• Glória Regina Mesquita da Silveira and Evandro Silva Coutinho.
• School of Nutrition, Federal University of the State of Rio de Janeiro, Urca, Rio de Janeiro, Brazil. regina_me@hotmail.com
• Nutrition. 2013 Mar 1;29(3):485-90.

ObjectivePharmaconutrients have been shown in clinical and laboratory studies to modulate human and animal immune responses and thus to have potential benefits for the critically ill. However, reviews and meta-analyses continue to reflect controversy in the published research and a lack of agreement regarding these benefits. The objective of this study was to contribute to the resolution of such controversy by evaluating the effectiveness of immunonutrient-enriched diets in decreasing complications and mortality in patients with different critical illnesses.MethodsThe present study is a meta-analysis of randomized clinical trials that evaluated the use of immunomodulating nutrients in critically ill adults. The PubMed and CINAHL datasets were searched.ResultsTwo hundred sixteen articles were initially found, but only 39 met the established inclusion criteria. In the general population, mortality did not show a statistically significant relative risk (RR) decrease (0.92, confidence interval [CI] 0.80-1.05); infection complications were decreased, with a general RR of 0.57 (CI 0.44-0.74) and an RR of 0.56 (CI 0.46-0.68) in surgical patients; and the sepsis incidence was decreased (RR 0.48, CI 0.27-0.83).ConclusionsThe administration of immunomodulating nutrient-enriched diets did not change the mortality of critically ill or surgical patients, but infection complications in critically ill patients, in particular the surgical population, were decreased. Explanatory clinical trials using isolated immunomodulating nutrients in different populations of critically ill patients followed by pragmatic trials based on clinical trial results should be considered in future research.Copyright © 2013 Elsevier Inc. All rights reserved.

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