pract, 15 (2000), pp. S13
[61.]
C. Jones, T.E. Palmer, R.D. Griffiths.
Randomized clinical outcome study of critically ill patients given glutamine supplemented enteral nutrition.
Nutrition, 15 (1999), pp. 108-115
[62.]
B. Lokesh, J. Licari, J.E. Kinsella.
Effect of different dietary triglycerides on liver fatty acids and prostaglandin synthesis by mouse peritoneal cells.
J Par Enter Nutr, 16 (1992), pp. 316-321
[63.]
K.S. Broughtgon, J. Whiwlan, I. Hardardottir.
Effect of increasing the dietary n-3 to n-6 polyunsaturated fatty acid ratio on murine liver and peritoneal cell fatty acids and eicosanoid formation.
J Nutr, 121 (1991), pp. 155-164
[64.]
E. Soyland, M.S. Nessenter, L. Branathen, C.A. Drevon.
Very long chain n-3 and n-6 polyunsaturated fatty acids inhibit proliferation of human T-lymphocytes in vitro.
Eur J Clin Invest, 23 (1993), pp. 112-121
[65.]
N. Yamashita, N. Maruyama, K. Yamazaki, T. Hamazaki, S. Yano.
Effects of eicosapentanoic and docosahexanoic acid on natural killer cell activity in human peripheral blood lymphocyte.
Clin Immunol Immunopathol, 59 (1991), pp. 335-345
[66.]
M. Fujikawa, N. Yamashita, K. Yamazaki, E. Sugiyama, H. Suzuki, T. Hamazaki.
Eicosapentanoic acids inhibits antigen presenting cell function of murine splenocytes.
Immunology, 175 (1992), pp. 330-335
[67.]
C.J. Field.
Use of T cell function to determine the effect of physiologically active food components.
Am J Clin Nutr, 71 (2000), pp. S1720-S1725
[68.]
S. Adams, Y. Yeh, G.L. Jensen.
Changes in plasma and erythrocyte fatty acids in patients fed enteral formulas containing different fats.
J Par Enter Nutr, 17 (1993), pp. 30-34
[69.]
P. Wachtler, R.A. Hilger, W. Konig.
Influence of a preoperative enteral supplement on fuctional activities of peripheral leukocytes from patients with mayor surgery.
Clin Nutr, 14 (1995), pp. 275-282
[70.]
S. Celaya, C. León Cinto.
Inmunidad y nutrición:.
Nutrición clínica: bases y fundamentos, pp. 181-203
[71.]
J.E. Gadek, S.J. DeMichele, M.D. Karlstad, E.R. Packt, M. Donahoe, T.E. Albertson, et al.
Effect of enteral feeding with eicosapentaenoic acid, gamma linolenic acid, and antioxidants in patients with acute respiratory distress syndrome.
Crit Care Med, 27 (1999), pp. 1409-1420
[72.]
U. Suchner, D.K. Heyland, K. Peter.
Immune modulatory actions of arginine in the critically ill.
Br J Nutr, 87 (2002), pp. S121-S132
[73.]
N.H. Basu, G.U. Liepa.
Arginine: a clinical perspective.
Nutr Clin Pract, 17 (2002), pp. 218-225
[74.]
M.N. Muscara, J.L. Wallace.
Nitric oxide. The therapeutic potential of nitric oxide donors and inhibitors.
Am J Physiol, 276 (1999), pp. G1313-G1316
[75.]
J.M. Daly, J. Reynolds, A. Thom, L. Kinsley, M. Dietrick-Gallagher, J. Shou, et al.
Immune and metabolic effects of arginine in the surgical patient.
Ann Surg, 208 (1988), pp. 512-522
[76.]
J.C. Preiser, P.J. Berre, A. Van Gossum, L. Cynober, B. Vray, Y. Carpentier, et al.
Metabolic effect of arginine addition to the enteral feeding of critically ill patient.
J Par Enter Nutr, 25 (2001), pp. 182-187
[77.]
D.A. De Luis, R. Aller, O. Izaola, L. Cuellar, M.C. Terroba.
Postsurgery enteral nutrition in head and neck cancer patients.
Eur J Clin Nutr, 56 (2002), pp. 1126-1129
[78.]
D.A. De Luis, O. Izaola, L. Cuellar, M.C. Terroba, M. Arranz, R. Aller.
Effect of c-reactive protein and interleukins blood levels in postsurgery arginine enhaced enteral nutrition in head and neck cancer patients.
Eur J Clin Nutr, 57 (2003), pp. 96-99
[79.]
D.L. Dent, D.K. Heyland, H. Levy, R. Martindale, J. Tayek, P. Schloerb, et al.
