Nihon Geka Gakkai zasshi
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Several specific nutritional substrates have been shown to augment and/or modulate host immune function. Some enteral formulas enriched with specific immune-modulating nutrients are presently available for clinical use in Japan. Such nutrients include n-3 fatty acids, arginine, glutamine and nucleotides. ⋯ The benefits of enteral immunonutrition to be most pronounced in GI surgical patients. However, in critical illness, it is difficult to draw any conclusion on the effect of immunonutrition because of the heterogeneity of the critically ill patients and few clinical trials Further clinical trials to determine which groups of patients are indicated for immunonutrition, as well as what is the optimal combinations of specific nutrients, are needed. Studies are also required to determine the safety of immunonutrition.
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In elective gastrointestinal (GI) surgery, the patients' nutritional status should be assessed and if protein-energy malnutrition exists, preoperative nutritional support should be scheduled 7 to 14 days before surgery. In malnourished patients in particular, preoperative nutrition with total parenteral nutrition (TPN) reduces postoperative complication rates of infection. Preoperative enteral nutrition (EN) is considered to be as effective as TPN in improving postoperative surgical outcome. ⋯ When TPN is administered, hyperglycemia due to overfeeding should be carefully controlled. Patients who undergo distal gastrectomy or colectomy can start oral intake 3 to 4 days after surgery, with pertinent peripheral infusion. Immunonutrition containing immune-enhancing nutrients such as arginine, n-3 polyunsaturated fatty acid, glutamine, etc., especially administered preoperatively, is a promising nutritional therapy for reducing postoperative infectious complications.