Immunonutrition may increase mortality in cri-tically ill patients with pneumonia: results of a randomized trial.
Crit Care Med, 30 (2003), pp. A17
[80.]
R. Caparrós, J. López, T. Grau.
Early enteral nutrition in critically ill patients with a high protein diet enriched with arginine, fiber and antioxidants compared with a standard high protein diet: the effect on nosocomial infections and outcome.
J Par Enter Nutr, 25 (2001), pp. 299-308
[81.]
S. Atkinson, E. Sieffert, D. Bihari.
A prospective, randomized double blind, controlled clinical trial of enteral immunonutrition in the critically ill. Guy's Hospital Intensive Care Group.
Crit Care Med, 26 (1998), pp. 1164-1172
[82.]
R.H. Bower, F.B. Cerra, B. Bershadsky, J.J. Licari, D.B. Hoyt, G.L. Jensen, 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, prospective, randomized, clinical trial.
Crit Care Med, 23 (1995), pp. 436-449
[83.]
R.O. Brown, H. Hunt, C.A. Mowatt-Larssen, S.L. Wojtysiak, M.F. Henningfield, K.A. Kudsk.
Comparison of specialized and standard enteral formulas in trauma patients.
Pharmacotherapy, 14 (1994), pp. 314-320
[84.]
F.B. Cerra, S. Lehman, N. Konstantinides, F. Konstantinides, E.P. Shronts, R. Holman.
Effect of enteral nutrient on in vitro test of immune function in ICU patients: a preliminary report.
Nutrition, 6 (1990), pp. 84-87
[85.]
J.M. Engel, R. Menges, C. Neuhauser, B. Schaefer, G. Hempelmann.
Effects of various feeding regimens in multiple trauma patients on septic complications and immune parameters.
Anasthesiol Intens Med Notfallmed Schmerzther, 32 (1997), pp. 234-239
[86.]
C. Galbán, J.C. Montejo, A. Mesejo, P. Marco, S. Celaya, J.M. Sánchez-Segura, et al.
An immune enhacing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients.
Crit Care Med, 28 (2000), pp. 643-648
[87.]
M.M. Gottschlich, M. Jenkins, G.D. Warden, T. Baumer, P. Havens, J.T. Snook, et al.
Differential effects of three enteral dietary regimens on selected outcome variables in burn patients.
J Par Enter Nutr, 14 (1990), pp. 225-236
[88.]
K.A. Kudsk, G. Minaard, M.A. Croce, R.O. Brown, T.S. Lowrey, F.E. Pritchard, et al.
A randomized trial of isonitrogenous enteral diets after severe trauma. An immune-enhacing diet reduces septic complications.
Ann Surg, 224 (1996), pp. 531-540
[89.]
C. Méndez, G.J. Jurkovich, I. García, D. Davis, A. Parker, R.V. Maier.
Effects of an immune enhacing diet in critically injured patients.
J Trauma, 42 (1997), pp. 933-940
[90.]
F.A. Moore, E.E. Moore, K.A. Kudsk, R.O. Brown, R.H. Bower, M.J. Koruda, et al.
Clinical benefits of an immune enhacing diet for early postinjury enteral feeding.
J Trauma, 37 (1994), pp. 607-615
[91.]
M.P. Rodrigo Casanova, J.M. García Pena.
The effect of the composition of the enteral nutrition on infection in the critical patient.
Nutr Hosp, 12 (1997), pp. 80-84
[92.]
A. Weimann, L. Bastian, W.E. Bischoff, M. Grotz, M. Hansel, J. Lotz, et al.
Influence of arginine, omega 3 fatty acids and nucleotide supplemented enteral suport on systemic inflammatory response syndrome and multiple organ failure in patients after severe trauma.
Nutrition, 14 (1998), pp. 165-172
[93.]
D.K. Heyland, F. Novak, J.W. Drover, M. Jain, X. Su, U. Suchner.
Should immunonutrition become routine in critically ill patients: a systematic review of the evidence.
JAMA, 286 (2001), pp. 944-953
[94.]
G. Bertolini, G. Lapichino, D. Radrizzani, R. Facchini, B. Simini, P. Bruzzone, et al.
Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial.
Intensive Care Med, 29 (2003), pp. 834-840
[95.]
J.C. Montejo, A. Zarazaga, J. López Martínez, G. Urrutia, M. Roque, A.L. Blesa, et al.
Spanish Society of Intensive Care Medicine and Coronary Units. Immunonutrition in the intensive care unit. A systematic review and consensus statement.
Clin Nutr, 22 (2003), pp. 221-233
[96.]
M.H. Oltermann, T.N. Rassas.
Immunonutrition in a multidisciplinary ICU population: a review of the literature.
J Par Enter Nutr, 25 (2001), pp. S30-S34
[97.]
D.R. Garrel, M. Razi, F. Lariviere, N. Jobin, N. Naman, A. Emptoz-Bonneton, et al.
Improved clinical status and length of care with low fat nutrition support in burn patients.
J Par Enter Nutr, 19 (1995), pp. 482-491
[98.]
J.M. Daly, M.D. Lieberman, J. Goldfine, J. Shou, F. Weintraub, E.F. Rosato, et al.
Enteral nutrition with supplemental arginine, RNA and omega 3 fatty acids in patients after operation: immunologic, metabolic and clinical outcome.
Surgery, 112 (1992), pp. 56-67
[99.]
V. Di Carlo, L. Gianotti, G. Balzano, A. Zerbi.
Complications of pancreatic surgery and the role of perioperative nutrition.
Dig Surg, 16 (1999), pp. 320-326
[100.]
L. Gianotti, M. Braga, A. Vignali, G. Balzano, A. Zerbi, P. Bisagni, et al.
Effect of route of delivery and formulation of postoperative nutritional support in patients undergoing major operations for malignant neoplasms.
Arch Surg, 132 (1997), pp. 1222-1229
[101.]
A.S. Kenler, W.S. Swails, D.F. Driscoll, S.J. DeMichele, B. Daley, T.J. Babineau, et al.
Early enteral feeding in postsurgical cancer patients. Fish oil structurated lipid based polymeric formula versus a standard polymeric formula.
Ann Surg, 223 (1996), pp. 316-333
[102.]
E. Barbosa, E.A. Moreira, J.E. Goes, P. Faintuch.
Pilot study with a blutamine supplemented enteral formula in critically ill infants.
Rev Hosp Clin Fac Med Sao Paulo, 54 (1999), pp. 21-24
[103.]
J.E. Gadek, S.J. DeMichele, M.D. Karlstad, E.R. Pacht, M. Donahoe, T.E. Albertson, et al.
Effect of enteral feeding with eicosapentaenoic acid, gamma linolenic acid and antioxidants in patients with acute respiratory distress síndrome. Enteral Nutrition in ARDS Study Group.
Crit Care Med, 27 (1999), pp. 1409-1420
[104.]
U. Suchner, D.K. Heyland, K. Peter.
Immune-modulatory actions of arginine in the critically ill.
Br J Nutr, 87 (2002), pp. S121-S132
[105.]
J. Takala, E. Ruokonen, N.R. Webster, M.S. Nielsen, D.F. Zandstra, G. Vundelinckx, et al.
Increased mortality associated with growth hormone treatment in critically ill adults.
N Engl J Med, 341 (1999), pp. 785-792
[106.]
J.R. Saffle, G. Wiebke, K. Jennings, S.E. Morris, R.G. Barton.
Randomized trial of immune-enhacing enteral nutrition in burn patients.
J Trauma, 42 (1997), pp. 793-800
[107.]
J.M. Daly, F.N. Weintraub, J. Shov, E.F. Rosato, M. Lucia.
Enteral nutrition during multimodality therapy in upper gastrointestinal cancer patients.
Ann Surg, 221 (1995), pp. 327-338
[108.]
M. Braga, A. Vignoli, L. Gianotti, A. Cestari, M. Profili, V.D. Carlo.
Immune and nutritional effects of early enteral nutrition after major abdominal operations.
Eur J Surg, 162 (1996), pp. 105-112
[109.]
J. Schilling, N. Vranjes, W. Fierz, H. Joller, D. Gyurech, E. Ludwig, et al.
Clinical outcome and immunology of postoperative arginine, omega-3 fatty acids, and nucleotide-enriched enteral feeding: a randomized, prospective comparison with standard enteral and low calorie/low fat IV solutions.
Nutrition, 12 (1996), pp. 423-429
[110.]
M. Senkal, A. Mumme, U. Eickhoff, B. Geier, G. Spath, D. Wulfert, et al.
Early postoperative enteral immunonutrition: Clinical outcome and cost comparison analysis in surgical patients.
Crit Care Med, 25 (1997), pp. 1489-1496
[111.]
M.J. Heslin, L. Latknay, D. Leung, A.D. Brooks, S.N. Hochwald, P.W.T. Pisters, et al.
A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy.
Ann Surg, 226 (1997), pp. 567-580
[112.]
M. Senkal, V. Zumtobel, K.H. Bauer, B. Marpe, G. Wolfram, A. Frei, et al.
Ourcome and cost effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: A prospective, randomized study.
Arch Surg, 134 (1999), pp. 1309-1316
Copyright © 2004. Sociedad Española de Endocrinología y Nutrición
